Nucleoside Analogs (NRTIs)-Drug Interactions

Drugs Affected Zidovudine Didanosine Tenofovir Stavudine

(AZT, ZDV) (DDI) (TDF) (D4T)
Methadone No data DDI level ↓ by 41%, consider DDI D4T level ↓ by 27%, no dose
dose ↑ adjustment
Miscellaneous Antagonistic (combination avoid ) Only buffered formulation; ↑ DDI AUC44% Antagonism with AZT
 Ribavirin + AZT  Drugs that needs gastric PH for May ↑ serum levels
 D4T + AZT absorption→ separate dose by 1- of cidofovir,
Enhanced neutropenia 2hr valacyclovir &
 AZT + ganciclovir ganciclovir
 Quinolones (po) & doxycyline
(po) →Separate dose by 2 hrs
TDF ↑ DDI by 44%-Use 250mg QD

Non- Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)-Drug Interactions

Drugs Affected Nevirapine (Viramune®) Delavirdine (Rescriptor®) Efavirenz (Sustiva®)
(NVP) (DLV) (EFV)
Antifungals
Ketoconazole Keto level ↓ by 63% No data No data
NVP ↑ by 15-30%
No dose adjustment
Anti-mycobacterials
Rifampin NVP ↓ by 58-37% DLV ↓ by 96% EFV ↓ by 25%
Not recommended Contraindicated No dose adjustment
Rifabutin NVP ↓ by 16% DLV ↓ by 80% Rifabutin ↓ by 35%; EFV unchanged
No dose adjustment* Rifabutin ↑ by 100% ↑ rifabutin dose to 450-600mg qd or
Not recommended 600mg 2-3xwk*
EFV dose standard
Clarithromycin NVP ↑ by 26% DLV ↑ by 44% Clarithro ↓ by 39%
Clarithro ↓ by 30% Clarithro ↑ by 100% Alternative recommended
No dose adjustment Dose adjust for renal failure
Oral Contraceptives Ethinyl Estradiol ↓ 20% No data Ethinyl Estradiol ↑ by 37%
Use alternative/additional methods No data on other component
Use alternative/additional methods
Lipd Lowering Agents
Simvastatin No data Potential large ↑ in statin level. Avoid use No data
Lovastatin
Anticonvulsants
Phenobarbitol Unknown May ↓ DLV level substantially Unknown
Phenytoin Monitor anticonvulsant level Monitors anticonvulsant level Monitors anticonvulsant level
Carbamazepine

Methadone Methadone ↓ significantly No data Methadone ↓ significantly

Titrate methadone dose Titrate methadone dose
NVP level unchanged
Miscellaneous No data May ↑ dapsone/warfarin/quinidine Monitor warfarin when use
Sildenafil (Viagra®)-potential ↑ level (do concomitantly
not exceed 25mg of silfenadil in 48 hrs)
*These recommendation apply to regimens that do not include PIs, which can substantially increase rifabutin level.