Page 189 - HIV/AIDS Guidelines

Table 15a. Drug Interactions between Protease Inhibitors* and Other Drugs (Page 1 of 11)

This table provides information relating to PK interactions between PIs and non-ARV drugs. When information is available,
interactions with boosted and unboosted PIs are listed separately. For interactions among ARV agents and for dosing
recommendations, refer to Table 16a.

* NFV and IDV are not included in this table. Please refer to the NFV and IDV FDA package inserts for information regarding drug interactions
with these PIs.

Effect on PI or Dosing Recommendations and Clinical
Concomitant Drug PI Concomitant Drug Comments
Concentrations

Acid Reducers

ATV +/− RTV When given simultaneously, ↓ Give ATV at least 2 hours before or 1 hour after
ATV expected antacids or buffered medications.
FPV APV AUC ↓ 18%; no Give FPV simultaneously with or at least 2 hours
Antacids
significant change in APV C min before or 1 hour after antacids.

TPV/r TPV AUC ↓ 27% Give TPV at least 2 hours before or 1 hour after
antacids.
RTV-boosted PIs

ATV/r ↓ ATV H2 receptor antagonist dose should not exceed a
dose equivalent to famotidine 40 mg BID in ART-
naive patients or 20 mg BID in ART-experienced
patients.
Give ATV 300 mg + RTV 100 mg simultaneously
with and/or ≥10 hours after the H2 receptor
antagonist.
If using TDF and H2 receptor antagonist in ART-
experienced patients, use ATV 400 mg + RTV
100 mg.
H2 Receptor Antagonists DRV/r, LPV/r No significant effect No dosage adjustment necessary.

PIs without RTV
ATV ↓ ATV H2 receptor antagonist single dose should not
exceed a dose equivalent of famotidine 20 mg or
total daily dose equivalent of famotidine 20 mg BID
in ART-naive patients.

Give ATV at least 2 hours before and at least 10
hours after the H2 receptor antagonist.

FPV APV AUC ↓ 30%; no Give FPV at least 2 hours before H2 receptor
significant change in APV C min antagonist if concomitant use is necessary.
Consider boosting with RTV.

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents K-19

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