Drug-drug interactions in patients with HIV infection

Alison Duncan1 and Dianne Carey2 Pharmacy Department, The Alfred Hospital, Melbourne, VIC 3004 The Kirby Institute, UNSW Sydney, NSW 2052 Last reviewed: November 2019 Overview Drug-drug interactions between antiretroviral (ARV) drugs and co-prescribed medication are common and may lead to an increase or decrease in exposure to either drug. These alterations in exposure may result …

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Drug-drug interactions can be either pharmacokinetic or pharmacodynamic in nature. Pharmacokinetic interactions are the primary concern with ARV drugs. Pharmacokinetic interactions occur when one drug alters the absorption, distribution, metabolism or excretion of another drug, possibly increasing or decreasing its plasma concentration. For ARV drugs the interaction types of concern are absorption, metabolism and excretion. …

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In general, watch out for the potent enzyme inducers such as rifampicin, rifabutin, phenytoin and carbamazepine Specific interactions by ARV drug class to be aware of and their management, where appropriate, include: INSTIs Dolutegravir with metformin: adjust metformin dose. All INSTIs with cationic chelation (e.g. iron, magnesium, calcium, zinc), including antacids containing these cations: separate …

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