Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

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Drug-Drug Interactions

Drug Interactions between Non-Nucleoside Reverse Transcriptase Inhibitors and Other Drugs

Last Updated: October 25, 2018; Last Reviewed: October 25, 2018

Table 21b. Drug Interactions Between Non-Nucleoside Reverse Transcriptase Inhibitors and Other Drugs

This table provides information relating to PK interactions between NNRTIs and non-ARV drugs. For interactions between ARV agents and for dosing recommendations, refer to Tables 21c, 22a, and 22b. Recommendations for managing a particular drug interaction may differ depending on whether a new ARV drug is being initiated in a patient on a stable concomitant medication or if a new concomitant medication is being initiated in a patient on a stable ARV regimen. The magnitude and significance of drug interactions are difficult to predict when several drugs with competing metabolic pathways are prescribed concomitantly.

Note: DLV is not included in this table. Please refer to the DLV FDA package insert for information regarding drug interactions. The term “All NNRTIs” in this table refers to all NNRTIs except for DLV.

Table 21b. Drug Interactions Between Non-Nucleoside Reverse Transcriptase Inhibitors and Other Drugs
Concomitant Drug Class/Name NNRTIa Effect on NNRTI and/or Concomitant Drug Concentrations Dosing Recommendations and Clinical Comments
Acid Reducers
Antacids RPV ↓ RPV expected when given simultaneously Give antacids at least 2 hours before or at least 4 hours after RPV.
H2 Receptor Antagonists RPV ↓ RPV Give H2 receptor antagonists at least 12 hours before or at least 4 hours after RPV.
PPIs RPV With Omeprazole 20 mg Daily:
  • RPV AUC ↓ 40% and Cmin ↓ 33%
 Contraindicated. Do not coadminister.
Alpha-Adrenergic Antagonists for Benign Prostatic Hyperplasia
Alfuzosin, Doxazosin, Silodosin EFV, ETR, NVP ↓ alpha antagonist expected Consider alternative therapy. If coadministration is necessary, monitor for therapeutic effectiveness of alpha antagonist.
Tamsulosin EFV, ETR, NVP ↓ tamsulosin expected Monitor for therapeutic effectiveness of tamsulosin after 2 to 4 weeks of dosing. May need to increase to tamsulosin 0.8 mg once daily for patients who fail to respond to the 0.4 mg dose.
Anticoagulants/Antiplatelets
Apixaban EFV, ETR, NVP ↓ apixaban possible Consider alternative therapy.
Betrixaban All NNRTIs ↔ betrixaban expected No dose adjustment necessary.
Clopidogrel EFV, ETR ↓ activation of clopidogrel possible ETR may prevent metabolism of clopidogrel (inactive) to its active metabolite. Avoid coadministration, if possible.
DOR, NVP, RPV ↔ clopidogrel expected No dose adjustment necessary.
Dabigatran All NNRTIs ↔ dabigatran expected No dose adjustment necessary.
Edoxaban All NNRTIs ↔ edoxaban expected No dose adjustment necessary.
Prasugrel All NNRTIs ↔ prasugrel expected No dose adjustment necessary.
Rivaroxaban EFV, ETR, NVP ↓ rivaroxaban possible Consider alternative therapy.
Ticagrelor EFV, ETR, NVP ↓ ticagrelor expected Consider alternative therapy.
Warfarin EFV, ETR, NVP ↑ or ↓ warfarin possible Monitor INR and adjust warfarin dose accordingly.
Anticonvulsants
Carbamazepine, Phenobarbital, Phenytoin EFV Carbamazepine plus EFV:
  • Carbamazepine AUC ↓ 27%
  • EFV AUC ↓ 36%
Phenytoin plus EFV:
  • ↓ EFV
  • ↓ phenytoin possible
 Monitor anticonvulsant and EFV concentrations or, if possible, use alternative anticonvulsant to those listed.
ETR ↓ anticonvulsant and ETR possible Do not coadminister. Consider alternative anticonvulsant.
NVP ↓ anticonvulsant and NVP possible Monitor anticonvulsant and NVP concentrations and virologic responses or consider alternative anticonvulsant.
DOR, RPV ↓ NNRTI possible Contraindicated. Do not coadminister. Consider alternative anticonvulsant.
Eslicarbazepine All NNRTIs ↓ NNRTI possible Monitor virologic outcomes and consider monitoring plasma concentrations of ARVs, or consider alternative anticonvulsant or ARV drug.
Oxcarbazepine DOR, RPV ↓ NNRTI possible Contraindicated. Do not coadminister. Consider alternative anticonvulsant.
Ethosuximide, Lacosamide, Tiagabine, Zonisamide EFV, ETR ↓ anticonvulsant possible Monitor seizure control and plasma concentrations of anticonvulsants (when available).
Lamotrigine EFV ↓ lamotrigine possible Monitor seizure control and plasma concentrations of lamotrigine.
Antidepressants
Bupropion EFV, NVP Bupropion AUC ↓ 55%

