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Database of Antiretroviral Drug Interactions

Interactions between Antiepileptics and Antiretrovirals

Interactions with Carbamazepine
Antiretroviral (ARV)Dose of ARVDose of CarbamazepineEffect on ARV LevelsEffect on Carbamazepine LevelsPotential Clinical EffectsMechanism of InteractionManagement
Amprenavir60
(APV)(Agenerase)
--Not studied; may decrease amprenavir levelsNot studied; may increase carbamazepine levelsDecreased amprenavir effects; increased carbamazepine effectsInhibition of CYP450 3A4 by amprenavir; induction of CYP450 3A4 by carbamazepine

Avoid combination if possible; consider alternative agents; monitor carbamazepine levels and adjust as indicated

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Atazanavir/cobicistat727
(others)(Evotaz)
--Not studied; Potential decreased atazanavir and cobicistat levels. Possible increased carbamazepine levels Potential loss of antiviral efficacy-

Contraindicated; Use alternative anticonvulsant.

Darunavir412
(DRV)(Prezista)
600 mg BID with 100 mg ritonavir BID200 mg BIDDarunavir: No significant change; Ritonavir AUC: decreased 49%; Cmax: decreased 44%; Cmin: decreased 56%Carbamazepine AUC: 45%; Cmax: increased 43%; Cmin: increased 54%Increased carbamazepine effectsInhibition of CYP450 3A4 by darunavir/ritonavir

Monitor anticonvulsant level and adjust accordingly. Consider carbamazepine dose reduction by 25-50%

Darunavir/cobicistat727
(Prezcobix)
--Not studied; Potential decreased darunavir and cobicistat levels. Not studied; Possible increased carbamazepine levelsPotential loss of antiviral efficacy.-

Contraindicated; Use alternative anticonvulsant.

Delavirdine88
(DLV)(Rescriptor)
--Delavirdine Cmin: decreased-Decreased delavirdine effectsInduction of CYP450 3A4 by carbamazepine

Avoid combination if possible; consider alternative agents; monitor carbamazepine levels and adjust as indicated

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Antiretroviral (ARV)Dose of ARVDose of CarbamazepineEffect on ARV LevelsEffect on Carbamazepine LevelsPotential Clinical EffectsMechanism of InteractionManagement
Dolutegravir691
(Tivicay)
50 mg daily300 mg BIDDolutegravir AUC decreased 49%; Cmin decreased 73%-Decreased dolutegravir effectiveness-

Avoid combination if possible. If using, dose dolutegravir 50 mg twice daily in INSTI-naïve adult patients. If known or clinically suspected InSTI resistance use alternative agent.

Alternative Agents:
Gabapentin, Lamotrigine, Levitiracetam, Tiagabine Topiramate

Efavirenz90
(EFV)(Sustiva)
--Not studied; may decrease efavirenz levelsNot studied; may decrease carbamazepine levelsDecreased efavirenz and carbamazepine effectsInduction of CYP450 3A4 by both drugs

Avoid combination if possible; consider alternative agents; monitor carbamazepine levels and adjust as indicated

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Efavirenz290
(EFV)(Sustiva)
600 mg QD on days 1-35200 mg QD on days 1-3, 200 mg BID on days 4-6, 400 mg QD thereafterEfavirenz AUC: decreased 36%; Cmax: decreased 21%; Cmin: decreased 47%Carbamazepine AUC: decreased 27%; Cmax: decreased 20%; Cmin: decreased 35%Decreased efavirenz and carbamazepine levelsInduction of CYP450 by efavirenz and carbamazepine

Avoid combination

Elvitegravir/cobicistat623
(Genvoya, Stribild)
--Potential decreased elvitegravir and cobicistat concentrationsNot studied; Possible increased carbamazepine levelsPotentially decreased elvitegravir/cobicistat effects-

Consider alternative anticonvulsant

Elvitegravir/cobicistat707
(Genvoya, Stribild)
-- Potential decreased levels of elvitegravir and cobicistat Not studied; possible increased levels of carbamazepine Potential loss of antiretroviral efficacy-

Consider alternative anticonvulsant

Indinavir291, 16, 254
(IDV)(Crixivan)
800 mg Q8H200 mg QDIndinavir levels: decreased 4-25% of mean population values-Decreased indinavir effectsInduction of CYP450 3A4 by carbamazepine

Avoid combination if possible; consider alternative agents; monitor carbamazepine levels and adjust as indicated

