Corticosteroids & ARVs

Legend
↑     Potential elevated exposure of the corticosteroid
↓     Potential decreased exposure of the corticosteroid
↔   No significant effect
D     Potential decreased exposure of ARV drug
E     Potential elevated exposure of ARV drug

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

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

Interactions with ABC, FTC, 3TC, ZDV
ABC, FTC, 3TC, ZDV:
no clinically relevant interactions expected

Interactions with cabotegravir (oral)
None

Interactions with ibalizumab
None

Comments

1. Co-administration of RTV (100 mg bid) increased the concentrations of the active metabolite (beclometasone-17-monopropionate) but no significant effect on adrenal function was seen. Caution is still warranted, use the lowest possible corticosteroid dose and monitor for corticosteroid side effects.
2. DRV/r decreased the exposure of active metabolite (beclometasone-17- monopropionate), no significant effect on adrenal function was seen.
3. Risk of having elevated corticosteroid levels, Cushing's syndrome and adrenal suppression. This risk is present for oral and injected corticosteroid but also for topical, inhaled or eye drops administration.
4. No dose adjustment required but monitor closely, especially for signs of Cushing's syndrome when using a high dose or prolonged administration.
5. The extent of percutaneous absorption is determined by many factors such as degree of inflammation and alteration of the skin, duration, frequency and surface of application, use of occlusive dressings.
6. Consider using MVC a dose of 600 mg bid with dexamethasone in the absence of a PI or other potent CYP3A4 inhibitors, particularly if dexamethasone is used at a high dose and in case of long-term treatment. Consider decreasing MVC to 150 mg bid with dexamethasone in presence of a protease inhibitor or strong CYP3A4 inhibitor.
7. Use the lowest possible flunisolide dose with monitoring for corticosteroid side effects.

^ 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.

# At least a 2-week (moderate inducers) or 4-week (strong inducers) cessation period is recommended prior to initiation of LEN due to the persisting inducing effect after discontinuation of an inducer.

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)