↓ bupropion possible		 Titrate bupropion dose based on clinical response.
Citalopram, Escitalopram EFV, ETR, NVP ↓ antidepressant possible Titrate antidepressant dose based on clinical response.
Fluoxetine, Fluvoxamine All NNRTIs ↔ antidepressant expected No dose adjustment necessary.
Paroxetine EFV, ETR ↔ paroxetine observed with EFV or ETR No dose adjustment necessary.
DOR, NVP, RPV ↔ expected with DOR, NVP or RPV No dose adjustment necessary.
Nefazodone EFV, ETR, NVP ↓ nefazodone expected

↑ NNRTI possible		 Monitor the antidepressant effect and titrate dose as necessary. Monitor for ARV-related adverse events.
DOR, RPV ↑ NNRTI possible Monitor for ARV-related adverse events.
Sertraline EFV Sertraline AUC ↓ 39% Titrate sertraline dose based on clinical response.
Trazodone EFV, ETR, NVP ↓ trazodone possible Monitor the therapeutic effect of trazodone and titrate dose as necessary.
Antifungals
Fluconazole EFV ↔ fluconazole or EFV No dose adjustment necessary.
ETR ETR AUC ↑ 86% No dose adjustment necessary. Use with caution.
NVP NVP AUC ↑ 110% Increased risk of hepatotoxicity possible with this combination. Monitor NVP toxicity or use alternative ARV agent.
DOR, RPV ↑ NNRTI possible No dose adjustment necessary.
Isavuconazole EFV, ETR, NVP ↓ isavuconazole possible Dose adjustments for isavuconazole may be necessary. Consider monitoring isavuconazole concentration and antifungal response.
DOR, RPV ↑ NNRTI possible No dose adjustment necessary.
Itraconazole EFV Itraconazole and OH-itraconazole AUC, Cmax, and Cmin ↓ 35% to 44% Failure to achieve therapeutic itraconazole concentrations has been reported. Avoid this combination if possible. If coadministered, closely monitor itraconazole concentration and adjust dose accordingly.
ETR ↓ itraconazole possible

↑ ETR possible		 Dose adjustments for itraconazole may be necessary. Monitor itraconazole concentration and antifungal response.
NVP Itraconazole AUC ↓ 61%

↑ NVP possible		 Avoid this combination if possible. If coadministered, monitor itraconazole concentration and adjust dose accordingly.
DOR, RPV ↑ NNRTI possible No dose adjustment necessary.
Posaconazole EFV Posaconazole AUC ↓ 50%

↔ EFV		 Avoid concomitant use unless the benefit outweighs the risk. If coadministered, monitor posaconazole concentration and adjust dose accordingly.
DOR, ETR, NVP, RPV ↑ NNRTI possible Monitor for NNRTI toxicities.
Voriconazole EFV Voriconazole AUC ↓ 77%

EFV AUC ↑ 44%		 Contraindicated at standard doses.

Dose Adjustment:
  • Voriconazole 400 mg BID, EFV 300 mg daily
ETR ↔ Voriconazole AUC

ETR AUC ↑ 36%		 No dose adjustment necessary.
NVP ↓ voriconazole possible

↑ NVP possible		 Monitor for toxicity and antifungal response and/or voriconazole concentration.
DOR, RPV ↑ NNRTI possible No dose adjustment necessary.
Antihyperglycemics
Canagliflozin, Dapagliflozin, Empagliflozin, Sitagliptin All NNRTIs ↔ antihyperglycemic expected No dose adjustment necessary.
Linagliptin, Saxagliptin EFV, ETR, NVP ↓ antihyperglycemic possible Monitor glycemic control.
Antimalarials
Artemether/ Lumefantrine EFV Artemether AUC ↓ 79%

DHA AUC ↓ 75%

Lumefantrine AUC ↓ 56%		 Consider alternative ARV or antimalarial drug. If used in combination, monitor closely for antimalarial efficacy.
ETR Artemether AUC ↓ 38%