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Antiretroviral (ARV)Dose of ARVDose of CarbamazepineEffect on ARV LevelsEffect on Carbamazepine LevelsPotential Clinical EffectsMechanism of InteractionManagement
Lopinavir/ritonavir78
(LPV/r)(Kaletra)
--Not studied; may decrease lopinavir levels-Decreased lopinavir/ritonavir effects-

Avoid combination if possible; Do not coadminister with LPV/r or FPV/r once daily. Monitor carbamazepine levels and adjust as indicated or consider alternative agents;

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Nelfinavir254
(NFV)(Viracept)
--Not studied; may decrease nelfinavir levelsNot studied; may increase carbamazepine levels-Induction of CYP450 3A4 by carbamazepine; inhibition of CYP450 3A4 by nelfinavir

Avoid combination if possible; consider alternative agents; monitor carbamazepine levels and adjust as indicated

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Ritonavir178, 292
(RTV)(Norvir)
200 mg QD-TID350 mg BIDDecreased ritonavir levelsNot studied; May increase carbamazepine levelsIncreased carbamazepine effects; decreased ritonavir effectsInduction of CYP450 2C and 3A4

Avoid combination if possible; consider alternative agents;monitor carbamazepine levels and adjust as indicated

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Saquinavir254
(SQV)(Fortovase, Invirase)
--May decrease saquinavir levels-Decreased saquinavir effectsInduction of CYP450 3A4 by carbamazepine

Avoid combination if possible; consider alternative agents; monitor carbamazepine levels and adjust as indicated

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Tipranavir154
(TPV)(Aptivus)
500 mg BID with 200 mg ritonavir BID100 mg BID-Carbamazepine Cmin: increased 17%--

Dose adjustment not established

Tipranavir154
(TPV)(Aptivus)
500 mg BID with 200 mg ritonavir BID x 1 dose200 mg BID- Carbamazepine Cmin: increased 16%- -

Dose adjustment not established

Tipranavir154
(TPV)(Aptivus)
500 mg BID with 200 mg ritonavir BID x 15 doses200 mg BID-Carbamazepine AUC: increased 26%; Cmin: increased 35%; Cmax: increased 22%Increased carbamazepine effectsInhibition of CYP450 by tipranavir/ritonavir

Dose adjustment not established

"-" indicates that there are no data available
Interactions with Clonazepam
Antiretroviral (ARV)Dose of ARVDose of ClonazepamEffect on ARV LevelsEffect on Clonazepam LevelsPotential Clinical EffectsMechanism of InteractionManagement
Elvitegravir/cobicistat623
(Genvoya, Stribild)
----Potentially increased clonazepam effects-

More frequent clinical monitoring is recommended

"-" indicates that there are no data available
Interactions with Ethosuximide
Antiretroviral (ARV)Dose of ARVDose of EthosuximideEffect on ARV LevelsEffect on Ethosuximide LevelsPotential Clinical EffectsMechanism of InteractionManagement
Elvitegravir/cobicistat
(Genvoya, Stribild)
--- Not studied; possible increased levels of ethosuximide--

Monitor for psychiatric side effects of ethosuximide

"-" indicates that there are no data available
Interactions with Fosphenytoin
Antiretroviral (ARV)Dose of ARVDose of FosphenytoinEffect on ARV LevelsEffect on Fosphenytoin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Amprenavir222
(APV)(Agenerase)
--Not studied; may decrease amprenavir levels-Decreased amprenavir effectsInhibition of CYP450 3A4 by amprenavir; induction of CYP450 3A4 by phenytoin

Dose adjustment not established

Indinavir222, 16
(IDV)(Crixivan)
--Not studied, may decrease indinavir levels-Decreased indinavir effectsInduction of CYP450 3A4 by phenytoin

Dose adjustment not established

Nelfinavir222
(NFV)(Viracept)
--Not studied; may decrease nelfinavir levels- Decreased nelfinavir effectsInduction of CYP450 3A4 by phenytoin

Dose adjustment not established

"-" indicates that there are no data available
Interactions with Lamotrigine
Antiretroviral (ARV)Dose of ARVDose of LamotrigineEffect on ARV LevelsEffect on Lamotrigine LevelsPotential Clinical EffectsMechanism of InteractionManagement
Atazanavir727
(ATV)(Reyataz)
atazanavir 300 mg with 100 mg ritonavir-- AUC decreased 32%--

Monitor clinically and adjust dose as necessary. Consider therapeutic drug monitoring or use of alternative agent.

