Table 4. Significant Pharmacokinetic Interactions between Drugs Used to Treat or Prevent Opportunistic Infections

Body
Table 4. Significant Pharmacokinetic Interactions between Drugs Used to Treat or Prevent Opportunistic Infections

Primary Drug

Interacting Agent

Effect on Primary and/or Concomitant Drug Concentrations

Recommendations

Artemether/
Lumefantrine

Clarithromycin

↑ lumefantrine expected

Coadministration should be avoided, if possible. Consider azithromycin in place of clarithromycin.

Erythromycin

↑ lumefantrine possible

Do not coadminister. Consider azithromycin in place of erythromycin.

Fluconazole

↑ lumefantrine possible

Coadministration should be avoided, if possible. If coadministered, monitor for lumefantrine toxicities.

Isavuconazole

↑ lumefantrine possible

Coadministration should be avoided, if possible. If coadministered, monitor for lumefantrine toxicities.

Itraconazole

↑ lumefantrine expected

Coadministration should be avoided, if possible. If coadministered, monitor for lumefantrine toxicities.

Mefloquine

↓ lumefantrine possible

If mefloquine is administered immediately before artemether/lumefantrine, monitor for decreased efficacy of artemether/lumefantrine and encourage food intake.

Posaconazole

↑ lumefantrine expected

Coadministration should be avoided, if possible. If coadministered, monitor for lumefantrine toxicities.

Rifabutina

↓ artemether, DHA, and lumefantrine expected

Use with caution. Monitor for antimalarial efficacy.

Rifampina

Artemether AUC ↓ 89%

DHA AUC ↓ 85%

Lumefantrine AUC ↓ 68%

Do not coadminister.

Rifapentinea

↓ artemether, DHA, and lumefantrine expected

Do not coadminister.

Voriconazole

↑ lumefantrine expected

Coadministration should be avoided, if possible. If coadministered, monitor for lumefantrine toxicities.

Atovaquone*

Doxycycline

Atovaquone concentration ↓ approximately equal to 40% with tetracycline

No interaction study with doxycycline

Dose adjustment not established; if coadministered, instruct patient to take atovaquone with fatty meal and monitor for decreased atovaquone efficacy.

Rifabutina

Atovaquone Css ↓ 34%

Rifabutin Css ↓ 19%

Dose adjustment not established; if coadministered, instruct patient to take atovaquone with fatty meal and monitor for decreased atovaquone efficacy.

Rifampina

Atovaquone Css ↓ 52%

Rifampin Css ↑ 37%

Do not coadminister.

Rifapentinea

↓ atovaquone expected

Do not coadminister.

Bedaquiline*

Clarithromycin

↑ bedaquiline expected

Do not coadminister. Consider azithromycin in place of clarithromycin.

Erythromycin

↑ bedaquiline possible

Do not coadminister. Consider azithromycin in place of erythromycin.

Fluconazole

↑ bedaquiline possible

Coadministration should be avoided, if possible. If coadministered, monitor for bedaquiline toxicities.

Isavuconazole

↑ bedaquiline possible

Coadministration should be avoided, if possible. If coadministered, monitor for bedaquiline toxicities.

Itraconazole

↑ bedaquiline expected

Coadministration should be avoided, if possible. If coadministered, monitor for bedaquiline toxicities.

If coadministration is required for >14 days, weigh the benefits of therapy against the risks of bedaquiline toxicities.

Posaconazole

↑ bedaquiline expected

Coadministration should be avoided, if possible. If coadministered, monitor for bedaquiline toxicities.

Rifabutina

↔ bedaquiline

↓ rifabutin possible

If coadministered, separate time of administration; perform rifabutin TDM and adjust dose accordingly.

Rifampina

Bedaquiline AUC ↓ 53%

Do not coadminister.

Rifapentinea

Bedaquiline AUC ↓ 55% (with daily rifapentine)

Do not coadminister.

Voriconazole

↑ bedaquiline expected

Coadministration should be avoided, if possible. If coadministered, monitor for bedaquiline toxicities.