↔ DHA AUC

↔ Lumefantrine AUC

↔ ETR AUC		 Clinical significance of the reduced antimalarial drug concentrations unknown. If used in combination with ETR, monitor for antimalarial efficacy.
NVP Artemether AUC ↓ 67% to 72%

DHA:
  • Study results are conflicting. DHA AUC ↓ 37% in one study, no difference in another.
Lumefantrine:
  • Study results are conflicting. Lumefantrine AUC ↓ 25% to 58% in 2 studies but ↑ 56% in another.
 Clinical significance unknown. If used, monitor closely for antimalarial efficacy and lumefantrine toxicity.
Atovaquone/ Proguanil EFV Atovaquone AUC ↓ 75%

Proguanil AUC ↓ 43%		 No dose recommendation. Consider alternative drug for malaria prophylaxis, if possible.
Antimycobacterials
Bedaquiline EFV, ETR ↓ bedaquiline possible Do not coadminister.
NVP ↔ bedaquiline AUC No dose adjustment necessary.
Clarithromycin EFV Clarithromycin AUC ↓ 39% Monitor for effectiveness or consider alternative agent, such as azithromycin, for MAC prophylaxis and treatment.
ETR Clarithromycin AUC ↓ 39%

ETR AUC ↑ 42%		 Consider alternative agent, such as azithromycin, for MAC prophylaxis and treatment.
NVP Clarithromycin AUC ↓ 31%

NVP AUC ↑ 26%		 Monitor for effectiveness or use alternative agent, such as azithromycin, for MAC prophylaxis and treatment.
RPV ↔ clarithromycin expected

↑ RPV possible		 Consider alternative macrolide, such as azithromycin, for MAC prophylaxis and treatment.
Rifabutin DOR DOR AUC ↓ 50% Increase DOR dose to 100 mg twice daily. No dose adjustment for rifabutin.
EFV Rifabutin ↓ 38% Dose:
  • Rifabutin 450–600 mg/day; or
  • Rifabutin 600 mg 3 times/week if EFV is not coadministered with a PI
ETR ↔ Rifabutin and metabolite AUC

ETR AUC ↓ 37%		 Do not coadminister ETR plus PI/r with rifabutin.

Use rifabutin 300 mg once daily if ETR is administered without PI/r.
NVP Rifabutin AUC ↑ 17% and metabolite AUC ↑ 24%

NVP Cmin ↓ 16%		 No dose adjustment necessary. Use with caution.
RPV Rifabutin plus RPV 50 mg Once Daily Compared to RPV 25 mg Once Daily Alone:
  • ↔ RPV AUC and Cmin
 Increase RPV dose to 50 mg once daily. No dose adjustment for rifabutin.
Rifampin DOR DOR AUC ↓ 88% Contraindicated.
EFV EFV AUC ↓ 26% Do not use EFV 400 mg with rifampin. Maintain EFV dose at 600 mg once daily and monitor for virologic response.
ETR Significant ↓ ETR possible Do not coadminister.
NVP NVP ↓ 20% to 58% Do not coadminister.
RPV RPV AUC ↓ 80% Contraindicated.
Rifapentine EFV ↔ EFV concentrations No dose adjustment necessary.
ETR, NVP ↓ NNRTI possible Do not coadminister.
DOR, RPV ↓ NNRTI expected Contraindicated.
Antipneumocystis and Antitoxoplasmosis Drugs
Atovaquone EFV Atovaquone AUC ↓ 44% to 47% Consider alternative agent for PCP or toxoplasmosis treatment or use alternative ARV drug. If used in combination, monitor therapeutic efficacy of atovaquone.
Antipsychotics
Aripiprazole EFV, ETR, NVP ↓ aripiprazole expected Monitor effectiveness of antipsychotic. Consider doubling usual dose of aripiprazole over 1–2 weeks. Refer to aripiprazole prescribing information for dosing recommendations.
Brexpiprazole EFV, ETR, NVP ↓ brexpiprazole expected Monitor effectiveness of antipsychotic. Consider doubling the usual dose of brexpiprazole and making further adjustments based on clinical response. Refer to brexpiprazole prescribing information.
Cariprazine EFV, ETR, NVP ↓ cariprazine and ↑ or ↓ active metabolite possible Coadministration is not recommended.
Olanzapine EFV ↓ olanzapine possible Monitor effectiveness of olanzapine.
DOR, ETR, NVP, RPV ↔ olanzapine expected No dose adjustment necessary.
Pimozide EFV, ETR, NVP ↓ pimozide possible Monitor therapeutic effectiveness of pimozide.
Lurasidone, Pimavanserin, Quetiapine, Thioridazine EFV, ETR, NVP ↓ antipsychotic possible Monitor effectiveness of antipsychotic.
Benzodiazepines
Alprazolam EFV, ETR, NVP ↓ alprazolam possible Monitor for therapeutic effectiveness of alprazolam.
Diazepam EFV, NVP ↓ diazepam possible Monitor for therapeutic effectiveness of diazepam.
ETR ↑ diazepam possible Decreased dose of diazepam may be necessary. Monitor for diazepam toxicity.
Lorazepam EFV ↔ lorazepam AUC No dose adjustment necessary.
ETR, NVP ↔ lorazepam expected
Midazolam EFV ↑ or ↓ midazolam possible Monitor therapeutic effectiveness and toxicity of midazolam.
ETR Midazolam AUC ↓ 31%