Lopinavir/ritonavir395
(LPV/r)(Kaletra)
400/100 mg BID on days 11-2050 mg QD on days 1 and 2, then 100 mg BID on days 3-20No significant changeLamotrigine AUC: decreased 50%; Cmax: decreased 46%; Cmin: decreased 56%; half-life: decreased 46%Decreased lamotrigine effectsPossible induction of glucuronidation by lopinavir/ritonavir

Titrate to effect but may need to increase dose to 200 mg BID while patient is receiving lopinavir/ritonavir

Raltegravir437
(RAL)(Isentress)
400 mg BID100 mg- No significant change- -

No dose adjustment necessary

"-" indicates that there are no data available
Interactions with Oxcarbazepine
Antiretroviral (ARV)Dose of ARVDose of OxcarbazepineEffect on ARV LevelsEffect on Oxcarbazepine LevelsPotential Clinical EffectsMechanism of InteractionManagement
Dolutegravir691
(Tivicay)
--Not studied; may decrease dolutegravir levels -Potentially decreased dolutegravir effectiveness-

Contraindicated - consider alternative anticonvulsants

Alternative Agents:
Gabapentin, Lamotrigine, Levitiracetam, Tiagabine Topiramate

Elvitegravir/cobicistat623
(Genvoya, Stribild)
-- Not studied; Potentially decreased elvitegravir and cobicistat levels-Potential loss of antiretroviral efficacy-

Consider alternative anticonvulsants

"-" indicates that there are no data available
Interactions with Phenobarbital
Antiretroviral (ARV)Dose of ARVDose of PhenobarbitalEffect on ARV LevelsEffect on Phenobarbital LevelsPotential Clinical EffectsMechanism of InteractionManagement
Amprenavir60
(APV)(Agenerase)
--Not studied; may decrease amprenavir levels-Decreased amprenavir effectsInduction of CYP450 3A4 by phenobarbital

Avoid combination if possible; consider alternative agents. If using, monitor and adjust phenobarbital levels as indicated.

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Atazanavir727
(ATV)(Reyataz)
--Not studied, may decrease atazanavir levels-Potential loss of antiviral efficacy.-

Avoid combination if possible; Do not use with unboosted atazanavir. Consider alternative agents. If using, monitor and adjust phenobarbital levels as indicated.

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Atazanavir/cobicistat727
(others)(Evotaz)
-- Not studied; Potentially decreased atazanavir and cobicistat levels-Potential loss of antiretroviral efficacy -

Contraindicated. Do not coadminister.

Darunavir161
(DRV)(Prezista)
--Not studied; may decrease darunavir levels-Decreased darunavir/ritonavir effectsInduction of CYP450 by phenobarbital

Avoid combination if possible; consider alternative agents. If using, monitor and adjust phenobarbital levels as indicated.

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Darunavir/cobicistat727
(Prezcobix)
-- Not studied; Potentially decreased darunavir and cobicistat levels- Potential loss of antiretroviral efficacy -

Contraindicated. Do not coadminister.

Antiretroviral (ARV)Dose of ARVDose of PhenobarbitalEffect on ARV LevelsEffect on Phenobarbital LevelsPotential Clinical EffectsMechanism of InteractionManagement
Delavirdine88
(DLV)(Rescriptor)
--Delavirdine Cmin: decreased-Decreased delavirdine effectsInduction of CYP450 3A4 by phenobarbital

Avoid combination if possible; consider alternative agents. If using, monitor and adjust phenobarbital levels as indicated.

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Dolutegravir
(Tivicay)
--Not studied; may decrease dolutegravir levels-Potentially decreased dolutegravir effectiveness-

Contraindicated - consider alternative anticonvulsants

Alternative Agents:
Gabapentin, Lamotrigine, Levitiracetam, Tiagabine Topiramate

Efavirenz90
(EFV)(Sustiva)
--Not studied; may decrease levels-Decreased efavirenz effectsInduction of CYP450 3A4 by phenobarbital

Avoid combination if possible; consider alternative agents; monitor phenobarbital levels and adjust as indicated

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Elvitegravir/cobicistat623
(Genvoya, Stribild)
-- Not studied; Potentially decreased elvitegravir cobicistat levels-Potential loss of antiretroviral efficacy-

Consider alternative anticonvulsants

Fosamprenavir727
(FPV)(Lexiva)
-- Not studied, may decrease fosamprenavir levels- Potential loss of antiviral efficacy-

Avoid combination if possible; Do not use with unboosted fosamprenavir or once daily boosted fosamprenavir. Consider alternative agents. If using, monitor and adjust phenobarbital levels as indicated.

