An abbreviated, at-a-glance guide to
HIV drug interactions
Updated by Mariela Diaz-Linares and Enid Vázquez
Please see the drug’s page for details, or refer to the manufacturer’s package insert for a full comprehensive list of potential drug interactions. Also, make your pharmacist and health care providers aware of any drug that you add. Some interactions are more serious than others; some drugs may only require a dose adjustment, while others may either render the drug completely ineffective, or worse, lead to a potentially fatal reaction. Discuss any changes, however minor, with your healthcare providers, including your pharmacist, since small reactions may become serious. Look up your drugs with “Check my meds” at www.aidsmeds.com, which lists the effect of food as well as interactions for medications. The University of Liverpool also has an interactive database that allows you to look up antiretroviral drug interactions and has PDF charts of interactions between antiretrovirals and other drugs. Remember, brand names are usually capitalized, while generic names are not. Visit www.hiv-druginteractions.org.
| Nucleoside Reverse Transcriptase Inhibitors (also called nucleoside analogs, NRTIs, or nukes) |
| Potential drug class interactions |
None. |
Combivir
|
See Epivir and zidovudine (Retrovir). Do not take with zidovudine, Epivir, Epzicom, Trizivir, Emtriva, Truvada, or Atripla while taking Combivir, since all or part of these medications are already in Combivir or have equivalent medications. |
Emtriva (emtricitabine, FTC)
|
No significant drug interactions. Do not take Truvada, Atripla, Epivir, Epzicom, Combivir, or Trizivir while taking Emtriva, since they contain Emtriva or medication equivalent to it. |
Epivir (lamivudine, 3TC)
|
No significant drug interactions. Do not take Epzicom, Combivir, Trizivir, Truvada, or Atripla while taking Epivir, since they contain Epivir or medication equivalent to it. |
Epzicom
|
See Epivir and Ziagen. Do not take with Combivir, Epivir, Trizivir, Emtriva, Truvada, or Atripla while taking Epzicom, since all or part of these medications are already in Epzicom or have equivalent medications. |
Retrovir
(zidovudine or ZDV, AZT)
|
Do not take with Combivir or Trizivir, since zidovudine is already in these medications. Amphotericin B, Benemid, Biaxin, Cytovene, dapsone, Depakote, Dilantin, doxorubicin, flucytosine, ganciclovir, hydroxyurea, interferon-alpha, Mycobutin, pentamidine, Rebetol, ribavirin, rifampin, sulfadiazine, Valcyte, Vitrasert, and Zerit. |
Trizivir
|
See Epivir, Retrovir, and Ziagen. Do not take with zidovudine (Retrovir), Epivir, Ziagen, Emtriva, Truvada, or Atripla while taking Trizivir, since all or part of these medications are already in Trizivir or have equivalent medications. |
Truvada
|
See Emtriva and Viread. Do not take with Emtriva, Viread, Atripla, Epivir, Combivir, Epzicom, or Trizivir, since all or part of these medications are already in Truvada or have equivalent medications. |
Videx & Videx EC
(didanosine, ddI)
|
Alcohol, Cytovene, dapsone, HIV protease inhibitors, hydroxyurea, methadone, NebuPent, Nizoral, pentamidine, Rescriptor, Retrovir, ribavirin, Sporanox, Tagamet, Viread, and Zerit. |
Viread (tenofovir)
|
Do not take Truvada or Atripla, since Viread is in these medications. Kaletra, Norvir, Reyataz, Videx and Videx-EC. |
Zerit (stavudine, d4T)
|
Cytovene, dapsone, Foscavir, Fungizone, pentamidine, Valcyte, Videx and Videx-EC, Vitrasert, and zidovudine (AZT, Retrovir). |
| Ziagen (abacavir sulfate, ABC) |
Do not take with Epzicom or Trizivir, since Ziagen is already in these medications. Alcohol. |
