Potential Clinically Relevant Interactions between Antimalarial and Antiretroviral Drugs*

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Potential Clinically Relevant Interactions between Antimalarial and Antiretroviral Drugs
Antimalarial Drug Protease Inhibitors NRTI NNRTI
Quinine PIs: increase quinine levels No available data Efavirenz, Nevirapine: reduces quinine levels
Atovaquone/Proguanil Lopinavir/Ritonavir, Atazanavir/Ritonavir: reduces atovaquone and proguanil levels   Efavirenz: reduces atovaquone and proguanil levels
Mefloquine Ritonavir: reduces ritonavir levels   Efavirenz, Nevirapine: reduces mefloquine levels
Lumefantrine, Halofantrine PIs: increase lumefantrine or halofantrine levels, which can prolong QT interval   Efavirenz, Nevirapine: increases lumefantrine or halofantrine levels, which can prolong QT interval
Amodiaquine plus Artesunate     Efavirenz: increases amodiaquine concentration which can increase hepatic toxicity; do not co-administer
Chloroquine, Pyrimethamine, Sulfadoxine-Pyrimethamine Ritonavir: alters anti-malarial drug metabolism, may increase chloroquine levels    
Sulfadoxine-Pyrimethamine   Zidovudine: possibly increases risk of anemia Nevirapine: possibly increases adverse skin or liver adverse reactions; do not start both drugs simultaneously
Artemisinin PIs: alter artemisinin metabolism   Nevirapine: may decrease artemisinin levels
Dapsone Saquinavir: alters dapsone metabolism    
Key to Acronyms: NRTI=nucleoside reverse transcriptase inhibitor; NNRTI=non-nucleoside reverse transcriptase inhibitor; PI= protease inhibitor

* Modified from: Flateau, C., G. Le Loup, et al. Consequences of HIV infection on malaria and therapeutic implications: a systematic review. Lancet Infect Dis. 2011. 11(7);541-556.