Midazolam active metabolite Cmax ↑ 57%		 Monitor therapeutic effectiveness of midazolam.
NVP ↓ midazolam possible Monitor therapeutic effectiveness of midazolam.
Triazolam EFV, ETR, NVP ↓ triazolam possible Monitor therapeutic effectiveness of triazolam.
Cardiac Medications
Dihydropyridine CCBs EFV, ETR, NVP ↓ CCBs possible Titrate CCB dose based on clinical response.
Diltiazem, Verapamil EFV Diltiazem AUC ↓ 69%

↓ verapamil possible		 Titrate diltiazem or verapamil dose based on clinical response.
ETR, NVP ↓ diltiazem or verapamil possible
Corticosteroids
Dexamethasone DOR, EFV, ETR, NVP ↓ NNRTI possible Consider alternative corticosteroid for long-term use. If dexamethasone is used with NNRTI, monitor virologic response.
RPV Significant ↓ RPV possible Contraindicated with more than a single dose of dexamethasone.
Hepatitis C Direct-Acting Antiviral Agents
Daclatasvir EFV, ETR, NVP Daclatasvir 120 mg Once Daily plus EFV 600 mg Daily Compared with Daclatasvir 60 mg Alone:
  • Daclatasvir Cmin ↓ 17%, AUC ↑ 37%
 The recommended dose is daclatasvir 90 mg once daily.
DOR, RPV No data No dose adjustment necessary.
Dasabuvir plus Paritaprevir/ Ombitasivir/ RTV DOR ↑ DOR possible No dose adjustment necessary.
EFV No data Contraindicated.
ETR, NVP ↓ DAAs possible Do not coadminister.
RPV RPV AUC ↑ 150% to 225% Do not coadminister, due to potential for QT interval prolongation with higher concentrations of RPV.
Elbasvir/ Grazoprevir EFV Elbasvir AUC ↓ 54%

Grazoprevir AUC ↓ 83%

EFV ↔ by grazoprevir

EFV ↔ AUC by elbasvir		 Contraindicated.
ETR, NVP ↓ elbasvir and grazoprevir expected Do not coadminister.
DOR, RPV ↔ Elbasvir, grazoprevir

↔ DOR, RPV		 No dose adjustment necessary.
Glecaprevir/ Pibrentasvir DOR ↑ DOR expected No dose adjustment necessary.
EFV ↓ glecaprevir and pibrentasvir expected Do not coadminister.
ETR, NVP ↓ glecaprevir and pibrentasvir possible
RPV ↔ glecaprevir, pibrentasvir

RPV AUC ↑ 84%		 No dose adjustment necessary.
Ledipasvir/ Sofosbuvir EFV Ledipasvir AUC, Cmin, and Cmax ↓ 34%

↔ sofosbuvir		 No dose adjustment necessary.
ETR, NVP No significant effect expected
DOR, RPV ↔ Ledipasvir, sofosbuvir

↔ DOR, RPV
Simeprevir DOR No significant effect expected. No dose adjustment necessary.
EFV Simeprevir AUC ↓ 71%, Cmin ↓ 91%

