Anti-infective Drugs for OIs and STIs and ARVs

Legend

↑                  Potential elevated exposure of the antidepressant
↓                  Potential decreased exposure of the antidepressant
↔                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

Antibacterial
Refer to the Anti-tuberculosis table for interactions with amikacin, moxifloxacin and rifabutin.
Refer to the Anti-malarial table for interactions with clindamycin and doxycycline.

Antiparasitic
Refer to the Anti-malarial table for interactions with atovaquone, primaquine and pyrimethamine.

Interactions with ABC, FTC, 3TC, ZDV

ABC:   no clinically relevant interactions expected. 
FTC:    potential additive renal toxicity with sulfadiazine and flucytosine. 
FTC:    potential increased FTC exposure with trimethoprim, but no dose adjustment required in patients with
            normal renal function. 
3TC:    potential additive renal toxicity with sulfadiazine and flucytosine. 
3TC:    increased 3TC exposure (43%) with trimethoprim, but no dose 
            adjustment required in patients with normal renal function. 
            Some trimethoprim/sulfamethoxazole liquid preparations may contain sorbitol which decreases the
            bioavailability of lamivudine solutions. 
ZDV:    potential risk of additive haematoxicity with brincidofovir and flucytosine. 
ZDV:    increased ZDV exposure (20%) with ganciclovir. 
ZDV:    decreased ZDV exposure (12%) with clarithromycin. 
ZDV:    potential increased risk of ZDV adverse reactions with trimethoprim, sulfamethoxazole, amphotericin B
            and flucytosine. 
ZDV:    increased ZDV exposure (74%) with fluconazole. Routine ZDV dose modification not required, but
            monitor for potential ZDV toxicity. 
ZDV:    no PK interaction observed with dapsone but potential increased risk of ZDV adverse reactions. 
ZDV:    potential increased risk of ZDV adverse reactions with pentamidine (but not with aerosolised
            pentamidine at doses used in prophylaxis). 

Interactions with cabotegravir (oral)

None

Interactions with ibalizumab

None

Comments

1. TDF should be avoided with concurrent or recent use of a nephrotoxic agent. If co-administration is unavoidable, monitor renal function closely.
2. ECG monitoring is recommended.
3. Caution as both drugs can induce QT interval prolongation.
4. Co-administration could potentially increase haematological toxicity. Monitor haematological parameters and consider dose reduction if required.
5. Renal impairment and sometimes fatal renal failure have been described with meglumine antimoniate treatment. Close monitoring of renal function is warranted.

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)