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. |
Dasabuvir/Ombitasvir/ Paritaprevir/Ritonavir |
↑ artemether and lumefantrine possible |
Use with caution. Monitor for artemether and lumefantrine toxicities. |
|
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 |
Dasabuvir/Ombitasvir/ Paritaprevir/Ritonavir |
↔ atovaquone (based on interaction data for atovaquone oral solution with ATV/r) |
No dosage adjustment necessary. |
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. |
|
Atovaquone/ Proguanil |
Dasabuvir/Ombitasvir/ Paritaprevir/Ritonavir |
↓ atovaquone and proguanil AUC (when coadministered with ATV/r or LPV/r) |
Consider alternative drug for malaria prophylaxis. |
Bedaquiline |
Clarithromycin |
↑ bedaquiline expected |
Do not coadminister. Consider azithromycin in place of clarithromycin. |
Dasabuvir/Ombitasvir/ Paritaprevir/Ritonavir |
↑ bedaquiline expected |
Coadministration should be avoided, if possible. Consider alternative HCV regimen. |
|
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 coadministration is required for >14 days, weigh the benefits of therapy against the risks of bedaquiline toxicities. If coadministered, monitor for bedaquiline toxicities. |
|
Posaconazole |
↑ bedaquiline expected |
Coadministration should be avoided, if possible. If coadministered, monitor for bedaquiline toxicities. |
|
Rifabutina |
↔ bedaquiline |
If coadministered, monitor for rifabutin toxicities. |
|
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 |
No data ↓ 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 |
No data ↓ 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 co-administered, 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 |
|
Daclatasvir |
↑ daclatasvir expected |
Decrease daclatasvir dose to 30 mg once daily. |
|
Dasabuvir/Ombitasvir/Paritaprevir/Ritonavir |
↑ clarithromycin and paritaprevir expected ↑ ombitasvir and dasabuvir possible |
Coadministration should be avoided, if possible. Consider azithromycin in place of clarithromycin. |
|
Elbasvir/Grazoprevir |
↑ elbasvir and grazoprevir expected |
Coadministration should be avoided, if possible. If coadministered, monitor closely for hepatotoxicity. Consider azithromycin in place of clarithromycin. |
|
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); consider monitoring itraconazole concentration 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. |
|
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, monitoring clarithromycin and rifabutin concentrations, and monitoring 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 |
Use with caution. Consider azithromycin in place of clarithromycin. If coadministered, monitor for rifapentine toxicities; consider monitoring clarithromycin and rifapentine concentrations and adjusting doses accordingly. |
|
Voriconazole |
↑ clarithromycin expected |
Coadministration should be avoided, if possible. Consider azithromycin in place of clarithromycin. |
|
Daclatasvir |
Clarithromycin |
See Clarithromycin |
See Clarithromycin |
Erythromycin |
↑ daclatasvir possible |
No dosage adjustment. Monitor for daclatasvir toxicities. |
|
Fluconazole |
↑ daclatasvir possible |
No dosage adjustment. Monitor for daclatasvir toxicities. |
|
Isavuconazole |
↑ daclatasvir possible |
Dose not established. Monitor for daclatasvir toxicities. |
|
Itraconazole |
↑ daclatasvir expected |
Reduce daclatasvir dose to 30 mg once daily. |
|
Posaconazole |
↑ daclatasvir expected |
Reduce daclatasvir dose to 30 mg once daily. |
|
Rifabutina |
↓ daclatasvir expected |
Dose not established. Consider increasing daclatasvir dose to 90 mg once daily and monitor for therapeutic efficacy. |
