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

Drug Interactions

Interactions between Integrase Inhibitors or Maraviroc and Non-Nucleoside Reverse Transcriptase Inhibitors or Protease Inhibitors

(Last updated:2/12/2013; last reviewed:2/12/2013)

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*Delavirdine (DLV), indinavir (IDV), and nelfinavir (NFV) are not included in this table. Refer to the DLV, IDV, and NFV Food and Drug Administration package inserts for information regarding drug interactions.

 

Table 16c. Interactions between Integrase Inhibitors or Maraviroc and Non-Nucleoside Reverse Transcriptase Inhibitors or Protease Inhibitors*
No title EVG/COBI/TDF/FTC RAL MVC
ATV
+/-
RTV
 
PK Data ↑ or ↓ EVG, COBI, ATV possible With unboosted ATV
RAL: AUC ↑ 72%
With (ATV 300 mg + RTV 100 mg) once daily
RAL: AUC ↑ 41%
With unboosted ATV
MVC: AUC ↑ 257%
With (ATV 300 mg + RTV 100 mg) once daily
MVC: AUC ↑ 388%
Dose Do not co-administer. Standard MVC 150 mg BID with ATV +/− RTV
DRV
(always use with RTV)
PK Data ↑ or ↓ EVG, COBI, DRV possible With (DRV 600 mg + RTV 100 mg) BID
RAL: AUC ↓ 29% and Cmin ↑ 38%
With (DRV 600 mg + RTV 100 mg) BID
MVC: AUC ↑ 305%
With (DRV 600 mg + RTV 100 mg) BID + ETR
MVC: AUC ↑ 210%
Dose Do not co-administer. Standard MVC 150 mg BID
EFV PK Data ↑ or ↓ EVG, COBI, EFV possible EFV: AUC ↓ 36% MVC: AUC ↓ 45%
Dose Do not co-administer. Standard MVC 600 mg BID
EVG/COBI/TDF/FTC PK Data No data ↑ MVC possible
Dose Do not co-administer. Do not co-administer. 
ETR PK Data ↑ or ↓ EVG, COBI, ETR possible ETR: Cmin ↓ 17%
RAL: Cmin ↓ 34%
MVC: AUC ↓ 53%, Cmax ↓ 60%
Dose Do not co-administer. Standard MVC 600 mg BID in the absence of a potent CYP3A inhibitor
FPV PK Data ↑ or ↓ EVG, COBI, FPV possible No significant effect Unknown; ↑ MVC possible
Dose Do not co-administer. Standard MVC 150 mg BID
LPV/r PK Data ↑ or ↓ EVG, COBI, LPV possible RTV and COBI have similar effects on CYP3A. ↓ RAL
↔ LPV/r
MVC: AUC ↑ 295% With LPV/r + EFV
MVC: AUC ↑ 153%
Dose Do not co-administer. Standard MVC 150 mg BID
NVP PK Data ↑ or ↓ EVG, COBI, NVP possible No data MVC: AUC ↔ and Cmax ↑ 54%
Dose Do not co-administer. Standard Without PI
MVC 300 mg BID
With PI (except TPV/r)
MVC 150 mg BID
RAL PK Data No data RAL: AUC ↓ 37%
MVC: AUC ↓ 21%
Dose Do not co-administer. Standard
RPV PK Data ↑ or ↓ EVG, COBI, RPV possible No data No data
Dose Do not co-administer. No data No data
RTV PK Data ↑ or ↓ EVG, COBI possible RTV and COBI have similar effects on CYP3A. With RTV 100 mg BID
RAL: AUC ↓ 16%
With RTV 100 mg BID
MVC: AUC ↑ 161%
Dose Do not co-administer. Standard MVC 150 mg BID
SQV
(always use with RTV)
PK Data ↑ or ↓ EVG, COBI, SQV possible RTV and COBI have similar effects on CYP3A. No data With (SQV 1000 mg + RTV 100 mg) BID
MVC: AUC ↑ 877%
With (SQV 1000 mg + RTV 100 mg) BID + EFV
MVC: AUC ↑ 400%
Dose Do not co-administer. Standard MVC 150 mg BID
TPV
(always use with RTV)
PK Data ↑ or ↓ EVG, COBI, TPV possible RTV and COBI have similar effects on CYP3A. With (TPV 500 mg +
RTV 200 mg) BID
RAL: AUC ↓ 24%
With (TPV 500 mg + RTV 200 mg) BID
MVC: No significant change in AUC
TPV: No data
Dose Do not co-administer. Standard MVC 300 mg BID
Key to Abbreviations: APV = amprenavir, ART = antiretroviral therapy, ATV = atazanavir, AUC = area under the curve, BID = twice daily, COBI = cobicistat, Cmax = maximum plasma concentration, Cmin = minimum plasma concentration, CYP = cytochrome P, DLV = delavirdine, DRV = darunavir, DRV/r = darunavir/ritonavir, EFV = efavirenz, EVG = elvitegravir, ETR = etravirine, FDA = Food and Drug Administration, FPV = fosamprenavir, IDV = indinavir, LPV = lopinavir, LPV/r = lopinavir/ritonavir, MVC = maraviroc, NFV = nelfinavir, NVP = nevirapine, PI = protease inhibitor, PK = pharmacokinetic, RAL = raltegravir, RPV = rilpivirine, RTV = ritonavir, SQV = saquinavir, SQV/r = saquinavir/ritonavir, TID = three times a day, TPV = tipranavir