| Non-Nucleoside Reverse Transcriptase Inhibitors (also called non-nucleoside analogs, NNRTIs, or non-nukes) |
| Potential drug class interactions |
HIV protease inhibitors; methadone. |
Intelence (etravirine, TMC-125)
|
Aptivus/Norvir, Kaletra, Lexiva/Norvir, Norvir, Reyataz/Norvir, Selzentry, Sustiva, and unboosted PIs. |
Rescriptor (delavirdine)
|
Adalat, Agenerase, certain amphetamines and antiarrhythmic drugs, Biaxin, birth control pills, Cafergot, carbamazepine (Tegretol and others), Cialis, Coumadin, Crixivan, dapsone, Dilantin, fluticasone (Advair, Flonase, Flovent), immunosuppressants, Invirase, Kaletra, Levitra, Lexiva, methadone, Methergine, lovastatin, midazolam, Mycobutin, Norvasc, Norvir, Orap, phenobarbital, pimozide, Plendil, Procardia, Propulsid, quinidine, rifampin, Reyataz, simvastatin, St. John’s wort, triazolam, trazodone, Viagra, Viracept, Vytorin, Wigraine, and Xanax. |
Sustiva (efavirenz)
|
Do not take with Atripla, since Sustiva is already in Atripla. Biaxin, bepridil, birth control pills, Cafergot, carbamazepine (Tegretol and others), Coumadin, Crixivan, Dilantin, Invirase, Kaletra, Lexiva, Lipitor, methadone, Methergine, midazolam, Mycobutin, Norvir, pravastatin, Reyataz, rifabutin, rifampin, phenobarbital, simvastatin, Sporanox, St. John’s wort, triazolam, Vfend, and Wigraine. |
Viramune (nevirapine)
|
Biaxin, birth control pills, calcium channel blockers, Coumadin, Diflucon (flucanozole), HIV protease inhibitors, methadone, midazolam, Mycobutin (rifabutin), Nizoral (ketoconazole), prednisone, rifampin, St. John’s wort, and triazolam. See drug page for more. |
| Dual-class Fixed Dose Combination |
Atripla (Sustiva/Truvada)
|
See Sustiva and Truvada (Emtriva/Viread). Do not take Sustiva, Emtriva, Truvada, Viread, Epivir, Epzicom, Combivir, or Trizivir, while taking Atripla, since all or part of these medications are already in Atripla or have equivalent medications. |
| Protease inhibitors (PIs) |
Potential drug class interactions
|
Cardiac medications, cholesterol medication, migraine medications, erectile dysfunction drugs, sedatives, tuberculosis drugs. |
Aptivus (tipranavir)
(must be taken with Norvir;
see Norvir)
|
Aptivus/Norvir interacts with many other drugs, so it is important to tell your healthcare professonial all the medications you are taking. See the manufacturer package insert for the most complete list. Antabuse, birth control pills, Cafergot, carbamazepine (Tegretol and others), Cialis, Cordarone, Coumadin, Crestor, D.H.E. 45, Diflucan, Dilantin, Flagyl, fluticasone (Advair, Flonase, and Flovent), other HIV protease inhibitors, immunosuppressants, ketoconazole, Lescol, Levitra, Lipitor, lovastatin, methadone, Methergine, midazolam, Mycobutin, Norvasc, Orap, Paxil, phenobarbital, pravastatin, Procardia, quinidine, rifampin, Rythmol, simvastatin, St. John’s wort, Sporanox, Tambocor, trazodone, triazolam, Viagra, Vfend, Videx, Vytorin, Wigraine, Ziagen, zidovudine, and Zoloft. |
Crixivan (indinavir sulfate)
|
Birth control pills, Cafergot, Cialis, Crestor, D.H.E. 45, fluticasone (Advair, Flonase, Flovent), garlic supplements, Lescol, Levitra, Lipitor, lovastatin, methadone, Methergine, midazolam, Mycobutin, Nizoral, Orap, pravastatin, Rescriptor, Reyataz, rifampin, Rythmol, simvastatin, Sporanax, St. John’s wort, Sustiva, Tambocor, triazolam, Viagra, Viramune, Vytorin, and Wigraine. See drug page for more. |
Invirase (saquinavir)
(must be taken with Norvir;
see Norvir)
|
