Anti-malarial Drugs & ARVs

Drug-drug Interactions between Anti-malarial Drugs & ARVs

Drug-drug Interactions between Anti-malarial Drugs and ARVs 2023 EACS v12.0

Colour Legend from EACS v10.1 2020

Legend

↑                  Potential elevated exposure of the antimalarial drug
↓                  Potential decreased exposure of the antimalarial drug
↔                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)
CAB/RPV   CAB and RPV im long acting injections (PK and/or QT interactions shown are with RPV)

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

Interactions with ABC, FTC, 3TC, ZDV

ABC:  no clinically relevant interactions expected.
FTC:   increased FTC exposure with pyrimethamine, sulfadoxine.
3TC:   increased 3TC exposure with pyrimethamine, sulfadoxine.
ZDV:   potential additive haematological toxicity with amodiaquine, atovaquone, primaquine, pyrimethamine, sulfadoxine.

Interactions with cabotegravir (oral)

None

Interactions with ibalizumab

None

Comments

  1. Liver toxicity.
  2. Take with high fat meal, consider dose increase.
  3. ECG monitoring is recommended.
  4. Chloroquine concentrations may increase, but to a moderate extent. No dose adjustment is required but monitor toxicity.
  5. Chloroquine/hydroxychloroquine concentrations may increase or decrease. No dose adjustment is required but monitor toxicity and efficacy.
  6. Chloroquine concentrations may decrease, but to a moderate extent. No dose adjustment is required but monitor efficacy.
  7. Caution as both drugs can induce QT interval prolongation.
  8. Increase of haemotoxic metabolites.

^ LEN causes moderate inhibition of CYP3A4 and, when discontinued, remains in the circulation for prolonged periods. Residual concentrations of LEN may affect the exposure of sensitive CYP3A4 substrates and/ or narrow therapeutic index drugs that are initiated within 9 months after the last subcutaneous dose of LEN. 

Further Information

For additional drug-drug interactions and for more detailed pharmacokinetic interaction data and dosage adjustments, please refer to: http://www.hiv-druginteractions.org (University of Liverpool)