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Database of Antiretroviral Drug Interactions

Interactions between Antiinflammatories and Antiretrovirals

Interactions with Beclomethasone
Antiretroviral (ARV)Dose of ARVDose of BeclomethasoneEffect on ARV LevelsEffect on Beclomethasone LevelsPotential Clinical EffectsMechanism of InteractionManagement
Darunavir581
(DRV)(Prezista)
600 mg darunavir BID with 100 mg ritonavir BID160 mcg inhaled BIDNot studiedBeclomethasone 17-monopropionate AUC decreased 11%; Cmax decreased 19%--

No dose adjustment necessary

Ritonavir583
(RTV)(Norvir)
100 mg BID160 mcg inhaled BIDNot studiedBeclomethasone-17-monopriopionate AUC: increased 108%; Cmax: increased 67%--

Use lowest possible dose and titrate to effect

"-" indicates that there are no data available
Interactions with Colchicine
Antiretroviral (ARV)Dose of ARVDose of ColchicineEffect on ARV LevelsEffect on Colchicine LevelsPotential Clinical EffectsMechanism of InteractionManagement
Atazanavir727, 551
(ATV)(Reyataz)
----Increased colchicine effectsnhibition of P450 3A4 by atazanavir/ritonavir

For treatment of gout, reduce colchicine dosage to 0.6 mg x 1 then 0.3 mg one hour later. Dose not to be repeated no earlier than 3 days. For prophylaxis of gout, reduce colchicine dosage to 0.3 mg QD if on 0.6 mg BID prior to PI therapy or reduce colchicine dose to 0.3 mg QOD if on 0.6 mg QD prior to PI therapy. For treatment of familial Mediterranean fever: Do not exceed colchicine 0.6 mg once daily or 0.3 mg BID. Do not coadminister in patients with hepatic or renal impairment

Darunavir553
(DRV)(Prezista)
----Increased colchicine effectsInhibition of P450 3A4 by darunavir/ritonavir

For treatment of gout, reduce colchicine dosage to 0.6 mg x 1 then 0.3 mg one hour later. Dose not to be repeated no earlier than 3 days. For prophylaxis of gout, reduce colchicine dosage to 0.3 mg QD if on 0.6 mg BID prior to PI therapy or reduce colchicine dose to 0.3 mg QOD if on 0.6 mg QD prior to PI therapy. For treatment of familial Mediterranean fever: Do not exceed colchicine 0.6 mg once daily or 0.3 mg BID. Do not coadminister in patients with hepatic or renal impairment

Fosamprenavir549
(FPV)(Lexiva)
----Increased colchicine effectsInhibition of P450 3A4 by fosamprenavir/ritonavir

For treatment of gout, reduce colchicine dosage to 0.6 mg x 1 then 0.3 mg one hour later. Dose not to be repeated no earlier than 3 days. For prophylaxis of gout, reduce colchicine dosage to 0.3 mg QD if on 0.6 mg BID prior to PI therapy or reduce colchicine dose to 0.3 mg QOD if on 0.6 mg QD prior to PI therapy. For treatment of familial Mediterranean fever: Do not exceed colchicine 0.6 mg once daily or 0.3 mg BID. Do not coadminister in patients with hepatic or renal impairment.

Indinavir557
(IDV)(Crixivan)
----Increased colchicine effectsInhibition of P450 3A4 by indinavir

For treatment of gout, reduce colchicine dosage to 0.6 mg x 1 then 0.3 mg one hour later. Dose not to be repeated no earlier than 3 days. For prophylaxis of gout, reduce colchicine dosage to 0.3 mg QD if on 0.6 mg BID prior to PI therapy or reduce colchicine dose to 0.3 mg QOD if on 0.6 mg daily prior to PI therapy. For treatment of familial Mediterranean fever: Do not exceed colchicine 0.6 mg once daily or 0.3 mg BID. Do not coadminister in patients with hepatic or renal impairment.

Lopinavir/ritonavir555
(LPV/r)(Kaletra)
----Increased colchicine effectsInhibition of P450 3A4 by lopinavir/ritonavir

For treatment of gout, reduce colchicine dosage to 0.6 mg x 1 then 0.3 mg one hour later. Dose not to be repeated no earlier than 3 days. For prophylaxis of gout, reduce colchicine dosage to 0.3 mg QD if on 0.6 mg BID prior to PI therapy or reduce colchicine dose to 0.3 mg QOD if on 0.6 mg QD prior to PI therapy. For treatment of familial Mediterranean fever: Do not exceed colchicine 0.6 mg once daily or 0.3 mg BID. Do not coadminister in patients with hepatic or renal impairment.