Aptivus, Biaxin, birth control pills, Cafergot, Cialis, Cordarone, Crestol, Crixivan, D.H.E. 45, fluticasone (Advair, Flonase, Flovent), garlic supplements, Kaletra, Lanoxin, Lescol, Levitra, Lipitor, lovastatin, methadone, Methergine, midazolam, Mycobutin, Nizoral, Norvir, Orap, pravastatin, quindine, rifampin, Rescriptor, Reyataz, Rythmol, simvastatin, St. John’s wort, Sporanox, Sustiva, Tambocor, trazodone, triazolam, Viracept, Viagra, Viramune, Vytorin, and Wigraine. |
| Kaletra (lopinavir/ritonavir) |
Antabuse, Biaxin, birth control pills, Cafergot, carbamazepine (Tegretol and others), certain calcium channel blockers, Cialis, Cordarone, Coumadin, D.H.E. 45, digoxin, Flagyl, fluticasone (Advair, Flonase, Flovent), garlic supplements, immunosuppressants, Lescol, Levitra, Lexiva, Lipitor, lovastatin, Mepron, methadone, Methergine, midazolam, Mycobutin, Orap, phenobarbital, phenytoin (Dilantin and others), pravastatin, Procardia, rifabutin, rifampin, Retrovir, Rythmol, simvastatin, St. John’s wort, Sporanox, steroids (especially Decadron), Sustiva, trazodone, triazolam, Uroxatral, Viagra, Videx, Viramune, Vytorin, Wigraine, and Ziagen. |
| Lexiva (fos-amprenavir calcium) |
Antabuse, birth control pills, Cafergot, certain calcium channel blockers, Cialis, Crestor, D.H.E. 45, Flagyl, fluticasone (Advair, Flonase, Flovent), Kaletra, Lipitor, Lescol, Levitra, lovastatin, Orap, pravastatin, Rescriptor, Rythmol, methadone, Methergine, midazolam, Mycobutin, rifampin, simvastatin, St. John’s wort, steroids, Sustiva, Tambocor, trazodone, triazolam, Viagra, warfarin, and Wigraine. |
Norvir (ritonavir)
|
See the manufacturer package insert for the most complete list. Alcohol, Antabuse, Biaxin, birth control pills, Cafergot, Cialis, Cordarone, D.H.E. 45, Ecstasy, Flagyl, fluticasone (Advair, Flonase, Flovent), garlic supplements, GHB, Lescol, Levitra, Lipitor, lovastatin, Methergine, midazolam, Orap, pravastatin, rifampin, Rythmol, simvastatin, St. John’s wort, Tambocor, tobacco, trazodone, triazolam, Uroxatral, Viagra, and Wigraine. |
Prezista (darunavir)
|
Biaxin, birth control pills, Cafergot, calcium channel blockers (Norvasc, Procardia, and others), Cialis, Coumadin, Crestor, D.H.E. 45, Decadron, fluticasone (Advair, Flonase, and Flovent), immunosuppressants, Invirase, itraconazole, Kaletra, ketoconazole, Lanoxin, Levitra, Lidoderm, Lipitor, lovastatin, methadone, Methergine, methadone, midazolam, Norvasc, Paxil, pravastatin, Procardia, rifabutin, simvastatin, St. John’s wort, Sporanox, trazodone, triazolam, Vascor, Vfend, Viagra, Vytorin, Wigraine, and Zoloft. |
| Reyataz (atazanavir sulfate) |
Aciphex (or any proton-pump inhibitor), birth control pills, Cialis, Cafergot, D.H.E. 45, fluticasone (Advair, Flonase, Flovent), garlic supplements, Lescol, Levitra, Lipitor, lovastatin, Methergine, midazolam, Mylanta, Nexium, Orap, pravastatin, Prevacid, Prilosec-OTC, rifabutin, rifampin, Rythmol, simvastatin, St. John’s wort, Sustiva, Tambocor, triazolam, trazodone, Viagra, Videx and Videx-EC, Viread, and Wigraine. See drug page for more. |
| Viracept (nelfinavir) |
Birth control pills, Cafergot, carbamazepine (Tegretol and others), Cialis, Cordarone, Crixivan, D.H.E. 45, fluticasone (Advair, Flonase, Flovent), garlic supplements, Invirase, Lescol, Levitra, Lipitor, lovastatin, methadone, Methergine, midazolam, Mycobutin, phenobarbital, phenytoin, pravastatin, Prilosec-OTC, rifampin, simvastatin, St. John’s wort, triazolam, trazodone, Viagra, and Wigraine. |
Fuzeon (enfuvirtide, T-20)
|
None found to be clinically significant. |
Selzentry (maraviroc)
|
Invirase, Kaletra, ketoconazole, Norvir, Reyataz, rifampin, and Sustiva. |
Isentress (raltegravir, formerly MK-0518)
|
Aptivus/Norvir, Epivir, medications that can cause muscle problems, Reyataz, Reyataz/Norvir, rifampin, and Viread. |
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