↔ EFV		 Do not coadminister.
ETR, NVP ↓ simeprevir expected Do not coadminister.
RPV ↔ simeprevir and RPV No dose adjustment necessary.
Sofosbuvir/ Velpatasvir EFV Velpatasvir AUC ↓ 43% , Cmax ↓ 37%, and Cmin ↓ 47% Do not coadminister.
ETR, NVP ↓ velpatasvir expected Do not coadminister.
DOR, RPV No significant effect expected No dose adjustment necessary.
Sofosbuvir/ Velpatasvir/ Voxilaprevir EFV Velpatasvir AUC ↓ 43% , Cmax ↓ 37%, and Cmin ↓47%

↓ voxilaprevir expected		 Do not coadminister.
ETR, NVP ↓ voxilaprevir expected

↓ velpatasvir expected		 Do not coadminister.
DOR, RPV No significant effect expected No dose adjustment necessary.
Herbal Products
St. John’s Wort EFV, ETR, NVP ↓ EFV, ETR, and NVP expected Do not coadminister.
DOR, RPV ↓ NNRTI expected Contraindicated.
Hormonal Therapies
Hormonal Contraceptives
Oral		 EFV ↔ Ethinyl estradiol

Etonogestrel (metabolite of oral desogestrel) Cmin ↓ 61%

Levonorgestrel (metabolite of oral norgestimate) AUC ↓ 83%

Norelgestromin (metabolite of oral norgestimate) AUC ↓ 64%

 Use alternative or additional contraceptive methods.
ETR Ethinyl estradiol AUC ↑ 22%

No significant effect on norethindrone		 No dose adjustment necessary.
NVP Ethinyl estradiol AUC ↓ 29%, Cmin ↓ 58%

Norethindrone AUC ↓ 18%

Etonogestrel (metabolite of oral desogestrel) Cmin ↓ 22%		 Based on clinical data demonstrating no change in effectiveness, no dose adjustment necessary.
RPV ↔ Ethinyl estradiol

↔ Norethinodrone		 No dose adjustment necessary.
DOR ↔ Ethinyl estradiol

↔ Levonorgestrel		 No dose adjustment necessary.
Depot Medroxy- progesterone Acetate (MPA) Injectable EFV, NVP DMPA: no significant change No dose adjustment necessary.
Etonogestrel- Releasing Subdermal Implant EFV Etonogestrel AUC ↓ 63% to 82% Use alternative or additional contraceptive methods.
NVP Etonogestrel: no significant change No dose adjustment necessary.
Etonogestrel/ Ethinyl Estradiol Vaginal Ring EFV Ethinyl estradiol (intravaginal ring) AUC ↓ 56%

Etonogestrel (intravaginal ring) AUC ↓ 81%		 Use alternative or additional contraceptive methods.
Levonorestrel-Releasing Subdermal Implant EFV Levonorgestrel AUC ↓ 47% Use alternative or additional contraceptive methods.

Unintended pregnancies were observed in women who used EFV and levonorgestrel implant concomitantly.
NVP Levonorgestrel AUC ↑ 35% No dose adjustment necessary.
Levonorgestrel
For emergency contraception		 EFV Levonorgestrel AUC ↓ 58% Effectiveness of emergency postcoital contraception may be diminished.
Menopausal Hormone Replacement Therapy EFV, ETR, NVP ↓ estrogen possible with estradiol or conjugated estrogen (equine and synthetic)

↓ medroxyprogesterone possible

↓ micronized progesterone possible

↓ drospirenone possible

See Hormonal Contraceptives for other progestin-NNRTI interactions		 Monitor menopausal symptoms. Titrate to the dose of hormonal therapy that achieves menopausal symptom relief.
Gender-Affirming Hormone Therapy EFV, ETR, NVP ↓ estradiol possible

↔ goserelin, leuprolide acetate, and spironolactone expected

↓ dutasteride and finasteride possible

 Monitor feminizing effects of estrogen and antiandrogen therapy and titrate dosing as necessary to achieve therapeutic goals.
EFV, ETR, NVP ↓ testosterone possible Monitor masculinizing effects of testosterone and titrate testosterone dose as necessary to achieve therapeutic goals.
HMG-CoA Reductase Inhibitors
Atorvastatin EFV, ETR Atorvastatin AUC ↓ 32% to 43% Adjust atorvastatin dose according to lipid response, but do not exceed the maximum recommended dose.
NVP ↓ atorvastatin possible Adjust atorvastatin dose according to lipid response, but do not exceed the maximum recommended dose.
DOR, RPV ↔ atorvastatin AUC No dose adjustment necessary.
Fluvastatin EFV, ETR ↑ fluvastatin possible Dose adjustments for fluvastatin may be necessary. Monitor for fluvastatin toxicity.
Lovastatin, Simvastatin EFV Simvastatin AUC ↓ 68%