Caspofungin

Rifabutina

↓ caspofungin possible

Monitor for antifungal efficacy. Dose not established. Consider increasing caspofungin dose to 70 mg/day or switch to another echinocandin (e.g., micafungin or anidulafungin).

Rifampina

Caspofungin Cmin ↓ 30%

If coadministered, caspofungin dose should be increased to 70 mg/day. Consider alternative echinocandin (e.g., micafungin or anidulafungin).

Rifapentinea

Daily Rifapentine

  • ↓ caspofungin expected

Weekly Rifapentine

  • ↓ caspofungin possible

Monitor for antifungal efficacy. Dose not established. Consider increasing caspofungin dose to 70 mg/day or switch to another echinocandin (e.g., micafungin or anidulafungin).

Chloroquine* Clarithromycin

↑ chloroquine expected

Do not coadminister. Consider azithromycin in place of clarithromycin.

Erythromycin

↑ chloroquine possible

Do not coadminister. Consider azithromycin in place of erythromycin.

Fluconazole

↑ chloroquine possible

Coadministration should be avoided, if possible. If coadministered, monitor for chloroquine toxicities.

Isavuconazole

↑ chloroquine possible

Coadministration should be avoided, if possible. If coadministered, monitor for chloroquine toxicities.

Itraconazole

↑ chloroquine expected

Coadministration should be avoided, if possible. If coadministered, monitor for chloroquine toxicities.

Posaconazole

↑ chloroquine expected

Coadministration should be avoided, if possible. If coadministered, monitor for chloroquine toxicities.

Rifabutina

↓ chloroquine expected

Monitor for chloroquine efficacy.

Rifampina

↓ chloroquine expected

Monitor for chloroquine efficacy.

Rifapentinea

↓ chloroquine expected

Monitor for chloroquine efficacy.

Voriconazole

↑ chloroquine expected

Coadministration should be avoided, if possible. If coadministered, monitor for chloroquine toxicities.

Clarithromycin*

Artemether/Lumefantrine

See Artemether/Lumefantrine.

See Artemether/Lumefantrine.

Bedaquiline

See Bedaquiline.

See Bedaquiline.

Chloroquine

See Chloroquine.

See Chloroquine.

Fluconazole

Clarithromycin AUC ↑ 18% and Cmin↑ 33%

No dose adjustment necessary in patients with normal renal function. Monitor for clarithromycin toxicity.

Isavuconazole

↑ isavuconazole and clarithromycin expected

Coadministration should be avoided, if possible. Consider azithromycin in place of clarithromycin. If coadministered, monitor for toxicities of both isavuconazole and clarithromycin. Role of isavuconazole TDM has not been established.

Itraconazole

↑ itraconazole and clarithromycin expected

Coadministration should be avoided, if possible. Consider azithromycin in place of clarithromycin. If coadministered, monitor for toxicities of both itraconazole and clarithromycin; perform itraconazole and clarithromycin TDM and adjust dose accordingly.

Mefloquine

↑ mefloquine expected

Use with caution. Consider azithromycin in place of clarithromycin. If coadministered, monitor for mefloquine toxicity.

Posaconazole

↑ clarithromycin expected

Coadministration should be avoided, if possible. Consider azithromycin in place of clarithromycin. If coadministered, monitor for toxicities of clarithromycin; perform clarithromycin TDM and adjust dose accordingly.

Quinine

↑ quinine expected

↑ clarithromycin possible

Do not coadminister. Consider azithromycin in place of clarithromycin.

Rifabutina

Clarithromycin AUC ↓ 44%

14-OH AUC ↑ 57%

Rifabutin AUC ↑ 76% to 99%

des-Rbt AUC ↑ 375%

Use with caution. Consider azithromycin in place of clarithromycin. If coadministered, consider reducing rifabutin dose, perform clarithromycin and rifabutin TDM and adjust dose accordingly. Monitor for rifabutin toxicities.

Rifampina

Clarithromycin concentration ↓ 87%

Rifampin AUC ↑ 60%

Do not coadminister. Use azithromycin in place of clarithromycin.

Rifapentinea

↓ clarithromycin expected

↑ 14-OH and rifapentine expected

Daily Rifapentine

  • Do not coadminister.

