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Are You a Good Interaction, or a Bad Interaction?
A Guide to HIV Drug Interactions

Updated by Renata Smith, Pharm.D., and Enid Vázquez

March/April 2012

Click on the name of each drug for further details, or refer to the manufacturer's package insert for a comprehensive list of potential drug interactions. NOTE: If "Do not take with" appears before a list of drugs, it's because they contain the drug you're looking up or equivalent drug(s). This is different from an "interaction." Some drugs may only need a dose adjustment, while others may either decrease effectiveness, or worse, lead to a potentially fatal reaction. Be sure you tell your providers about all the drugs, herbs, or supplements you're taking or planning to take, prescribed or not.

Discuss any symptoms, however minor, with your health care providers, including your pharmacist, since small reactions may become serious. A database is available at www.hiv-druginteractions.org that allows you to look up interactions and has downloadable PDFs of charts listing interactions between antiretrovirals and other drugs.


Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
Potential drug class interactions None
Combivir (lamivudine/zidovudine)

See Epivir and Retrovir. Do not take with Atripla, Complera, Emtriva, Epivir, Epivir-HBV, Epzicom, Retrovir, Trizivir, or Truvada. Interacts with Zerit.

Emtriva (emtricitabine, or FTC) Do not take with Atripla, Combivir, Complera, Epivir, Epivir-HBV, Epzicom, Trizivir, or Truvada. No other significant drug interactions.
Epivir (lamivudine, or 3TC)

Do not take with Atripla, Combivir, Complera, Emtriva, Epivir-HBV, Epzicom, Trizivir, or Truvada. No other significant drug interactions.

Epzicom (abacavir/lamivudine)

See Epivir and Ziagen. Do not take with Atripla, Combivir, Complera, Emtriva, Epivir, Epivir-HBV, Trizivir, Truvada, or Ziagen.

Retrovir (zidovudine, AZT, or ZDV)

Do not take with Combivir or Trizivir. Amphotericin B, Aptivus, Benemid, Biaxin, dapsone, Depakote, doxorubicin, flucytosine, ganciclovir, hydroxyurea, interferon-alpha, Kaletra, methadone, pentamidine, phenytoin (Dilantin and others), ribavirin, rifampin, sulfadiazine, Valcyte, and Zerit.

Trizivir (abacavir/lamivudine/zidovudine)

See Epivir, Retrovir, and Ziagen. Do not take with Atripla, Complera, Emtriva, Epivir,
Epivir-HBV, Epzicom, Retrovir, Truvada, or Ziagen. Interacts with Zerit.

Truvada (emtricitabine/ tenofovir)

See Emtriva and Viread. Do not take with Atripla, Combivir, Complera, Emtriva, Epivir, Epivir-HBV, Epzicom, Trizivir, or Viread.

Videx EC and Videx (didanosine, or ddI)

Alcohol, allopurinol, Aptivus, Atripla, cimetidine, Complera, dapsone, ganciclovir, HIV protease inhibitors, hydroxyurea, itraconazole, ketoconazole, Kaletra, methadone, pentamidine, Rescriptor, Retrovir, Reyataz, ribavirin, valganciclovir, Viread, and Zerit.

Viread (tenofovir DF, or TDF)

Do not take with Atripla, Complera, or Truvada. Interacts with Hepsera, Incivek, Kaletra, Norvir, Reyataz, and Videx or Videx-EC.

Zerit (stavudine, or d4T)

Amphotericin B, Combivir, dapsone, foscarnet, ganciclovir, pentamidine, Retrovir, Trizivir, Valcyte, and Videx or Videx EC.

Ziagen (abacavir, or ABC)

Do not take with Epzicom or Trizivir. Interacts with alcohol, Aptivus, and Kaletra.

Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
Potential drug class interactions

Anti-convulsants, HIV protease inhibitors, methadone.

Edurant (rilpivirine, or RPV)

Do not take with Complera, Intelence, Rescriptor, Sustiva, or Viramune. Antacids, Biaxin, dexamethasone, erythromycin, fluconazole, H2RAs (such as Pepcid, Tagamet, and Zantac), Hepsera, itraconazole, ketoconazole, medications with a known risk of Torsade de Pointes or QT prolongation, methadone, Noxafil, oxcarbazepine, phenobarbital, phenytoin (Dilantin and others), proton pump inhibitors (Nexium, Prevacid, and Prilosec OTC), rifabutin, rifampin, rifapentine, St. John's wort, Tegretol, troleandomycin (Tao), and Vfend.