Simvastatin active metabolite AUC ↓ 60%		 Adjust simvastatin dose according to lipid response, but do not exceed the maximum recommended dose. If EFV is used with a PI/r, simvastatin and lovastatin should be avoided.
ETR, NVP ↓ lovastatin possible

↓ simvastatin possible		 Adjust lovastatin or simvastatin dose according to lipid responses but do not exceed the maximum recommended dose. If ETR or NVP is used with a PI/r, simvastatin and lovastatin should be avoided.
Pitavastatin EFV ↔ pitavastatin AUC No dose adjustment necessary.
DOR, ETR, NVP, RPV ↔ pitavastatin expected No dose adjustment necessary.
Pravastatin EFV Pravastatin AUC ↓ 44% Adjust statin dose according to lipid responses, but do not exceed the maximum recommended dose.
ETR ↓ pravastatin possible
Rosuvastatin EFV, ETR, NVP ↔ rosuvastatin expected No dose adjustment necessary.
Immunosuppressants
Cyclosporine, Everolimus, Sirolimus, Tacrolimus EFV, ETR, NVP ↓ immunosuppressant possible Increase in immunosuppressant dose may be necessary. Therapeutic drug monitoring of immunosuppressant is recommended. Consult with specialist as necessary.
Narcotics/Treatments for Opioid Dependence
Buprenorphine
Sublingual or buccal		 EFV Buprenorphine AUC ↓ 50%

Norbuprenorphineb AUC ↓ 71%		 No dose adjustment recommended; monitor for withdrawal symptoms.
ETR Buprenorphine AUC ↓ 25% No dose adjustment necessary.
NVP No significant effect No dose adjustment necessary.
Buprenorphine Implant EFV, ETR, NVP No data Clinical monitoring is recommended if NNRTI is initiated after insertion of buprenorphine implant.
Methadone EFV Methadone AUC ↓ 52% Opioid withdrawal common; increased methadone dose often necessary.
DOR, ETR No significant effect No dose adjustment necessary.
NVP Methadone AUC ↓ 37% to 51%

No significant effect on NVP		 Opioid withdrawal is common; increased methadone dose is often necessary.
RPV R-methadonec AUC ↓ 16% No dose adjustment necessary, but monitor for withdrawal symptoms.
PDE5 Inhibitors
Sildenafil DOR, RPV ↔ sildenafil expected No dose adjustment necessary.
ETR Sildenafil AUC ↓ 57% May need to titrate sildenafil dose based on clinical effect.
EFV, NVP ↓ sildenafil possible
Tadalafil EFV, ETR, NVP ↓ tadalafil possible May need to titrate tadalafil dose based on clinical effect.
RPV ↔ tadalafil No dose adjustment necessary.
Avanafil, Vardenafil EFV, ETR, NVP ↓ PDE5 inhibitor possible May need to increase PDE5 inhibitor dose based on clinical effect.
Miscellaneous Drugs
Enzalutamide All NNRTIs ↓ NNRTI expected Contraindicated.
Mitotane All NNRTIs ↓ NNRTI expected Contraindicated.
a Approved dose for RPV is 25 mg once daily. Most PK interaction studies were performed using 75 to 150 mg per dose.
b Norbuprenorphine is an active metabolite of buprenorphine.
c R-methadone is the active form of methadone.

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

Key to Acronyms: ARV = antiretroviral; AUC = area under the curve; BID = twice daily; CCB = calcium channel blocker; Cmax = maximum plasma concentration; Cmin = minimum plasma concentration; DAA = direct-acting antiviral; DHA = dihydroartemisinin; DMPA = depot medroxyprogesterone acetate; DOR = doravirine; EFV = efavirenz; ETR = etravirine; HMG-CoA = hydroxy-methylglutaryl-coenzyme A; INR = international normalized ratio; MAC = Mycobacterium avium complex; NNRTI = non-nucleoside reverse transcriptase inhibitor; NVP = nevirapine; OH-itraconazole = active metabolite of itraconazole; PCP = Pneumocystis jirovecii pneumonia; PDE5 = phosphodiesterase type 5; PI = protease inhibitor; PI/r = protease inhibitor/ritonavir; PK = pharmacokinetic; PPI = proton pump inhibitor; RPV = rilpivirine; RTV = ritonavir

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