Weekly Rifapentine

  • Use with caution. Consider azithromycin in place of clarithromycin.

If coadministered, monitor for rifapentine toxicities and clarithromycin efficacy; perform clarithromycin and rifapentine TDM and adjust doses accordingly.

Voriconazole

↑ clarithromycin expected

Coadministration should be avoided, if possible. Consider azithromycin in place of clarithromycin. If coadministered, monitor for toxicities of clarithromycin; perform clarithromycin TDM and adjust dose accordingly.

Dapsone*

Rifabutina

Dapsone AUC ↓ 27% to 40%

Coadministration should be avoided, if possible. Consider alternatives for dapsone.

Rifampina

Dapsone concentration ↓ 7-fold to 10-fold and t1/2 ↓ from 24 hours to 11 hours

Coadministration should be avoided, if possible. Consider alternatives for dapsone.

Rifapentinea

↓ dapsone expected

Coadministration should be avoided, if possible. Consider alternatives for dapsone.

Doxycycline

Atovaquone

See Atovaquone.

See Atovaquone.

Rifabutina

↓ doxycycline possible

Monitor closely for doxycycline efficacy or consider alternative therapy.

Rifampina

Doxycycline AUC ↓ 59%

Use with caution. Monitor closely for doxycycline efficacy or consider alternative therapy.

Rifapentinea

Daily Rifapentine

  • ↓ doxycycline expected

Weekly Rifapentine

  • ↓ doxycycline possible

Use with caution. Monitor closely for doxycycline efficacy or consider alternative therapy.

Erythromycin

Artemether/Lumefantrine

See Artemether/Lumefantrine.

See Artemether/Lumefantrine.

Bedaquiline

See Bedaquiline.

See Bedaquiline.

Chloroquine

See Chloroquine.

See Chloroquine.

Fluconazole

↑ erythromycin possible

Do not coadminister. Consider azithromycin in place of erythromycin.

Isavuconazole

↑ erythromycin and isavuconazole possible

Do not coadminister. Consider azithromycin in place of erythromycin.

Itraconazole

Itraconazole AUC ↑ 36%

↑ erythromycin possible

Do not coadminister. Consider azithromycin in place of erythromycin.

Mefloquine

↑ mefloquine possible

Do not coadminister. Consider azithromycin in place of erythromycin.

Posaconazole

↑ erythromycin expected

Do not coadminister. Consider azithromycin in place of erythromycin.

Quinine

↑ quinine expected

↑ erythromycin possible

Do not coadminister. Consider azithromycin in place of erythromycin.

Rifabutina

↓ erythromycin possible

↑ rifabutin possible

Use with caution. Consider azithromycin in place of erythromycin. If coadministered, monitor for erythromycin efficacy and rifabutin toxicities; perform rifabutin TDM and adjust dose accordingly.

Rifampina

↓ erythromycin expected

Consider azithromycin in place of erythromycin. If coadministered, monitor for erythromycin efficacy.

Rifapentinea

↓ erythromycin expected

Consider azithromycin in place of erythromycin. If coadministered, monitor for erythromycin efficacy.

Voriconazole

↑ erythromycin expected

Do not coadminister. Consider azithromycin in place of erythromycin.

Fluconazole*

Artemether/Lumefantrine

See Artemether/Lumefantrine.

See Artemether/Lumefantrine.

Bedaquiline

See Bedaquiline.

See Bedaquiline.

Chloroquine

See Chloroquine.

See Chloroquine.

Clarithromycin

See Clarithromycin.

See Clarithromycin.

Erythromycin

See Erythromycin.

See Erythromycin.

Mefloquine

↑ mefloquine possible

Coadministration should be avoided, if possible. If coadministered, monitor for mefloquine toxicities.

Quinine

↑ quinine expected

↑ fluconazole possible

Coadministration should be avoided, if possible. If coadministered, monitor for quinine and fluconazole toxicity.

Rifabutina

Rifabutin AUC ↑ 80%

↔ fluconazole

Use with caution. Monitor for rifabutin toxicities. Perform rifabutin TDM; may need to decrease rifabutin dose to 150 mg/day.

