skip navigation

Skip Nav

Clinical Guidelines Portal

Clinical Guidelines Portal

Table of Contents

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents

Drug Interactions

Drugs That Should Not Be Used With Antiretroviral Agents

(Last updated: July 14, 2016; last reviewed: July 14, 2016)

Table 18. Drugs That Should Not Be Used With Selected Antiretroviral Agents Due to Proven or Predicted Pharmacokinetic Interactions

This table only lists drugs that should not be coadministered at any dose, regardless of RTV or COBI boosting (unless stated otherwise). See Tables 19 and 20 for more detailed pharmacokinetic (PK) interaction data.

Table 18. Drugs That Should Not Be Used With Selected Antiretroviral Agents Due to Proven or Predicted Pharmacokinetic Interactions
ARV Agentsa,b Cardiac Agents Lipid-Lowering Agents Antimyco-bacterial Agents Antiepileptic Agents Neurologic Agents Herbs HCV Agentsc Other Agents
ATV 
+/−
RTV or COBI
Dronedarone 
Eplerenone
Ivabradine
Ranolazine
Lovastatin
Simvastatin
Rifampin
Rifapentine
ATV/c only: Carbamazepine
Phenobarbital
Phenytoin
Lurasidone
Midazolame

Pimozide

Triazolam
St. John’s wort Elbasvir/Grazoprevir
Simeprevir
Alfuzosin
Cisapridee
Ergot derivatives
Flibanserin
Irinotecan
Salmeterol
Sildenafil for PAH
DRV/c
or
DRV/r
Dronedarone
Eplerenone
Ivabradine
Ranolazine
 
Lovastatin
Simvastatin
Rifampin
Rifapentine
DRV/c only: Carbamazepine
Phenobarbital
Phenytoin
Lurasidone
Midazolame
Pimozide
Triazolam
St. John’s wort
Dasabuvir
Elbasvir/Grazoprevir
Ombitasvir
Paritaprevir
Simeprevir
Alfuzosin
Cisapridee
Ergot derivatives
Flibanserin
Salmeterol
Sildenafil for PAH
FPV
+/−
RTV
Dronedarone
Eplerenone
Flecainide
Ivabradine
Propafenone
Ranolazine
Lovastatin
Simvastatin
Rifampin
Rifapentine
None Lurasidone
Midazolame
Pimozide
Triazolam
St. John’s wort Dasabuvir
Ombitasvir
Paritaprevir
Simeprevir
Alfuzosin
Cisapridee
Ergot derivatives
Flibanserin
Salmeterol
Sildenafil for PAH
LPV/r Dronedarone
Eplerenone
Ivabradine
Ranolazine
Lovastatin
Simvastatin
Rifampinf
Rifapentine
None Lurasidone
Midazolame
Pimozide
Triazolam
St. John’s wort Dasabuvir
Elbasvir/Grazoprevir
Ombitasvir 
Paritaprevir 
Simeprevir
Alfuzosin
Cisapridee
Ergot derivatives
Flibanserin
Salmeterol
Sildenafil for PAH
SQV/r Amiodarone
Disopyramide
Dofetilide
Dronedarone
Eplerenone
Flecainide
Ivabradine
Lidocaine
Propafenone
Quinidine
Ranolazine
Lovastatin
Simvastatin
Clarithromycin
Dapsone
Erythromycin
Pentamidine (parenteral)
Rifampinf
Rifapentine
Quinine
None Clozapine
Haloperidol
Lurasidone
Midazolame
Phenothiazinesg 
Pimozide
Trazodone
Triazolam
Ziprasidone
Garlic supplements 
St. John’s wort
Dasabuvir
Elbasvir/Grazoprevir
Ombitasvir
Paritaprevir 
Simeprevir
Alfuzosin
Cisapridee
Ergot derivatives
Flibanserin
Tacrolimus
Salmeterol
Sildenafil for PAH
TPV/r Amiodarone
Dronedarone
Eplerenone
Flecainide
Ivabradine
Propafenone
Quinidine
Ranolazine
Lovastatin
Simvastatin
Rifampin
Rifapentine
None Lurasidone
Midazolamd
Pimozide
Triazolam
St. John’s wort
Dasabuvir 
Elbasvir/Grazoprevir
Ledipasvir
Ombitasvir
Paritaprevir
Simeprevir
Sofosbuvir
Alfuzosin
Cisapridee
Ergot derivatives
Flibanserin
Salmeterol
Sildenafil for PAH
EFV None None None None None St. John’s wort Dasabuvir
Elbasvir/Grazoprevir
Ombitasvir
Paritaprevir
Simeprevir
None
ETR None None Rifampin
Rifapentine
Carbamazepine
Phenobarbital
Phenytoin
None St John’s wort Dasabuvir
Elbasvir/Grazoprevir
Ombitasvir
Paritaprevir
Simeprevir 
Clopidogrel
NVP None None Rifapentine None None St. John’s wort Dasabuvir
Elbasvir/Grazoprevir
Ombitasvir
Paritaprevir
Simeprevir
Ketoconazole
RPV None None Rifampin
Rifapentine
Carbamazepine
Oxcarbazepine
Phenobarbital
Phenytoin
None St. John’s wort Dasabuvir
Ombitasvir
Paritaprevir
Proton pump inhibitors
MVC None None Rifapentine None None St. John’s wort Dasabuvir
Ombitasvir
Paritaprevir
None
DTG Dofetilide
None Rifapentine None None St. John’s wort None None
EVG/c