|
Rifampina |
Daclatasvir AUC ↓ 79% |
Do not coadminister. |
|
Rifapentinea |
↓ daclatasvir expected |
Dose not established. Consider increasing daclatasvir dose to 90 mg once daily and monitor for therapeutic efficacy. |
|
TDF |
TFV AUC ↑ 10% |
No dosage adjustment. |
|
Voriconazole |
↑ daclatasvir expected |
Reduce daclatasvir dose to 30 mg once daily. |
|
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 T½ ↓ 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. |
|
Dasabuvir/ Ombitasvir/ Paritaprevir/ Ritonavir |
Artemether/Lumefantrine |
See Artemether/lumefantrine |
See Artemether/Lumefantrine |
Atovaquone (oral solution) |
See Atovaquone (oral solution) |
See Atovaquone (oral solution) |
|
Atovaquone/Proguanil |
See Atovaquone/Proguanil |
See Atovaquone/Proguanil |
|
Bedaquiline |
See Bedaquiline |
See Bedaquiline |
|
Clarithromycin |
See Clarithromycin |
See Clarithromycin |
|
Erythromycin |
↑ erythromycin and paritaprevir expected ↑ ombitasvir and dasabuvir possible |
Coadministration should be avoided, if possible. Consider azithromycin in place of erythromycin. |
|
Isavuconazole |
Isavuconazole ↑ 96% and RTV AUC ↓ 31% (when studied with LPV/r) ↑ or ↓ paritaprevir, ombitasvir, and dasabuvir possible |
Coadministration should be avoided, if possible. If coadministered, monitor for isavuconazole toxicity and HCV regimen-associated toxicities and efficacy. |
|
Itraconazole |
↑ itraconazole and paritaprevir expected ↑ ombitasvir and dasabuvir possible |
Itraconazole doses >200 mg/day are not recommended unless dosing is guided by itraconazole concentration. Monitor for itraconazole- and HCV regimen-associated toxicities. |
|
Mefloquine |
RTV AUC ↓ 31% (based on study with RTV 200 mg twice daily) |
Monitor for HCV antiviral activity. |
|
Posaconazole |
↑ posaconazole and paritaprevir expected ↑ ombitasvir and dasabuvir possible |
Monitor for posaconazole- and HCV regimen-associated toxicities. Monitor posaconazole concentration and adjust dose if necessary. |
|
Rifabutina |
↑ rifabutin expected ↓ paritaprevir possible |
Coadministration should be avoided, if possible. With coadministration, decrease rifabutin dose to 150 mg/day and monitor rifabutin concentration. Monitor HCV regimen for efficacy. |
|
Rifampina |
↓ paritaprevir, ritonavir, ombitasvir, and dasabuvir expected |
Do not coadminister. |
|
Rifapentinea |
↓ paritaprevir, ritonavir, ombitasvir, and dasabuvir expected |
Do not coadminister. |
|
Voriconazole |
Voriconazole AUC ↓ 39% (when given with RTV 100 mg twice daily) ↑ paritaprevir expected |
Coadminister only if the benefits outweigh the risk. Monitor voriconazole concentration to guide dosage adjustments. |
|
Doxycycline |
Atovaquone |
See Atovaquone |
See Atovaquone |
Rifabutina |
No data ↓ 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 |
No data ↓ doxycycline possible |
Monitor closely for doxycycline efficacy or consider alternative therapy. |
|
Elbasvir/ Grazoprevir |
Clarithromycin |
See Clarithromycin |
See Clarithromycin |
Erythromycin |
↑ elbasvir and grazoprevir expected |
Coadministration should be avoided, if possible. If coadministered, monitor closely for hepatotoxicity. Consider azithromycin in place of erythromycin. |
|
Isavuconazole |
↑ elbasvir and grazoprevir expected |
Coadministration should be avoided, if possible. If coadministered, monitor closely for hepatotoxicity. |
|
Itraconazole |
↑ elbasvir and grazoprevir expected |
Coadministration should be avoided, if possible. If coadministered, monitor closely for hepatotoxicity. |
|
Posaconazole |
↑ elbasvir and grazoprevir expected |