Rifampina

Fluconazole AUC ↓ 23% to 56%

Monitor for antifungal efficacy; may need to increase fluconazole dose.

Rifapentinea

↓ fluconazole expected

Monitor for antifungal efficacy; may need to increase fluconazole dose.

Glecaprevir/

Pibrentasvir

Rifabutina

↓ glecaprevir and pibrentasvir possible

Coadministration should be avoided, if possible. Consider alternative agents.

Rifampina

Glecaprevir AUC ↓ 88%

Pibrentasvir AUC ↓ 87%

Do not coadminister.

Rifapentinea

↓ glecaprevir and pibrentasvir expected

Do not coadminister. Consider alternative agents.

TDF

TFV AUC ↑ 29% when coadministered as EFV/TDF/FTC

Use usual dose. Monitor renal function or consider TAF.

TAF

↔ TFV concentration when coadministered as EVG/c/TAF/FTC

No dose adjustment

Isavuconazole*

Artemether/Lumefantrine

See Artemether/Lumefantrine.

See Artemether/Lumefantrine.

Bedaquiline

See Bedaquiline.

See Bedaquiline.

Chloroquine

See Chloroquine.

See Chloroquine.

Clarithromycin

See Clarithromycin.

See Clarithromycin.

Erythromycin

See Erythromycin.

See Erythromycin.

Mefloquine

↑ mefloquine expected

Coadministration should be avoided, if possible. If coadministered, monitor for mefloquine toxicities.

Quinine

↑ quinine expected

↑ isavuconazole possible

Coadministration should be avoided, if possible. If coadministered, monitor for quinine and isavuconazole toxicities.

Rifabutina

↓ isavuconazole expected

↑ rifabutin expected

Consider alternative agent(s). If alternative agents are not available, use with close monitoring for isavuconazole antifungal activity and rifabutin toxicity. Perform rifabutin TDM and adjust dose accordingly.

Rifampina

Isavuconazole AUC ↓ 97%

Do not coadminister. Consider alternative antifungal and/or antimycobacterial agent(s).

Rifapentinea

Significant ↓ isavuconazole expected

Do not coadminister. Consider alternative antifungal and/or antimycobacterial agent(s).

Itraconazole*

Artemether/Lumefantrine

See Artemether/Lumefantrine.

See Artemether/Lumefantrine.

Bedaquiline

See Bedaquiline.

See Bedaquiline.

Chloroquine

See Chloroquine.

See Chloroquine.

Clarithromycin

See Clarithromycin.

See Clarithromycin.

Erythromycin

See Erythromycin.

See Erythromycin.

Mefloquine

↑ mefloquine expected

Coadministration should be avoided, if possible. If coadministered, monitor for mefloquine toxicities.

Quinine

↑ quinine expected

↑ itraconazole possible

Coadministration should be avoided, if possible. If coadministered, monitor for quinine and itraconazole toxicities; perform itraconazole TDM and adjust dose accordingly.

Rifabutina

Itraconazole AUC ↓ 70%

↑ rifabutin expected

Do not coadminister. Consider alternative antifungal and/or antimycobacterial agent(s).

Rifampina

Itraconazole AUC ↓ 64% to 88%

Do not coadminister. Consider alternative antifungal and/or antimycobacterial agent(s).

Rifapentinea

↓ itraconazole expected

Do not coadminister. Consider alternative antifungal and/or antimycobacterial agent(s).

Linezolid*

Rifabutina

↓ linezolid possible

Monitor for linezolid efficacy.

Rifampina

Linezolid AUC ↓ 32%

Monitor for linezolid efficacy. Perform linezolid TDM and adjust dose accordingly.

Rifapentinea

Daily Rifapentine

  • ↓ linezolid expected

Weekly Rifapentine

  • ↓ linezolid possible

Daily rifapentine

  • Monitor for linezolid efficacy. Perform linezolid TDM and adjust dose accordingly.

Weekly rifapentine

  • Monitor for linezolid efficacy.

Mefloquine*

Artemether/Lumefantrine

See Artemether/Lumefantrine.

See Artemether/Lumefantrine.

Clarithromycin

See Clarithromycin.

See Clarithromycin.