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Indinavir254, 16
(IDV)(Crixivan)
--Not studied, may decrease indinavir levels-Decreased indinavir effectsInduction of CYP450 3A4 by phenobarbital

Avoid combination if possible; consider alternative agents. If using, monitor and adjust phenobarbital levels as indicated.

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Lopinavir/ritonavir78
(LPV/r)(Kaletra)
--Not studied; may decrease lopinavir levels-Decreased lopinavir/ritonavir effectsInduction of CYP450 3A4 by phenobarbital

Avoid combination if possible; Do not use with once daily lopinavir/ritonavir. Consider alternative agents. If using, monitor phenobarbital levels and adjust as indicated

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Nelfinavir24
(NFV)(Viracept)
--Not studied; may decrease nelfinavir levels-Decreased nelfinavir effectsInduction of CYP450 3A4 by phenobarbital

Avoid combination if possible; consider alternative agents; monitor phenobarbital levels and adjust as indicated

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Saquinavir254
(SQV)(Fortovase, Invirase)
--May decrease saquinavir levels-May decrease saquinavir effectsInduction of CYP450 3A4 by phenobarbital

Avoid combination if possible; consider alternative agents; monitor phenobarbital levels and adjust as indicated

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

"-" indicates that there are no data available
Interactions with Phenytoin
Antiretroviral (ARV)Dose of ARVDose of PhenytoinEffect on ARV LevelsEffect on Phenytoin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Amprenavir60
(APV)(Agenerase)
--Not studied; may decrease amprenavir levels-Decreased amprenavir effectsInduction of CYP450 3A4 by phenytoin

Avoid combination if possible; consider alternative agents. Monitor phenytoin levels and adjust as indicated. Monitor virologic response.

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Atazanavir727
(ATV)(Reyataz)
--Not studied; may decrease atazanavir levels.-Potentially decreased antiviral effects.-

Avoid combination if possible; do not coadminister with unboosted atazanavir. Consider alternative agents. If using, monitor phenytoin levels and adjust as indicated and monitor for virologic response.

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Atazanavir/cobicistat727
(others)(Evotaz)
--Not studied; Potentially decreased atazanavir and cobicistat levels -Potential loss of antiretroviral efficacy -

Contraindicated. Do not coadminister.

Darunavir161
(DRV)(Prezista)
--Not studied; may decrease darunavir levels-Decreased darunavir/ritonavir effectsInduction of CYP450 by phenytoin

Avoid combination if possible; consider alternative agents. Monitor phenytoin levels and adjust as indicated. Monitor virologic response.

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Darunavir/cobicistat727
(Prezcobix)
--Not studied; Potentially decreased darunavir and cobicistat levels-Potential loss of antiretroviral efficacy -

Contraindicated. Do not coadminister.

Antiretroviral (ARV)Dose of ARVDose of PhenytoinEffect on ARV LevelsEffect on Phenytoin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Delavirdine88
(DLV)(Rescriptor)
--Delavirdine Cmin: decreased-Decreased delavirdine effectsInduction of CYP450 3A4 by phenytoin

Avoid combination if possible; consider alternative agents; monitor phenytoin levels and adjust as indicated

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Dolutegravir691
(Tivicay)
--Not studied; may decrease dolutegravir levels-Potentially decreased dolutegravir effectiveness-

Contraindicated; consider alternative anticonvulsants

Alternative Agents:
Gabapentin, Lamotrigine, Levitiracetam, Tiagabine Topiramate

Efavirenz90
(EFV)(Sustiva)
--Not studied; may decrease efavirenz levelsNot studied; may decrease phenytoin levelsDecreased efavirenz and phenytoin effectsInduction of CYP450 3A4 by both drugs

Avoid combination if possible; consider alternative agents; monitor phenytoin levels and adjust as indicated

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Elvitegravir/cobicistat
(Genvoya, Stribild)
-- Not studied; Potentially decreased elvitegravir and cobicistat levels-Potential loss of antiretroviral efficacy-

Consider alternative anticonvulsants

Fosamprenavir727
(FPV)(Lexiva)
-- Not studied; may decrease fosamprenavir levels.- Potentially decreased antiviral effects.-

Avoid combination if possible; do not coadminister with unboosted fosamprenavir or once daily boosted fosamprenavir. Consider alternative agents. If using, monitor phenytoin levels and adjust as indicated and monitor for virologic response.

