Page 206 - HIV/AIDS Guidelines

Table 15c. Drug Interactions between Nucleoside Reverse Transriptase Inhibitors and Other Drugs
(Including Antiretroviral Agents) (Page 1 of 2)

Concomitant Effect on NRTI or Concomitant
Drug Class/ NRTI Drug Concentrations Dosage Recommendations and Clinical Comments
Name

Antivirals
Boceprevir TDF No significant PK effects No dose adjustment necessary.

TDF No data Serum concentrations of these drugs and/or TDF may be
Ganciclovir increased. Monitor for dose-related toxicities.
Valganciclovir
ZDV No significant PK effects Potential increase in hematologic toxicities
ddI ↑ intracellular ddI Contraindicated. Do not coadminister. Fatal hepatic
failure and other ddI-related toxicities have been reported
with coadministration.
Ribavirin
ZDV Ribavirin inhibits phosphorylation of Avoid coadministration if possible or closely monitor
ZDV. virologic response and hematologic toxicities.
Telaprevir TDF TDF AUC ↑ 30%, C min ↑ 6%–41% Monitor for TDF-associated toxicity.

Integrase Inhibitor
RAL TDF RAL AUC ↑ 49%, C max ↑ 64% No dosage adjustment necessary.
Narcotics/Treatment for Opioid Dependence

Buprenorphine 3TC, ddI, No significant effect No dosage adjustment necessary.
TDF, ZDV

ABC methadone clearance ↑ 22% No dosage adjustment necessary.
Methadone d4T d4T AUC ↓ 23%, C max ↓ 44% No dosage adjustment necessary.

ZDV ZDV AUC ↑ 29%–43% Monitor for ZDV-related adverse effects.
NRTIs
d4T No significant PK interaction Avoid coadministration. Additive toxicities of peripheral
neuropathy, lactic acidosis, and pancreatitis seen with this
ddI combination.
TDF ddI-EC AUC and C max ↑ 48%–60% Avoid coadministration.

Other
Allopurinol ddI ddI AUC ↑ 113% Contraindicated. Do not coadminister. Potential for
In patients with renal impairment: increased ddI-associated toxicities.
ddI AUC ↑ 312%
PIs
ddI With ddI-EC + ATV (with food): ddI Administer ATV with food 2 hours before or 1 hour after
AUC ↓ 34%; ATV no change didanosine.
TDF ATV AUC ↓ 25% and C min ↓ 23%– Dose: ATV/r 300/100 mg daily coadministered with
40% (higher C min with RTV than TDF 300 mg daily. Avoid concomitant use without RTV. If using
ATV without RTV) TDF and H2 receptor antagonist in ART-experienced patients,
TDF AUC ↑ 24%–37% use ATV/r 400 mg/100 mg daily.
Monitor for TDF-associated toxicity.
ZDV ZDV C min ↓ 30%, no change in AUC Clinical significance unknown.

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents K-36

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