Erythromycin

See Erythromycin.

See Erythromycin.

Fluconazole

See Fluconazole.

See Fluconazole.

Isavuconazole

See Isavuconazole.

See Isavuconazole.

Itraconazole

See Itraconazole.

See Itraconazole.

Posaconazole

↑ mefloquine expected

Coadministration should be avoided, if possible. If coadministered, monitor for mefloquine toxicities.

Rifabutina

↓ mefloquine possible

Monitor for mefloquine efficacy.

Rifampina

Mefloquine AUC ↓ 68%

Do not coadminister. Use alternative antimalarial drug or rifabutin.

Rifapentinea

↓ mefloquine expected

Do not coadminister. Use alternative antimalarial drug or rifabutin.

Voriconazole

↑ mefloquine expected

Coadministration should be avoided, if possible. If coadministered, monitor for mefloquine toxicities.

Posaconazole*

Artemether/Lumefantrine

See Artemether/Lumefantrine.

See Artemether/Lumefantrine.

Bedaquiline

See Bedaquiline.

See Bedaquiline.

Chloroquine

See Chloroquine.

See Chloroquine.

Clarithromycin

See Clarithromycin.

See Clarithromycin.

Erythromycin

See Erythromycin.

See Erythromycin.

Mefloquine

See Mefloquine.

See Mefloquine.

Quinine

↑ quinine expected

↑ posaconazole possible

Coadministration should be avoided, if possible. If coadministered, monitor for quinine toxicities.

Rifabutina

Posaconazole AUC ↓ 49%

Rifabutin AUC ↑ 72%

Coadministration should be avoided, if possible. If coadministered, perform posaconazole and rifabutin TDM and adjust doses accordingly; monitor for clinical response to posaconazole and rifabutin toxicities.

Rifampina

Significant ↓ posaconazole expected

Do not coadminister when treating invasive fungal infections. If coadministered for treatment of non-invasive fungal infections, perform posaconazole TDM and adjust dose accordingly; monitor for clinical response.

Rifapentinea

↓ posaconazole expected

Daily Rifapentine

  • Do not coadminister.

Weekly Rifapentine

  • Coadministration should be avoided, if possible. If coadministered, perform posaconazole TDM and adjust dose accordingly; monitor clinical response.
Quinine*

Clarithromycin

See Clarithromycin.

See Clarithromycin.

Erythromycin

See Erythromycin.

See Erythromycin.

Fluconazole

See Fluconazole.

See Fluconazole.

Itraconazole

See Itraconazole.

See Itraconazole.

Posaconazole

See Posaconazole.

See Posaconazole.

Rifabutina

↓ quinine possible

↑ rifabutin possible

Monitor for quinine efficacy.

Monitor for rifabutin toxicity.

Rifampina

Quinine AUC ↓ 75% to 85%

Do not coadminister.

Rifapentinea

↓ quinine expected

Do not coadminister.

Voriconazole

↑ quinine expected

Coadministration should be avoided, if possible. If coadministered, monitor for quinine toxicities.

Rifabutina*

Artemether/Lumefantrine

See Artemether/Lumefantrine.

See Artemether/Lumefantrine.

Atovaquone

See Atovaquone.

See Atovaquone.

Bedaquiline

See Bedaquiline.

See Bedaquiline.

Caspofungin

See Caspofungin.

See Caspofungin.

Chloroquine

See Chloroquine.

See Chloroquine.

Clarithromycin

See Clarithromycin.

See Clarithromycin.

Dapsone

See Dapsone.

See Dapsone.

Doxycycline

See Doxycycline.

See Doxycycline.

Erythromycin

See Erythromycin.

See Erythromycin.

Fluconazole

See Fluconazole.

See Fluconazole.

Glecaprevir/Pibrentasvir

See Glecaprevir/Pibrentasvir.

See Glecaprevir/Pibrentasvir.

Isavuconazole

See Isavuconazole.

See Isavuconazole.

Itraconazole

See Itraconazole.

See Itraconazole.

Linezolid

See Linezolid.

See Linezolid.

Mefloquine

See Mefloquine.

See Mefloquine.

Posaconazole

See Posaconazole.