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Indinavir254, 16
(IDV)(Crixivan)
--Decreased indinavir levels-Decreased indinavir effectsInduction of CYP450 3A4 by phenytoin

Avoid combination if possible; consider alternative agents. Monitor phenytoin levels and adjust as indicated. Monitor virologic response.

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Antiretroviral (ARV)Dose of ARVDose of PhenytoinEffect on ARV LevelsEffect on Phenytoin LevelsPotential Clinical EffectsMechanism of InteractionManagement
Lopinavir/ritonavir224
(LPV/r)(Kaletra)
400/100 mg BID on days 1-22300 mg QHS for 10 daysLopinavir AUC: decreased 33%; Cmax: decreased 24%; Cmin: decreased 46%; half-life: decreased 51%.Ritonavir AUC: decreased 28%; Cmax: decreased 20%; Cmin: decreased 47%; half-life: decreased 38%Phenytoin AUC: decreased 31%; Cmax: decreased 28%; Cmin: decreased 34%; half-life: decreased 38%Decreased lopinavir/ritonavir and phenytoin effectsInduction of CYP450 3A4 by phenytoin; possible induction of CYP450 2C9 by lopinavir

Avoid combination if possible; do not use with once daily lopinavir/ritonavir. Consider alternative agents. If combination cannot be avoided, possible options include increasing LPV/r to 4 caps BID or adding ritonavir 100 mg BID to regimen and monitoring levels. Neither option currently has any data. Monitor phenytoin levels and adjust as indicated and monitor for virologic response.

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Nelfinavir24, 226, 227
(NFV)(Viracept)
1250 mg BID300 mg QAMNelfinavir: no significant change; M8 levels: decreased 20-30%Phenytoin Cmax: decreased 21%; AUC: decreased 30%; Cmin: decreased 39%Decreased phenytoin effectsInduction of CYP450 3A4 by phenytoin

Avoid combination if possible; consider alternative agents; monitor phenytoin levels and adjust as indicated

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Ritonavir225
(RTV)(Norvir)
---Increased phenytoin levelsIncreased phenytoin effects-

Avoid combination if possible; consider alternative agents. Monitor phenytoin levels and adjust as indicated. Monitor virologic response.

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Saquinavir254
(SQV)(Fortovase, Invirase)
--May decrease saquinavir levels-May decrease saquinavir effectsInduction of CYP450 3A4 by phenytoin

Avoid combination if possible; consider alternative agents. Monitor phenytoin levels and adjust as indicated. Monitor virologic response.

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Zidovudine81
(AZT, ZDV)(Retrovir)
200 mg Q4H300 mg QDZidovudine clearance: decreased 30%No significant change--

No dose adjustment necessary

"-" indicates that there are no data available
Interactions with Valproic acid
Antiretroviral (ARV)Dose of ARVDose of Valproic acidEffect on ARV LevelsEffect on Valproic acid LevelsPotential Clinical EffectsMechanism of InteractionManagement
Efavirenz220
(EFV)(Sustiva)
600 mg QD250 mg BID x 7 daysEfavirenz Cmin: no significant change; Cmax: no significant change; AUC: no significant change; half-life: decreased 22%No significant change--

No dose adjustment necessary

Lopinavir/ritonavir220
(LPV/r)(Kaletra)
400/100 mg BID250 mg BID x 7 daysLopinavir Cmax: increased 33%; Cmin: increased 57%; AUC: increased 75%; half-life: no significant changeNo significant changeIncreased lopinavir effectsPossible inhibition of UGT-mediated metabolism of lopinavir

Dose adjustment not established. Monitor VPA levels and virologic response. Monitor for LPV- related toxicities.

Zidovudine221
(AZT, ZDV)(Retrovir)
--Zidovudine AUC: increased 100%-Increased zidovudine effectsInhibition of glucuronidation

No dose adjustment necessary

Zidovudine81
(AZT, ZDV)(Retrovir)
100 mg Q8H250 mg Q8H, 500 mg Q8HZidovudine AUC: increased 79%-Increased zidovudine effectsInhibition of glucuronidation

No dose adjustment necessary

"-" indicates that there are no data available
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