Antiretroviral Guidelines
US DHHS Guidelines with Australian commentary
Interactions between Non-Nucleoside Reverse Transcriptase Inhibitors and Protease Inhibitors
Last Updated: October 25, 2018; Last Reviewed: October 25, 2018
Note: Delavirdine (DLV), fosamprenavir (FPV), indinavir (IDV), nelfinavir (NFV), and saquinavir (SQV) are not included in this table. Please refer to the Food and Drug Administration product labels for DLV, FPV, IDV, NFV, and SQV for information regarding drug interactions.
PIs | NNRTIs | |||||
---|---|---|---|---|---|---|
DOR | EFV | ETR | NVP | RPVa | ||
ATV Unboosted |
PK Data | ↑ DOR expected ↔ ATV expected |
↔ EFV ATV AUC ↓ 74% |
ETR AUC ↑ 50% and Cmin ↑ 58% ATV AUC ↓ 17% and Cmin ↓ 47% |
↓ ATV possible | ↑ RPV possible |
Dose | Standard doses | Do not coadminister. | Do not coadminister. | Do not coadminister. | Standard doses | |
ATV/c | PK Data | ↑ DOR expected ↔ ATV expected |
↓ ATV possible ↓ COBI possible |
↓ ATV possible ↓ COBI possible |
↓ ATV possible ↓ COBI possible |
↑ RPV possible ↔ ATV expected |
Dose | Standard doses | EFV standard dose In ART-Naive Patients:
|
Do not coadminister. | Do not coadminister. | Standard doses | |
ATV/r | PK Data | ↑ DOR expected ↔ ATV expected |
(ATV 400 mg plus RTV 100 mg) Once Daily:
|
(ATV 300 mg plus RTV 100 mg) Once Daily:
|
(ATV 300 mg plus RTV 100 mg) Once Daily:
|
↑ RPV possible |
Dose | Standard doses | EFV standard dose In ART-Naive Patients:
|
ETR standard dose (ATV 300 mg plus RTV 100 mg) once daily |
Do not coadminister. | Standard doses | |
DRV/c | PK Data | ↑ DOR expected ↔ DRV expected |
↓ DRV possible ↓ COBI possible |
ETR 400 mg Once Daily with (DRV 800 mg plus COBI 150 mg) Once Daily:
|
↓ DRV possible ↓ COBI possible |
↔ DRV expected ↑ RPV possible |
Dose | Standard doses | Do not coadminister. | Do not coadminister. | Do not coadminister. | Standard doses | |
DRV/r | PK Data | ↑ DOR expected ↔ DRV expected |
With (DRV 300 mg plus RTV 100 mg) BID:
|
ETR 100 mg BID with (DRV 600 mg plus RTV 100 mg) BID:
|
With (DRV 400 mg plus RTV 100 mg) BID:
|
RPV 150 mg Once Daily with (DRV 800 mg plus RTV 100 mg) Once Daily:
|
Dose | Standard doses | Clinical significance unknown. Use standard doses and monitor patient closely. Consider monitoring drug levels. | Standard doses Despite reduced ETR concentration, safety and efficacy of this combination have been established in a clinical trial. |
Standard doses | Standard doses | |
LPV/r | PK Data | ↑ DOR expected ↔ LPV expected |
With LPV/r Tablets 500 mg/125 mgc BID:
|
With LPV/r Tablets:
|
With LPV/r Capsules:
|
RPV 150 mg Once Daily with LPV/r Capsules:
|
Dose | Standard doses | LPV/r tablets 500 mg/125 mgc BID; LPV/r oral solution 533 mg/133 mg BID EFV standard dose |
Standard doses | LPV/r tablets 500 mg/125 mgc BID; LPV/r oral solution 533 mg/133 mg BID NVP standard dose |
Standard doses | |
TPV/r Always use TPV with RTV |
PK Data | ↑ DOR expected ↔ TPV expected |
With (TPV 500 mg plus RTV 100 mg) BID:
|
With (TPV 500 mg plus RTV 200 mg) BID:
|
With (TPV 250 mg plus RTV 200 mg) BID or with (TPV 750 mg plus RTV 100 mg) BID:
|
↑ RPV possible |
Dose | Standard doses | Standard doses | Do not coadminister. | Standard doses | Standard doses | |
a Approved dose for RPV is 25 mg once daily. Most PK studies were performed using RPV 75 mg to 150 mg per dose. b DRV concentration was compared to a historic control. c Use a combination of two LPV/r 200 mg/50 mg tablets plus one LPV/r 100 mg/25 mg tablet to make a total dose of LPV/r 500 mg/125 mg. Key to Symbols: ↑ = increase ↓ = decrease ↔ = no change Key to Acronyms: ART = antiretroviral therapy; ATV = atazanavir; ATV/c = atazanavir/cobicistat; ATV/r = atazanavir/ritonavir; AUC = area under the curve; BID = twice daily; Cmin = minimum plasma concentration; COBI = cobicistat; DOR = doravirine; DRV = darunavir; DRV/c = darunavir/cobicistat; DRV/r = darunavir/ritonavir; EFV = efavirenz; ETR = etravirine; LPV = lopinavir; LPV/r = lopinavir/ritonavir; NNRTI = non-nucleoside reverse transcriptase inhibitor; NVP = nevirapine; PI = protease inhibitor; PK = pharmacokinetic; RPV = rilpivirine; RTV = ritonavir; TPV = tipranavir |