See Posaconazole.

Quinine

See Quinine.

See Quinine.

Sofosbuvir/Velpatasvir

↓ velpatasvir, sofosbuvir expected

Do not coadminister.

TAF

↓ TAF, TFV, TFV-DP expected

↑ TFV-DP expected versus TDF alone

If coadministered, monitor for HIV and HBV treatment efficacy.

Note: Interpretation extrapolated from TAF and rifampin (see Rifampin). FDA labeling recommends not to coadminister.

TDF

↔ TDF, TFV, TFV-DP expected

No dosage adjustment necessary.

Voriconazole

Voriconazole AUC ↓ 79%

Rifabutin AUC ↑ 4-fold

Do not coadminister. Consider alternative antifungal and/or antimycobacterial agent(s).

Coadministration may be considered if both voriconazole and rifabutin TDM is available to guide therapy.

Rifampina*

Artemether/Lumefantrine

See Artemether/Lumefantrine.

See Artemether/Lumefantrine.

Atovaquone

See Atovaquone.

See Atovaquone.

Bedaquiline

See Bedaquiline.

See Bedaquiline.

Caspofungin

See Caspofungin.

See Caspofungin.

Chloroquine

See Chloroquine.

See Chloroquine.

Clarithromycin

See Clarithromycin.

See Clarithromycin.

Dapsone

See Dapsone.

See Dapsone.

Doxycycline

See Doxycycline.

See Doxycycline.

Erythromycin

See Erythromycin.

See Erythromycin.

Fluconazole

See Fluconazole.

See Fluconazole.

Glecaprevir/Pibrentasvir

See Glecaprevir/Pibrentasvir.

See Glecaprevir/Pibrentasvir.

Isavuconazole

See Isavuconazole.

See Isavuconazole.

Itraconazole

See Itraconazole.

See Itraconazole.

Linezolid

See Linezolid.

See Linezolid.

Mefloquine

See Mefloquine.

See Mefloquine.

Posaconazole

See Posaconazole.

See Posaconazole.

Quinine

See Quinine.

See Quinine.

Sofosbuvir/Velpatasvir

Sofosbuvir AUC ↓ 72%

Velpatasvir AUC ↓ 82%

Do not coadminister.

TAF

TAF plus Rifampin

  • TAF AUC ↓ 56%
  • TFV AUC ↓ 53%
  • TFV-DP AUC ↓ 36%

Intracellular TFV-DP concentration is 4.2-fold greater than with TDF alone.

If coadministered, monitor for HIV and HBV treatment efficacy.

Note: FDA labeling recommends not to coadminister.

TDF

TDF plus Rifampin 600 mg Daily

  • ↔ TFV

No dosage adjustment necessary

Voriconazole

Voriconazole AUC ↓96%

Do not coadminister. Consider alternative antifungal and/or antimycobacterial agent(s).

Rifapentinea*

Artemether/Lumefantrine

See Artemether/Lumefantrine.

See Artemether/Lumefantrine.

Atovaquone

See Atovaquone.

See Atovaquone.

Bedaquiline

See Bedaquiline.

See Bedaquiline.

Caspofungin

See Caspofungin.

See Caspofungin.

Chloroquine

See Chloroquine.

See Chloroquine.

Clarithromycin

See Clarithromycin.

See Clarithromycin.

Dapsone

See Dapsone.

See Dapsone.

Doxycycline

See Doxycycline.

See Doxycycline.

Erythromycin

See Erythromycin.

See Erythromycin.

Fluconazole

See Fluconazole.

See Fluconazole.

Glecaprevir/Pibrentasvir

See Glecaprevir/Pibrentasvir.

See Glecaprevir/Pibrentasvir.

Isavuconazole

See Isavuconazole.

See Isavuconazole.

Itraconazole

See Itraconazole.

See Itraconazole.

Linezolid

See Linezolid.

See Linezolid.

Mefloquine

See Mefloquine.

See Mefloquine.

Posaconazole

See Posaconazole.

See Posaconazole.

Quinine

See Quinine.

See Quinine.

