Pulmonary Antihypertensives & ARVs

Drug-drug interactions between Pulmonary Antihypertensives & ARVs

  Potential increased exposure of the pulmonary antihypertensive
  Potential decreased exposure of the pulmonary antihypertensive
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)

ERA =  endothelin receptor antagonists 
IPr  =  IP receptor agonists  
PA  =  prostacyclin analogues  
PDE5 = phosphodiesterase type 5 inhibitors   
sGC = soluble guanylate cyclase stimulators

Interactions with ZDV
No clinically relevant interactions expected with ZDV and pulmonary antihypertensives


  1. Co-administration is not recommended in the European labels, but the US labels suggest the following dose modifications: When starting bosentan in individuals already on PI/r, PI/c or EVG/c use a bosentan dose of 62.5 mg qd or every other day. Discontinue bosentan at least 36 h prior to starting PI/r, PI/c or EVG/c and restart after at least 10 days at 62.5 mg qd or every other day
  2. Potential additive liver toxicity
  3. Exposure of parent drug increased but exposure of active metabolite unchanged
  4. This change is unlikely to be clinically relevant

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).