Analgesics & ARVs

Drug-drug interactions between Analgesics & ARVs


  Potential elevated exposure of the analgesic   
Potential decreased exposure of the analgesic
No significant effect 
D  Potential decreased exposure of ARV drug
E  Potential elevated exposure of ARV drug

ATV/c    ATV co-formulated with COBI (300/150 mg qd);  
DRV/c    DRV co-formulated with COBI (800/150 mg qd)

Numbers refer to increased or decreased AUC as observed in drug-drug interactions studies.

Interactions with ZDV

Ibuprofen, naproxen (potential additive hematological toxicity)
Methadone (moderate increase in ZDV exposure, monitor for toxicity)


  1. Clinical significance unknown. Use the lowest recommended dose particularly in individuals with risk factors for CVD, those individuals at risk of developing gastrointestinal complications, persons with hepatic or renal impairment, and in elderly persons
  2. Potential risk of nephrotoxicity which is increased if NSAID is used for a long duration, if the person has a pre-existing renal dysfunction, a low body weight or receives other drugs that may increase TDF exposure. Concurrent use of NSAIDs with TDF warrants monitoring of renal function
  3. Concentrations of norbuprenorphine increased
  4. Potential decrease of the analgesic effect due to the reduced conversion to the active metabolite
  5. Both drugs can potentially prolong the QT interval, ECG monitoring recommended
  6. Inhibition of P-gp by RTV, COBI or ETV could potentiate the effect of opiate in the CNS
  7. Concentrations of parent drug decreased and concentrations of neurotoxic metabolite increased
  8. Concentrations of parent drug decreased but no change in concentrations of more active metabolite  

Further Information

For additional drug-drug interactions and for more detailed pharmacokinetic interaction data and dosage adjustments, please refer to (University of Liverpool).