Page 201 - HIV/AIDS Guidelines

Table 15b. Drug Interactions between Non-Nucleoside Reverse Transcriptase Inhibitors* and Other
Drugs (Page 2 of 6)

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

Antifungals
EFV No significant effect No dosage adjustment necessary.
ETR ETR AUC ↑ 86% No dosage adjustment necessary. Use with caution.

NVP NVP AUC ↑ 110% Increased risk of hepatotoxicity possible with this
combination. Monitor NVP toxicity or use alternative ARV
Fluconazole
agent.
RPV ↑ RPV possible No dosage adjustment necessary. Clinically monitor for
breakthrough fungal infection. (RPV 150 mg/day reduces
ketoconazole exposure; no data on interaction with
fluconazole.)
EFV itraconazole and OH- Failure to achieve therapeutic itraconazole concentrations
itraconazole AUC, C max , and has been reported. Avoid this combination if possible. If
C min ↓ 35%–44% coadministered, closely monitor itraconazole concentration
and adjust dose accordingly.
ETR ↓ itraconazole possible Dose adjustments for itraconazole may be necessary.
↑ ETR possible Monitor itraconazole level and antifungal response.
Itraconazole
NVP ↓ itraconazole possible Avoid combination if possible. If coadministered, monitor
↑ NVP possible itraconazole concentration and adjust dose accordingly.
RPV ↑ RPV possible No dosage adjustment necessary. Clinically monitor for
breakthrough fungal infection. (RPV 150 mg/day reduces
ketoconazole exposure; no data on interaction with
itraconazole.)

EFV posaconazole AUC ↓ 50% Avoid concomitant use unless the benefit outweighs the risk.
↔ EFV If coadministered, monitor posaconazole concentration and
adjust dose accordingly.
ETR ↑ ETR possible No dosage adjustment necessary.
Posaconazole
RPV ↑ RPV possible No dosage adjustment necessary. Clinically monitor for
breakthrough fungal infection. (RPV 150 mg/day reduces
ketoconazole exposure; no data on interaction with
posaconazole.)
EFV voriconazole AUC ↓ 77% Contraindicated at standard doses.
EFV AUC ↑ 44% Dose: voriconazole 400 mg BID, EFV 300 mg daily.
ETR voriconazole AUC ↑ 14% No dosage adjustment necessary; use with caution.
ETR AUC ↑ 36% Consider monitoring voriconazole level.
Voriconazole NVP ↓ voriconazole possible Monitor for toxicity and antifungal response and/or
↑ NVP possible voriconazole level.

RPV ↑ RPV possible No dosage adjustment necessary. Clinically monitor for
breakthrough fungal infection. (RPV 150 mg/day reduces
ketoconazole exposure; no data on interaction with
voriconazole.)
Antimycobacterials
Clarithromycin EFV clarithromycin AUC ↓ 39% Monitor for effectiveness or consider alternative agent,
such as azithromycin, for MAC prophylaxis and treatment.

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents K-31

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