TAF

Daily Rifapentine

  • ↓ TAF, TFV, TFV-DP expected

Weekly Rifapentine

  • ↔ TAF, TFV, TFV-DP expected

Daily Rifapentine

  • Do not coadminister.

Weekly Rifapentine

If coadministered, monitor for HIV and HBV treatment efficacy.

Note: FDA labeling recommends not to coadminister.

TDF

↔ TDF, TFV, TFV-DP expected

No dosage adjustment necessary.

Sofosbuvir/Velpatasvir

↓ sofosbuvir, velpatasvir expected

Do not coadminister.

Voriconazole

↓ voriconazole expected

Do not coadminister. Consider alternative antifungal and/or antimycobacterial agent(s).

Sofosbuvir*/ Velpatasvir

Rifabutina

See Rifabutin.

See Rifabutin.

Rifampina

See Rifampin.

See Rifampin.

Rifapentinea

See Rifapentine.

See Rifapentine.

TAF

TFV AUC ↑ 52% (when RPV/TAF/FTC given with SOF/VEL/VOX)

No dosage adjustment.

TDF

TFV AUC ↑ 35% to 40% (when given with EVG/c/FTC or RPV/FTC)

TFV AUC ↑ 81% (when given with EFV/FTC and SOF/VEL)

TFV AUC ↑ 39% (when given with DRV/r/FTC and SOF/VEL/VOX)

Monitor for TDF toxicities.

Consider TAF in place of TDF.

Tenofovir* Alafenamide

Glecaprevir/Pibrentasvir

See Glecaprevir/Pibrentasvir.

See Glecaprevir/Pibrentasvir.

Rifabutina

See Rifabutin.

See Rifabutin.

Rifampina

See Rifampin.

See Rifampin.

Rifapentinea

See Rifapentine.

See Rifapentine.

Sofosbuvir/Velpatasvir

See Sofosbuvir/Velpatasvir.

See Sofosbuvir/Velpatasvir.

Tenofovir* Disoproxil Fumarate

Rifabutina

See Rifabutin.

See Rifabutin.

Rifampina

See Rifampin.

See Rifampin.

Rifapentinea

See Rifapentine.

See Rifapentine.

Glecaprevir/Pibrentasvir

See Glecaprevir/Pibrentasvir.

See Glecaprevir/Pibrentasvir.

Sofosbuvir/Velpatasvir

See Sofosbuvir/Velpatasvir.

See Sofosbuvir/Velpatasvir.

Voriconazole*

Artemether/Lumefantrine

See Artemether/Lumefantrine.

See Artemether/Lumefantrine.

Bedaquiline

See Bedaquiline.

See Bedaquiline.

Chloroquine

See Chloroquine.

See Chloroquine.

Clarithromycin

See Clarithromycin.

See Clarithromycin.

Erythromycin

See Erythromycin.

See Erythromycin.

Mefloquine

See Mefloquine.

See Mefloquine.

Quinine

See Quinine.

See Quinine.

Rifabutina

See Rifabutin.

See Rifabutin.

Rifampina

See Rifampin.

See Rifampin.

Rifapentinea

See Rifapentine.

See Rifapentine.

aRefer to the description of Rifamycin-Related Induction Interactions in the Table 4 introduction above.

* Drug names marked with asterisk (*) are known to have assays available in the United States and, typically, in Europe as well.

Key to Symbols
↑ = increase
↓ = decrease
↔ = no substantial change

Key: 14-OH = active metabolite of clarithromycin; AUC = area under the curve; Cmin = minimum concentration; Css = concentration at steady state; des-Rbt = desacetyl rifabutin; DHA = dihydroartemisinin; DRV/r = darunavir/ritonavir; EFV = efavirenz; EVG/c = elvitegravir/cobicistat; FDA = U.S. Food and Drug Administration; FTC = emtricitabine; HBV = hepatitis B virus; RPV = rilpivirine; SOF = sofosbuvir; t1/2 = half-life; TAF = tenofovir alafenamide; TDF = tenofovir disoproxil fumarate; TDM = therapeutic drug monitoring; TFV= tenofovir; TFV-DP = tenofovir diphosphate; VEL = velpatasvir; VOX = voxilaprevir

 

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