Antiretroviral (ARV)Dose of ARVDose of ColchicineEffect on ARV LevelsEffect on Colchicine LevelsPotential Clinical EffectsMechanism of InteractionManagement
Nelfinavir559
(NFV)(Viracept)
----Increased colchicine effectsInhibition of P450 3A4 by nelfinavir

For treatment of gout, reduce colchicine dosage to 0.6 mg x 1 then 0.3 mg one hour later. Dose not to be repeated no earlier than 3 days. For prophylaxis of gout, reduce colchicine dosage to 0.3 mg QD if on 0.6 mg BID prior to PI therapy or reduce colchicine dose to 0.3 mg QOD if on 0.6 mg QD prior to PI therapy. For treatment of familial Mediterranean fever: Do not exceed colchicine 0.6 mg once daily or 0.3 mg BID. Do not coadminister in patients with hepatic or renal impairment.

Ritonavir529
(RTV)(Norvir)
100 mg BID x 5 days0.6 mg x 1-Colchicine AUC: increased 296%; Cmax: increased 184%Increased colchicine effectsInhibition of P450 3A4 by ritonavir

For treatment of gout, reduce colchicine dosage to 0.6 mg x 1 then 0.3 mg one hour later. Dose not to be repeated no earlier than 3 days. For prophylaxis of gout, reduce colchicine dosage to 0.3 mg QD if on 0.6 mg BID prior to PI therapy or reduce colchicine dose to 0.3 mg QOD if on 0.6 mg QD prior to PI therapy. For treatment of familial Mediterranean fever: Do not exceed colchicine 0.6 mg once daily or 0.3 mg BID. Do not coadminister in patients with hepatic or renal impairment.

Saquinavir561
(SQV)(Fortovase, Invirase)
----Increased colchicine effectsInhibition of P450 3A4 by saquinavir

For treatment of gout, reduce colchicine dosage to 0.6 mg x 1 then 0.3 mg one hour later. Dose not to be repeated no earlier than 3 days. For prophylaxis of gout, reduce colchicine dosage to 0.3 mg QD if on 0.6 mg BID prior to PI therapy or reduce colchicine dose to 0.3 mg QOD if on 0.6 mg QD prior to PI therapy. For treatment of familial Mediterranean fever: Do not exceed colchicine 0.6 mg once daily or 0.3 mg BID. Do not coadminister in patients with hepatic or renal impairment.

Tipranavir563
(TPV)(Aptivus)
----Increased colchicine effectsInhibition of P450 3A4 by tipranavir/ritonavir

For treatment of gout, reduce colchicine dosage to 0.6 mg x 1 then 0.3 mg one hour later. Dose not to be repeated no earlier than 3 days. For prophylaxis of gout, reduce colchicine dosage to 0.3 mg QD if on 0.6 mg BID prior to PI therapy or reduce colchicine dose to 0.3 mg QOD if on 0.6 mg QD prior to PI therapy. For treatment of familial Mediterranean fever: Do not exceed colchicine 0.6 mg once daily or 0.3 mg BID. Do not coadminister in patients with hepatic or renal impairment.

"-" indicates that there are no data available
Interactions with Dexamethasone
Antiretroviral (ARV)Dose of ARVDose of DexamethasoneEffect on ARV LevelsEffect on Dexamethasone LevelsPotential Clinical EffectsMechanism of InteractionManagement
Darunavir161
(DRV)(Prezista)
--May decrease darunavir levels-Decreased darunavir effectsInduction of CYP450 3A4 by dexamethasone

No dose adjustment necessary; use with caution

Elvitegravir/cobicistat699
(Genvoya, Stribild)
-- Not studied; may decrease levels of elvitegravir and cobicistat- Possible loss of antiviral efficacy-

Use with caution; monitor viral load if extended dexamethasone use.

Elvitegravir/ritonavir-boosted protease inhibitor699
--Not studied; may decrease levels of elvitegravir-Possible decreased elvitegravir effectiveness-

Use with caution; monitor viral load if extended dexamethasone use.

