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Table 15b. Drug Interactions between Non-Nucleoside Reverse Transcriptase Inhibitors* and Other
Drugs (Page 5 of 6)

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

EFV ethinyl estradiol ↔ Use alternative or additional contraceptive
levonorgestrel AUC ↓ 83% methods. Norelgestromin and levonorgestrel
norelgestromin AUC ↓ 64% are active metabolites of norgestimate.
↓ etonogestrel (implant) possible
ETR ethinyl estradiol AUC ↑ 22% No dosage adjustment necessary.
norethindrone: no significant effect
Hormonal contraceptives
NVP ethinyl estradiol AUC ↓ 20% Use alternative or additional contraceptive
norethindrone AUC ↓ 19% methods.
DMPA: no significant change No dosage adjustment necessary.

RPV ethinyl estradiol AUC ↑ 14% No dosage adjustment necessary.
norethindrone: no significant change

Levonorgestrel (for EFV el AUC ↓ 58% Effectiveness of emergency postcoital
emergency contraception) levonorgestr contraception may be diminished.

HMG-CoA Reductase Inhibitors
EFV, ETR atorvastatin AUC ↓ 32%–43% Adjust atorvastatin according to lipid
responses, not to exceed the maximum
recommended dose.
Atorvastatin
RPV Atorvastatin AUC ↔ No dosage adjustment necessary.
Atorvastatin metabolites ↑

Fluvastatin ETR ↑ fluvastatin possible Dose adjustments for fluvastatin may be
necessary.
EFV simvastatin AUC ↓ 68% Adjust simvastatin dose according to lipid
responses, not to exceed the maximum
recommended dose. If EFV used with
RTV-boosted PI, simvastatin and lovastatin
should be avoided.
Lovastatin
Simvastatin ETR, NVP ↓ lovastatin possible Adjust lovastatin or simvastatin dose
↓ simvastatin possible according to lipid responses, not to exceed the
maximum recommended dose. If ETR or NVP
used with RTV-boosted PI, simvastatin and
lovastatin should be avoided.
Pitavastatin EFV, ETR, No data No dosage recommendation.
NVP, RPV
Pravastatin EFV pravastatin AUC ↓ 44% Adjust statin dose according to lipid
Rosuvastatin rosuvatatin: no data responses, not to exceed the maximum
recommended dose.

ETR No significant effect expected No dosage adjustment necessary.

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents K-34

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