Coadministration should be avoided, if possible. If coadministered, monitor closely for hepatotoxicity. |
|
Rifabutina |
↓ elbasvir and grazoprevir possible |
Coadministration should be avoided if possible. Consider alternative HCV regimen. |
|
Rifampina |
Grazoprevir AUC ↓ 7% and C24h ↓ 90% ↓ elbasvir expected |
Do not coadminister. |
|
Rifapentinea |
↓ elbasvir and grazoprevir expected |
Do not coadminister. |
|
Voriconazole |
↑ elbasvir and grazoprevir expected |
Coadministration should be avoided if possible. If coadministered, monitor closely for hepatotoxicity. |
|
Erythromycin |
Artemether/Lumefantrine |
See Artemether/Lumefantrine |
See Artemether/Lumefantrine |
Bedaquiline |
See Bedaquiline |
See Bedaquiline |
|
Chloroquine |
See Chloroquine |
See Chloroquine |
|
Daclatasvir |
See Daclatasvir |
See Daclatasvir |
|
Dasabuvir/Ombitasvir/Paritaprevir/ |
See Dasabuvir/Ombitasvir/ |
See Dasabuvir/Ombitasvir/ |
|
Elbasvir/Grazoprevir |
See Elbasvir/Grazoprevir |
See Elbasvir/Grazoprevir |
|
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 or rifabutin toxicities. |
|
Rifampina |
↓ erythromycin expected |
Consider azithromycin in place of erythromycin. If co-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 |
|
Daclatasvir |
See Daclatasvir |
See Daclatasvir |
|
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. Consider monitoring rifabutin concentration; 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 |
Coadminsitration should be avoided, if possible. Consider alternative agents. |
Rifampina |
Glecaprevir AUC ↓ 88% Pibrentasvir AUC ↓ 87% |
Do not coadminister. |
|
Rifapentinea |
↓ glecaprevir and pibrentasvir possible |
Do not coadminister. |
|
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 |
|
Daclatasvir |
See Daclatasvir |
See Daclatasvir |
|
Dasabuvir/Ombitasvir/Paritaprevir/ |
See Dasabuvir/Ombitasvir/ |
See Dasabuvir/Ombitasvir/ |
|
Elbasvir/Grazoprevir |
See Elbasvir/Grazoprevir |
See Elbasvir/Grazoprevir |
|
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 anti-fungal activity and rifabutin toxicity. |
|
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 |
|
Daclatasvir |
See Daclatasvir |
See Daclatasvir |
|
Dasabuvir/Ombitasvir/Paritaprevir/ |
See Dasabuvir/Ombitasvir/ |
See Dasabuvir/Ombitasvir/ |
|
Elbasvir/Grazoprevir |
See Elbasvir/Grazoprevir |
See Elbasvir/Grazoprevir |
|
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; monitor itraconazole concentration 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). |
|
Ledipasvir/ Sofosbuvir |
Rifabutina |
↓ ledipasvir and sofosbuvir expected |
Do not coadminister. |
Rifampina |
Ledipasvir AUC ↓ 59% Sofosbuvir AUC ↓ 72% |
Do not coadminister. |
|
Rifapentinea |
↓ ledipasvir and sofosbuvir expected |
Do not coadminister. |
|
TAF |
Ledipasvir AUC ↑ 79% (when given with EVG/c/TAF/FTC) |
No dosage adjustment. |
|
TDF |
TFV AUC ↑ 98% (when given with EFV/FTC) TFV AUC ↑ 40% (when given with RPV/FTC) TFV AUC ↑ 50% (when given with DRV/r/FTC) |
Monitor for TDF toxicities. |
|
Linezolid |
Rifabutina |
↓ linezolid possible |
Monitor for linezolid efficacy. |
Rifampina |
Linezolid AUC ↓ 32% |
Monitor for linezolid efficacy. |
|
Rifapentinea |
↓ linezolid possible |
Monitor for linezolid efficacy. |
|
Mefloquine |
Artemether/Lumefantrine |
See Artemether/Lumefantrine |
See Artemether/Lumefantrine |
Clarithromycin |
See Clarithromycin |
See Clarithromycin |
|
Dasabuvir/Ombitasvir/Paritaprevir/ |
See Dasabuvir/Ombitasvir/ |
See Dasabuvir/Ombitasvir/ |
|
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 |
|
Daclatasvir |
See Daclatasvir |
See Daclatasvir |
|
Dasabuvir/Ombitasvir/Paritaprevir/ |