Indinavir16
(IDV)(Crixivan)
- - May decrease indinavir levels- Decreased indinavir effectsInduction of CYP450 3A4 by dexamethasone

No dose adjustment necessary

Lopinavir/ritonavir78
(LPV/r)(Kaletra)
--Not studied; may decrease lopinavir levels-Decreased lopinavir/ritonavir effects-

No dose adjustment necessary; use with caution. Consider alternative corticosteroid for long-term use.

Saquinavir254
(SQV)(Fortovase, Invirase)
- - May decrease saquinavir levels- Decreased saquinavir effectsPossible induction of CYP450 3A4 by dexamethasone

No dose adjustment necessary

"-" indicates that there are no data available
Interactions with Fluticasone
Antiretroviral (ARV)Dose of ARVDose of FluticasoneEffect on ARV LevelsEffect on Fluticasone LevelsPotential Clinical EffectsMechanism of InteractionManagement
Atazanavir
(ATV)(Reyataz)
---Increased fluticasone concentrationsDecreased plasma cortisol concentrations (eg, Cushing's syndrome, adrenal suppression)-

Use with caution with atazanavir; use with atazanavir/ritonavir is not recommended unless the potential benefit outweighs the risk

Alternative Agents:
Beclomethasone

Darunavir161
(DRV)(Prezista)
---Increased fluticasone concentrationsDecreased plasma cortisol concentrations (eg, Cushing's syndrome, adrenal suppression)-

Use with caution; use with darunavir/ritonavir is not recommended unless the potential benefit outweighs the risk

Elvitegravir/cobicistat699
(Genvoya, Stribild)
--- Not studied; possible increased fluticasone levels Possible increased fluticasone effects (eg, Cushing's syndrome, adrenal suppression)-

Consider using alternative corticosteroid such as beclomethasone

Alternative Agents:
Beclomethasone

Elvitegravir/ritonavir-boosted protease inhibitor699
---Not studied; likely increased levels of fluticasone Possible increased fluticasone effects (eg, Cushing's syndrome, adrenal suppression)Inhibition of fluticasone metabolism by CYP3A4

Consider using alternative corticosteroid such as beclomethasone

Alternative Agents:
Beclomethasone

Lopinavir/ritonavir78
(LPV/r)(Kaletra)
---Increased fluticasone concentrationsDecreased plasma cortisol concentrations (eg, Cushing's syndrome, adrenal suppression)-

Avoid if possible

Ritonavir55
(RTV)(Norvir)
---Fluticasone AUC: increased 350-fold; Cmax: increased 25-foldDecreased plasma cortisol concentrations (eg, Cushing's syndrome, adrenal suppression)-

Avoid if possible

Ritonavir392
(RTV)(Norvir)
100 mg BID x 7 d200 mcg once daily x 7 d-Fluticasone Cmax: increased 2572%; AUC: increased 36697%Increased fluticasone effects (eg, Cushing's syndrome, adrenal suppression)Inhibition of CYP450 3A4 by ritonavir

Dose adjustment not established; use caution

"-" indicates that there are no data available
Interactions with Prednisolone
Antiretroviral (ARV)Dose of ARVDose of PrednisoloneEffect on ARV LevelsEffect on Prednisolone LevelsPotential Clinical EffectsMechanism of InteractionManagement
Dolutegravir641
(Tivicay)
50 mg QD60 mg QD with taperDolutegravir Cmin: increased 17% ---

No dose adjustment necessary

Efavirenz426
(EFV)(Sustiva)
not stated20 mg x 1-Prednisolone AUC: decreased 21%Possibly increased prednisolone effects (adrenal insufficiency, Cushing’s syndrome).-

No dose adjustment necessary

Elvitegravir/cobicistat
(Genvoya, Stribild)
---Not studied; may increase prednisolone levelsPossibly increased prednisolone effects (adrenal insufficiency, Cushing’s syndrome).-

Do not coadminister

Elvitegravir/ritonavir-boosted protease inhibitor
---Not studied; may increase prednisolone levelsPossibly increased prednisolone effects (adrenal insufficiency, Cushing’s syndrome).-

Do not coadminister

Lopinavir/ritonavir425, 727
(LPV/r)(Kaletra)
not stated20 mg x 1-Prednisolone AUC: increased 31%Possibly increased prednisolone effects (adrenal insufficiency, Cushing’s syndrome).-

No dose adjustment necessary. Do not coadminister unless potential benefits of prednisone outweigh the risks of systemic corticosteroid adverse effects.