Intelence (etravirine, or ETR)

Do not take with other NNRTIs. The only PIs it can be taken with are Kaletra, Invirase/Norvir, and Prezista/Norvir. Biaxin, Cialis, Coumadin, diazepam, dolutegravir, fluconazole, Levitra, Mycobutin, phenobarbital, phenytoin (Dilantin and others), Plavix, rifampin, Selzentry, St. John's wort, Tegretol, Viagra, and voriconazole.

Rescriptor (delavirdine, or DLV)

Do not take with other NNRTIs. Amlodipine, certain amphetamines and antiarrhythmic drugs, Biaxin, birth control pills, Cialis, cisapride, Coumadin, dapsone, felodipine, fluticasone (Advair, Flonase, Flovent), immunosuppressants, Levitra, lovastatin, methadone, midazolam, Mycobutin, nifedipine, Norvir, phenobarbital, phenytoin (Dilantin and others), pimozide, Propulsid, quinidine, rifampin, simvastatin, St. John's wort, Tegretol, trazodone, triazolam, Viagra, Viracept, Vytorin, and Xanax.

Sustiva (efavirenz, or EFV)

Do not take with Atripla or other NNRTIs. Biaxin, birth control pills, buprenorphine, bupropion, Coumadin, Crixivan, diltiazem, dolutegravir, Gingko biloba, immunosuppressants, Invirase, itraconazole, Kaletra, Lexiva, Lipitor, Malarone, methadone, midazolam, Mycobutin, Norvir, Noxafil, phenobarbital, phenytoin (Dilantin, etc.), pimozide, pravastatin, Reyataz, rifampin, sertraline, simvastatin, St. John's wort, Tegretol, triazolam, Victrelis, Vfend, and Zoloft.

Viramune XR and Viramune (nevirapine, or NVP)

Do not take with other NNRTIs. Biaxin, birth control pills, calcium channel blockers (Adalat, Norvasc, Procardia, etc.), cisapride, clonazepam, Cordarone, Coumadin, Crixivan, disopyramide, ethosuxomide, flucanozole, immunosuppressants, Invirase, Kaletra, ketoconazole, Lexiva, lidocaine, methadone, midazolam, Mycobutin, Norvir, phenobarbital, phenytoin (Dilantin, etc.), prednisone, Reyataz, rifampin, St. John's wort, Tegretol, and triazolam.

Protease Inhibitors (PIs)
Potential drug class interactions

Birth control pills, cardiac medications, cholesterol medications, dexamethasone, erectile dysfunction drugs, fluticasone, immunosuppressants, sedatives, St. John's wort, and tuberculosis drugs.

Aptivus (tipranavir, or TPV)
(must be taken with Norvir)

Advicor, alfuzosin, Altoprev, Antabuse, antacids, birth control pills, bosentan, buprenorphine, bupropion, calcium channel blockers (Adalat, Norvasc, Procardia, and others), Cialis, colchicine, Coumadin, Crestor, dolutegravir, Flagyl, fluconazole, fluticasone (Advair, Flonase, Flovent), Fuzeon, other HIV protease inhibitors, immunosuppressants, itraconazole, ketoconazole, Lescol, Levitra, Lipitor, Livalo, lovastatin, methadone, midazolam (oral), Mycobutin, Paxil, phenobarbital, phenytoin (Dilantin, etc.), pimozide, pravastatin, Prilosec, quinidine, Retrovir, Revatio, rifabutin, rifampin, Rythmol, salmeterol, simvastatin, St. John's wort, Suboxone, Tambocor, Tegretol, trazodone, triazolam, valproic acid, Viagra, Victrelis, Videx and Videx EC, vitamin E, Vytorin, Ziagen, and Zoloft.

Crixivan (indinavir sulfate, or IDV)

Advicor, alcohol, alfuzosin, Altoprev, Aptivus/Norvir, birth control pills, bosentan, calcium channel blockers (Adalat, Norvasc, Procardia, etc.), Cialis, coffee, colchicine, Cordarone, Coumadin, fluticasone (Advair, Flonase, Flovent), garlic supplements, grapefruit juice, itraconazole, immunosuppressants, Invirase, ketoconazole, Lescol, Levitra, Lipitor, lovastatin, methadone, midazolam, Mycobutin, phenobarbital, phenytoin (Dilantin and others), pimozide, pravastatin, Rescriptor, Revatio, Reyataz, rifampin, Rythmol, salmeterol, simvastatin, St. John's wort, Sustiva, Tambocor, Tegretol, trazodone, triazolam, Viagra, Victrelis, Viramune, vitamin C, and Vytorin.