See Dasabuvir/Ombitasvir/ |
See Dasabuvir/Ombitasvir/ |
|
Elbasvir/Grazoprevir |
See Elbasvir/Grazoprevir |
See Elbasvir/Grazoprevir |
|
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, monitor posaconazole and rifabutin concentrations 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, monitor posaconazole concentration and adjust dose accordingly; monitor for clinical response. |
|
Rifapentinea |
↓ posaconazole expected |
Coadministration should be avoided, if possible. If coadministered, monitor posaconazole concentration 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 rifabutin concentration and 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 |
|
Daclatasvir |
See Daclatasvir |
See Daclatasvir |
|
Dasabuvir/Ombitasvir/Paritaprevir/ |
See Dasabuvir/Ombitasvir/ |
See Dasabuvir/Ombitasvir/ |
|
Dapsone |
See Dapsone |
See Dapsone |
|
Doxycycline |
See Doxycycline |
See Doxycycline |
|
Elbasvir/Grazoprevir |
See Elbasvir/Grazoprevir |
See Elbasvir/Grazoprevir |
|
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 |
|
Ledipasvir/Sofosbuvir |
See Ledipasvir/Sofosbuvir |
See Ledipasvir/Sofosbuvir |
|
Linezolid |
See Linezolid |
See Linezolid |
|
Mefloquine |
See Mefloquine |
See Mefloquine |
|
Posaconazole |
See Posaconazole |
See Posaconazole |
|
Quinine |
See Quinine |
See Quinine |
|
Sofosbuvir |
↓ sofosbuvir expected |
Do not coadminister. |
|
Sofosbuvir/Velpatasvir +/- Voxilaprevir |
↓ velpatasvir, voxilaprevir, and sofosbuvir expected |
Do not coadminister. |
|
TAF |
↓ TAF expected |
Do not coadminister. |
|
Voriconazole |
Voriconazole AUC ↓ 79% Rifabutin AUC ↑ 4-fold |
Do not coadminister. Consider alternative antifungal and/or antimycobacterial agent(s). If coadministration is absolutely necessary, monitor voriconazole and rifabutin concentrations 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 |
|
Daclatasvir |
See Daclatasvir |
See Daclatasvir |
|
Dapsone |
See Dapsone |
See Dapsone |
|
Dasabuvir/Ombitasvir/Paritaprevir/ |
See Dasabuvir/Ombitasvir/ |
See Dasabuvir/Ombitasvir/ |
|
Doxycycline |
See Doxycycline |
See Doxycycline |
|
Elbasvir/Grazoprevir |
See Elbasvir/Grazoprevir |
See Elbasvir/Grazoprevir |
|
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 |
|
Ledipasvir/Sofosbuvir |
See Ledipasvir/Sofosbuvir |
See Ledipasvir/Sofosbuvir |
|
Linezolid |
See Linezolid |
See Linezolid |
|
Mefloquine |
See Mefloquine |
See Mefloquine |
|
Posaconazole |
See Posaconazole |
See Posaconazole |
|
Quinine |
See Quinine |
See Quinine |
|
Sofosbuvir |
Sofosbuvir AUC ↓ 72% |
Do not coadminister. |
|
Sofosbuvir/Velpatasvir +/- Voxilaprevir |
Sofosbuvir AUC ↓ 72% Velpatasvir AUC ↓ 82% Voxilaprevir AUC ↓ 73% |
Do not coadminister. |
|
TAF |
TAF plus Rifampin:
Intracellular TFV-DP concentration is 4.2-fold greater than with TDF alone. |
If coadministered, monitor for HIV and HBV efficacy. Note: FDA labeling recommends not to coadminister. |
|
Voriconazole |
Voriconazole AUC ↓96% |
Do not coadminister. |
|
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 |
|
Daclatasvir |
See Daclatasvir |
See Daclatasvir |
|
Dapsone |
See Dapsone |
See Dapsone |
|
Dasabuvir/Ombitasvir/Paritaprevir/ |
See Dasabuvir/Ombitasvir/ |
See Dasabuvir/Ombitasvir/ |
|
Doxycycline |
See Doxycycline |
See Doxycycline |
|
Elbasvir/Grazoprevir |
See Elbasvir/Grazoprevir |
See Elbasvir/Grazoprevir |
|
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 |
|
Ledipasvir/Sofosbuvir |
See Ledipasvir/Sofosbuvir |
See Ledipasvir/Sofosbuvir |
|
Linezolid |
See Linezolid |
See Linezolid |
|
Mefloquine |
See Mefloquine |
See Mefloquine |
|
Posaconazole |
See Posaconazole |
See Posaconazole |
|
Quinine |
