Page 200 - HIV/AIDS Guidelines

Table 15b. Drug Interactions between Non-Nucleoside Reverse Transcriptase Inhibitors* and Other
Drugs (Page 1 of 6)

This table provides information relating to PK interactions between NNRTIs and non-ARV drugs. For interactions among
ARV agents and for dosing recommendations, refer to Table 16b.

*DLV is not included in this table. Please refer to the DLV FDA package insert for information regarding DLV drug interactions.

Effect on NNRTI or
Concomitant Drug NNRTI a Concomitant Drug Dosing Recommendations and Clinical
Class/Name Comments
Concentrations
Acid Reducers

Antacids RPV ↓ RPV expected when given Give antacids at least 2 hours before or at least 4 hours
simultaneously after RPV.

H2 Receptor Antagonists RPV ↓ RPV Give H2 receptor antagonists at least 12 hours before
or at least 4 hours after RPV.

Proton Pump Inhibitors RPV ↓ RPV Contraindicated. Do not coadminister.
(PPI)
Anticoagulants/Antiplatelets

EFV, NVP ↑ or ↓ warfarin possible Monitor INR and adjust warfarin dose accordingly.
Warfarin
ETR ↑ warfarin possible Monitor INR and adjust warfarin dose accordingly.

Clopidogrel ETR ↓ activation of clopidogrel ETR may prevent metabolism of clopidogrel (inactive)
possible to its active metabolite. Avoid coadministration, if
possible.

Anticonvulsants
EFV carbamazepine + EFV: Monitor anticonvulsant and EFV levels or, if possible,
carbamazepine AUC ↓ 27% use alternative anticonvulsant to those listed.
and EFV AUC ↓ 36%
phenytoin + EFV: ↓ EFV and
↓ phenytoin possible
Carbamazepine ETR ↓ anticonvulsant and ETR Do not coadminister. Consider alternative
Phenobarbital possible anticonvulsant.
Phenytoin
NVP ↓ anticonvulsant and NVP Monitor anticonvulsant and NVP levels and virologic
possible responses or consider alternative anticonvulsant.

RPV ↓ RPV possible Contraindicated. Do not coadminister. Consider
alternative anticonvulsant.
Antidepressants

Bupropion EFV bupropion AUC ↓ 55% Titrate bupropion dose based on clinical response.
Paroxetine EFV, ETR No significant effect No dosage adjustment necessary.
Sertraline EFV sertraline AUC ↓ 39% Titrate sertraline dose based on clinical response.

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents K-30

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