Immunosuppressants & ARVs

Drug-drug Interactions between Immunosuppresants (for SOT) & ARVs

Drug-drug Interactions between Immunosuppressants (for SOT) and ARVs 2023 EACS v12.0

Colour Legend from EACS v10.1 2020

↑                  Potential elevated exposure of the immunosuppressant
↓                  Potential decreased exposure of the immunosuppressant
↔                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)

available as prolonged release formulation

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

AM       antimetabolite
CNI       calcineurin inhibitors
CS         corticosteroids mTOR
mTOR   inhibitors

Interactions with ABC, FTC, 3TC, ZDV

ABC:   potential decrease in mycophenolate exposure.
ZDV:   potential risk of additive haematoxicity with azathioprine.
ZDV:   potential alteration in mycophenolate exposure, monitor plasma concentrations.

Interactions with cabotegravir (oral)


Interactions with ibalizumab



  1. TDM of immunosuppressant is recommended.
  2. Monitor renal function.
  3. Both drugs can potentially prolong the QT interval, ECG monitoring recommended.

^ 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: (University of Liverpool)