Invirase (saquinavir, or SQV)
(must be taken with Norvir)

Advicor, alfuzosin, Altoprev, Aptivus/Norvir, Biaxin, birth control pills, bosentan, Cialis, colchicine, Cordarone, Coumadin, Crestor, Crixivan, dapsone, dexamethasone, digoxin, fluticasone (Advair, Flonase, Flovent), garlic supplements, immunosuppressants, Kaletra, Lanoxin, Lescol, Levitra, Lipitor, lovastatin, methadone, midazolam (oral), Mycobutin, Nizoral, pimozide, pravastatin, proton pump inhibitors (such as Nexium, Prevacid, Prilosec OTC), quinidine, Rescriptor, Revatio, Reyataz, rifampin, Rythmol, salmeterol, simvastatin, St. John's wort, Sporanox, Sustiva, Tambocor, trazodone, triazolam, Viagra, Victrelis, Viracept, Viramune, and Vytorin.

Kaletra (lopinavir/ritonavir, or LPV/r)

Advicor, alfuzosin, Altoprev, anti-convulsants, Aptivus/Norvir, Biaxin, birth control pills, bosentan, bupropion, certain calcium channel blockers, Cialis, colchicine, Cordarone, Coumadin, digoxin, elvitegravir, Flagyl, fluticasone (Advair, Flonase, Flovent), garlic supplements, immunosuppressants, Incivek, itraconazole, Lescol, Levitra, Lexiva, Lipitor, Livalo, lovastatin, Mepron, methadone, midazolam (oral), Mycobutin, nifedipine, phenobarbital, phenytoin (Dilantin and others), pimozide, pravastatin, Retrovir, Revatio, rifabutin, rifampin, Rythmol, salmeterol, simvastatin, St. John's wort, steroids (especially Decadron), Sustiva, Tegretol, trazodone, triazolam, Viagra, Victrelis, Videx and Videx EC, Viramune, Vytorin, and Ziagen.

Lexiva (fosamprenavir calcium, or FPV)

Advicor, alfuzosin, Altoprev, Antabuse, Aptivus/Norvir, birth control pills, bosentan, calcium channel blockers, Cialis, colchicine, Coumadin (warfarin), Crestor, Flagyl, fluticasone (Advair, Flonase, Flovent), immunosuppressants, Incivek, Kaletra, Lescol, Levitra, Lipitor, Livalo, lovastatin, Paxil, pimozide, pravastatin, Rescriptor, Revatio, Rythmol, methadone, midazolam (oral), Mycobutin, rifampin, salmeterol, simvastatin, St. John's wort, steroids (especially Decadron), Sustiva, Tambocor, trazodone, triazolam, Viagra, Victrelis, and Vytorin.

Norvir (ritonavir, or RTV)

Advicor, alcohol, alfuzosin, Altoprev, Antabuse, Biaxin, birth control pills, bosentan, Cialis, colchicine, Cordarone, Ecstasy, Flagyl, fluticasone (Advair, Flonase, Flovent), garlic supplements, GHB, immunosuppressants, Lescol, Levitra, Lipitor, lovastatin, midazolam (oral), methadone, phenobarbital, phenytoin (Dilantin and others), pimozide, pravastatin, Revatio, rifampin, Rythmol, salmeterol, simvastatin, St. John's wort, Tambocor, Tegretol, tobacco, trazodone, triazolam, Viagra, Victrelis, and Vytorin.

Prezista (darunavir, or DRV)
(must be taken with Norvir)

Advicor, alfuzosin, Altoprev, Aptivus/Norvir, Biaxin, birth control pills, bosentan, calcium channel blockers (Norvasc, Procardia, etc.), Cialis, cisapride, cobicistat, colchicine, Coumadin, Crestor, desipramine, fluticasone (Advair, Flonase, and Flovent), immunosuppressants, Incivek, Intelence, Invirase, itraconazole, ketoconazole, Levitra, Lipitor, Livalo, lovastatin, methadone, Mevacor, midazolam (oral), nifedipine, Paxil, phenobarbital, phenytoin (Dilantin and others), pimozide, pravastatin, Revatio, rifabutin, rifampin, salmeterol, Simcor, simvastatin, St. John's wort, Suboxone, Subutex, Tegretol, trazodone, triazolam, Vfend, Viagra, Victrelis, Vytorin, and Zoloft.