Ritonavir396
(RTV)(Norvir)
200 mg BID for 4 and 14 days20 mg x 1 dose-Prednisolone AUC: increased 30%; clearance: decreased 23%Possibly increased prednisolone effects (adrenal insufficiency, Cushing's syndrome).-

No dose adjustment necessary. Do not coadminister unless potential benefits of prednisone outweigh the risks of systemic corticosteroid adverse effects.

"-" indicates that there are no data available
Interactions with Triamcinolone
Antiretroviral (ARV)Dose of ARVDose of TriamcinoloneEffect on ARV LevelsEffect on Triamcinolone LevelsPotential Clinical EffectsMechanism of InteractionManagement
Elvitegravir/cobicistat707
(Genvoya, Stribild)
---Not studied; may increase triamcinolone levelsPossible increased risk of adrenal insufficiency and Cushing's syndrome-

Do not coadminister

Elvitegravir/ritonavir-boosted protease inhibitor707
--- Not studied; may increase triamcinolone levelsPossible increased risk of adrenal insufficiency and Cushing's syndrome-

Do not coadminister

"-" indicates that there are no data available
 16:Crixivan [package insert]. Whitehouse Station, NJ: Merck & Co., Inc.; Oct 2005.
 55:Norvir [package insert]. North Chicago, IL: Abbott Laboratories, 2008.
 78:Kaletra [package insert]. North Chicago, IL: Abbott Laboratories; Oct 2005.
 161:Prezista [package insert]. Raritan, NJ: Tibotec Therapeutics Inc.; April 2010.
 254:CDC. Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents. Jan 28, 2000. [AIDS Treatment Information Service: Current Treatment] Available at: http://www.hivatis.org/trtgdlns.html.
 392:Flonase [package insert]. Research Triangle Park, NC: GlaxoSmith Kline, March 2004.
 396:Penzak S, Formentini E, Alfaro R, et al. Prednisolone pharmacokinetics in the presence and absence of ritonavir after oral prednisone administration to healthy volunteers. J Acquir Immune Defic Syndr 2005; 40: 573-80.
 425:Busse KH, Formentini E, Alfaro RM, Kovacs JA and Penzak SR. Influence of antiretroviral drugs on the pharmacokinetics of prednisolone in HIV-infected individuals. J Acquir Immune Defic Syndr 2008; 48: 561-66.
 426:Busse KH, Formentini E, Alfaro RA, Kovacs JA and Penzak SR. Influence of antiretroviral drugs on the pharmacokinetics of prednisolone in HIV-infected individuals. J Acquir Immune Defic Syndr 2008; 48: 561-66.
 529:Colcrys [package insert]. Philadelphia, PA: URL Pharma, Inc., May 2010.
 549:Colcrys [package insert]. Philadelphia, PA: URL Pharma, Inc., May 2010.
 551:Colcrys [package insert]. Philadelphia, PA: URL Pharma, Inc., May 2010
 553:Colcrys [package insert]. Philadelphia, PA: URL Pharma, Inc., May 2010
 555:Colcrys [package insert]. Philadelphia, PA: URL Pharma, Inc., May 2010.
 557:Colcrys [package insert]. Philadelphia, PA: URL Pharma, Inc., May 2010.
 559:Colcrys [package insert]. Philadelphia, PA: URL Pharma, Inc., May 2010
 561:Colcrys [package insert]. Philadelphia, PA: URL Pharma, Inc., May 2010
 563:Colcrys [package insert]. Philadelphia, PA: URL Pharma, Inc., May 2010.
 581:Boyd S, Hadigan C, Pau A, et al. Darunavir/ritonavir does not significantly increase plasma concentrations of orally inhaled beclomethasone in healthy volunteers [paper #611]. 19th Conference on Retroviruses and Opportunistic Infections, March 5-8, 2012. Seattle, WA.
 583:Boyd S, Hadigan C, Pau A, et al. Darunavir/ritonavir does not significantly increase plasma concentrations of orally inhaled beclomethasone in healthy volunteers [paper #611]. 19th Conference on Retroviruses and Opportunistic Infections, March 5-8, 2012. Seattle, WA.
 641:Tivicay [package insert]. Research Triangle Park, NC: Viiv Healthcare; Sept 2013.
 699:Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf.
 707:Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf.
 727:Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/AdultandAdolescentGL.pdf.