See Quinine |
See Quinine |
|
Sofosbuvir |
↓ sofosbuvir expected |
Do not coadminister. |
|
TAF |
↓ TAF expected |
Do not coadminister. |
|
Sofosbuvir/Velpatasvir +/- Voxilaprevir |
↓ sofosbuvir, velpatasvir, and voxilaprevir expected |
Do not coadminister. |
|
Voriconazole |
↓ voriconazole expected |
Do not coadminister. |
|
Sofosbuvir |
Rifabutina |
See Rifabutin |
See Rifabutin |
Rifampina |
See Rifampin |
See Rifampin |
|
Rifapentinea |
See Rifapentine |
See Rifapentine |
|
Sofosbuvir/ Velpatasvir +/- Voxilaprevir |
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 |
Ledipasvir/Sofosbuvir |
See Ledipasvir/Sofosbuvir |
See Ledipasvir/Sofosbuvir |
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 +/- Voxilaprevir |
See Sofosbuvir/Velpatasvir +/- Voxilaprevir |
See Sofosbuvir/Velpatasvir +/- Voxilaprevir |
|
Tenofovir Disoproxil Fumarate |
Daclatasvir |
See Daclatasvir |
See Daclatasvir |
Glecaprevir/Pibrentasvir |
See Glecaprevir/Pibrentasvir |
See Glecaprevir/Pibrentasvir |
|
Ledipasvir/Sofosbuvir |
See Ledipasvir/Sofosbuvir |
See Ledipasvir/Sofosbuvir |
|
Sofosbuvir/Velpatasvir |
See Sofosbuvir/Velpatasvir +/- Voxilaprevir |
See Sofosbuvir/Velpatasvir +/- Voxilaprevir |
|
Voriconazole |
Artemether/Lumefantrine |
See Artemether/Lumefantrine |
See Artemether/Lumefantrine |
Bedaquiline |
See Bedaquiline |
See Bedaquiline |
|
Chloroquine |
See Chloroquine |
See Chloroquine |
|
Clarithromycin |
See Clarithromycin |
See Clarithromycin |
|
Daclatasvir |
See Daclatasvir |
See Daclatasvir |
|
Dasabuvir/Ombitasvir/Paritaprevir/ |
See Dasabuvir/Ombitasvir/ |
See Dasabuvir/Ombitasvir/ |
|
Elbasvir/Grazoprevir |
See Elbasvir/Grazoprevir |
See Elbasvir/Grazoprevir |
|
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 |
|
a Rifamycin antibiotics are potent inducers of Phase 1 and Phase 2 drug-metabolizing reactions. Studies have demonstrated that with daily doses of rifampin, enzyme induction increases over a week or more. Based on limited data, larger doses of rifampin (e.g., 1,200 mg) appear to produce the same maximum induction as lower doses, but more rapidly. Single doses of rifampin may not produce significant induction. In general, rifabutin is about 40% as potent a CYP3A4 inducer as rifampin, but this can vary by substrate and enzymatic reaction. In general, daily rifapentine (for active TB disease) is at least as potent an inducer as rifampin. However, the potential of drug interactions with once weekly rifapentine (for latent TB infection, along with isoniazid) is not well studied, and may result in reduced exposure of drugs that are CYP3A4 substrates. When a rifamycin antibiotic is given with a potential interacting drug, close monitoring for clinical efficacy of the coadministered agent is advised. Key to Symbols: ↑ = increase ↓ = decrease ↔ = no change Key: 14-OH = active metabolite of clarithromycin; ARV = antiretroviral; ATV/r = atazanavir/ritonavir; AUC = area under the curve; C24h = concentration at 24 hours post dose; Cmin = minimum concentration; Css = concentration at steady state; CYP3A4 = Cytochrome P450 3A4; des-Rbt = desacetyl rifabutin; DHA = dihydroartemisinin; DRV/r = darunavir/ritonavir; EFV = efavirenz; EVG = elvitegravir; EVG/c = elvitegravir/cobicistat; FTC = emtricitabine; HCV = hepatitis C virus; LPV/r = lopinavir/ritonavir; OI = opportunistic infection; PK = pharmacokinetic; RPV = rilpivirine; RTV = ritonavir; SOF = sofosbuvir; T½ = half-life; TAF = tenofovir alafenamide; TB = tuberculosis; TDF = tenofovir disoproxil fumarate; TDM = therapeutic drug monitoring; TFV= tenofovir; TFV-DP = tenofovir diphosphate; VEL = velpastavir; VOX = voxilaprevir |