Reyataz (atazanavir sulfate, or ATV)

Advicor, alfuzosin, Altoprev, antacids (Rolaids, Tums, Mylanta, Pepcid, Zantac, etc.), Aptivus/Norvir, bepridil, birth control pills, bosentan, buprenorphine, calcium channel blockers (Adalat, Norvasc, Procardia, etc.), Camptosar, Cialis, cobicistat, colchicine, Coumadin, Cordarone, Crixivan, elvitegravir, fluticasone (Advair, Flonase, Flovent), garlic supplements, H2RAs (such as Pepcid, Tagamet, and Zantac), immunosuppressants, Invirase, Isentress, itraconazole, ketoconazole, Lescol, Levitra, lidocaine, Lipitor, Livalo, lovastatin, midazolam (oral), phenobarbital, phenytoin (Dilantin, etc.), pimozide, pravastatin, proton pump inhibitors (such as Nexium, Prevacid, Prilosec OTC), quinidine, Revatio, rifabutin, rifampin, salmeterol, simvastatin, St. John's wort, Sustiva, Tegretol, trazodone, triazolam, Vfend, Viagra, Victrelis, Videx and Videx-EC, Viread, and Vytorin.

Viracept (nelfinavir, or NFV)

Advicor, alfuzosin, Altoprev, Aptivus/Norvir, birth control pills, bosentan, Cialis, colchicine, Cordarone, Crixivan, fluticasone (Advair, Flonase, Flovent), garlic supplements, immunosuppressants, Invirase, Lescol, Levitra, Lipitor, Livalo, lovastatin, methadone, midazolam (oral), Mycobutin, phenobarbital, phenytoin (Dilantin and others), pravastatin, Prilosec OTC, Revatio, rifampin, salmeterol, simvastatin, St. John's wort, Tegretol, trazodone, triazolam, Viagra, and Vytorin.

Integrase Inhibitors (INSTIs)
Isentress (raltegravir, or RAL)

Aptivus/Norvir, Prilosec, Reyataz, Reyataz/Norvir, and rifampin.

dolutegravir (or DTG) (investigational drug)

Aptivus/Norvir, Intelence, and Sustiva. Available data is limited due to its investigational drug status at press time.

elvitegravir (or EVG) (investigational drug)

Cobicistat, Kaletra, and Reyataz. Available data is limited due to its investigational drug status at press time.

Entry Inhibitors
Fuzeon (enfuvirtide, T-20, ENF)

None found to be clinically significant.

Selzentry (maraviroc, or MVC)

Biaxin, Coumadin, Intelence, Invirase, itraconazole, Kaletra, ketoconazole, midazolam (oral), Mycobutin, non-nucleosides, Norvir, oral contraceptives, phenobarbital, phenytoin (Dilantin and others), Reyataz, rifampin, St. John's wort, Sustiva, Tegretol, Vfend, and Viramune.

Single-Tablet Regimens (STRs)
Atripla (efavirenz/emtricitabine/tenofovir)

See Sustiva and Truvada. Do not take with Combivir, Complera, Emtriva, Epivir, Epivir-HBV, Epzicom, Sustiva, Trizivir, Truvada, or Viread.

Complera (rilpivirine/emtricitabine/tenofovir)

See Edurant and Truvada. Do not take with Atripla, Combivir, Complera, Edurant, Emtriva, Epivir, Epivir-HBV, Epzicom, Sustiva, Trizivir, Truvada, or Viread.

The "Quad" (elvitegravir/cobicistat/emtricitabine/tenofovir) (investigational drug)

See elvitegravir, cobicistat, and Truvada. Do not take with Atripla, cobicistat, Combivir, Complera, elvitegravir, Emtriva, Epivir, Epivir-HBV, Epzicom, Trizivir, Truvada, or Viread. Available data is limited due to investigational drug status at press time.

PK Enhancer
Cobicistat (or COBI) (investigational drug)

Likely to increase levels of certain medications. Elvitegravir, Prezista, and Reyataz. Available data is limited due to investigational drug status at press time.


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