Page 188 - HIV/AIDS Guidelines

Table 14. Drugs That Should Not Be Used With Protease Inhibitors, Non-Nucleoside Reverse
Transcriptase Inhibitors, or CCR5 Antagonist (page 2 of 2)

a DLV, IDV, NFV, and RTV (as sole PI) are not included in this table. Refer to the FDA package insert for information regarding DLV-, IDV-, NFV-, and RTV
(as sole PI)-related drug interactions.
b Certain listed drugs are contraindicated on the basis of theoretical considerations. Thus, drugs with narrow therapeutic indices and suspected
metabolic involvement with CYP450 3A, 2D6, or unknown pathways are included in this table. Actual interactions may or may not occur in patients.
c HIV-infected patients treated with rifapentine have a higher rate of TB relapse than those treated with other rifamycin-based regimens. Therefore an
alternative agent to rifapentine is recommended.

d A high rate of Grade 4 serum transaminase elevation was seen when a higher dose of RTV was added to LPV/r or SQV or when double-dose LPV/r
was used with rifampin to compensate for rifampin’s induction effect, so these dosing strategies should not be used.
e The manufacturer of cisapride has a limited-access protocol for patients who meet specific clinical eligibility criteria.
f Use of oral midazolam is contraindicated. Parenteral midazolam can be used with caution as a single dose and can be given in a monitored situation
for procedural sedation.
Suggested alternatives to:
Lovastatin, simvastatin: Fluvastatin, pitavastatin, and pravastatin have the least potential for drug-drug interactions (except for pravastatin with
DRV/r, see Table 15a). Use atorvastatin and rosuvastatin with caution; start with the lowest possible dose and titrate based on tolerance and lipid-
lowering efficacy.
Rifampin: Rifabutin (with dosage adjustment, see Tables 15a and 15b)

Midazolam, triazolam: temazepam, lorazepam, oxazepam
Key to Abbreviations: ATV +/- RTV = atazanavir +/- ritonavir, ATV/r = atazanavir/ritonavir, CYP = cytochrome P, DLV = delavirdine,
DRV/r = darunavir/ritonavir, EFV = efavirenz, ETR = etravirine, FDA = Food and Drug Administration, FPV +/- RTV = fosamprenavir +/- ritonavir,
FPV/r = fosamprenavir/ritonavir, IDV = indinavir, LPV/r = lopinavir/ritonavir, MVC = maraviroc, NFV = nelfinavir, NNRTI = non-nucleoside reverse
transcriptase inhibitor, NVP = nevirapine, PAH = pulmonary arterial hypertension, PI = protease inhibitor, PK = pharmacokinetic, RPV = rilpivirine,
RTV = ritonavir, SQV = saquinavir, SQV/r = saquinavir/ritonavir, TB = tuberculosis, TPV/r = tipranavir/ritonavir

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents K-18

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