For EVG + PI/r, refer to agents listed for the selected PI
Eplerenone
Ivabradine
Ranolazine
Lovastatin
Simvastatin
Rifampin
Rifapentine
Carbamazepine
Phenobarbital
Phenytoin
Lurasidone
Pimozide
Midazolamd
Triazolam
St. John’s wort Dasabuvir 
Elbasvir/Grazoprevir
Ledipasvir
Ombitasvir
Paritaprevir 
Simeprevir
Alfuzosin
Cisapridee
Ergot derivatives
Flibanserin
Salmeterol
Sildenafil for PAH
RAL None None None None None None None None
TAF None None Rifabutin
Rifampin
Rifapentine
None None St. John’s wort None None
a. DLV, IDV, NFV, RTV (as sole PI), T-20, and NRTIs other than TAF are not included in this table. Refer to the appropriate FDA package insert for information regarding DLV-, IDV-, NFV-, and RTV (as sole PI)-related drug interactions.
b. Certain listed drugs are contraindicated on the basis of theoretical considerations. Thus, drugs with narrow therapeutic indices and suspected metabolic involvement with CYP 3A, 2D6, or unknown pathways are included in this table. Actual interactions may or may not occur in patients.
c. HCV agents listed include only those that are commercially available at the publication of these guidelines.
d. Use of oral midazolam is contraindicated. Single-dose parenteral midazolam can be used with caution and can be given in a monitored situation for procedural sedation.
e. The manufacturer of cisapride has a limited-access protocol for patients who meet specific clinical eligibility criteria.
f. In healthy volunteer studies, a high rate of Grade 4 serum transaminase elevation was seen when a higher dose of RTV was added to LPV/r or SQV or when double-dose LPV/r was used with rifampin to compensate for rifampin’s induction effect; therefore, these dosing strategies should not be used when alternatives exist.
g. Phenothiazines include chlorpromazine, fluphenazine, mesoridazine, perphenazine, prochlorperazine, promethazine, and thioridazine.
Suggested alternatives to:
  • Lovastatin, simvastatin: Fluvastatin, pitavastatin, and pravastatin (except for pravastatin with DRV/r) have the least potential for drug-drug interactions (see Table 19a). Use atorvastatin and rosuvastatin with caution; start with the lowest possible dose and titrate based on tolerance and lipid-lowering efficacy.
  • Rifampin: Rifabutin (with dosage adjustment, see Tables 19a and 19b)
  • Midazolam, triazolam: Temazepam, lorazepam, oxazepam
  • Sildenafil for PAH: Selexipag
Key to Acronyms: ARV = antiretroviral; ATV = atazanavir; COBI = cobicistat; CYP = cytochrome P; DLV = delavirdine; DRV/c = darunavir/cobicistat; DRV/r = darunavir/ritonavir; DTG = dolutegravir; EFV = efavirenz; ETR = etravirine; EVG = elvitegravir; EVG/c = elvitegravir/cobicistat; FDA = Food and Drug Administration; FPV = fosamprenavir; FTC = emtricitabine; HCV = hepatitis C virus; IDV = indinavir; LPV/r = lopinavir/ritonavir; MVC = maraviroc; NFV = nelfinavir; NRTI = nucleos(t)ide reverse transcriptase inhibitor; NVP = nevirapine; PAH = pulmonary arterial hypertension; PI = protease inhibitor; PI/r = ritonavir-boosted protease inhibitor; PK = pharmacokinetic; RPV = rilpivirine; RTV = ritonavir; SQV = saquinavir; SQV/r = saquinavir/ritonavir; TB = tuberculosis; T-20 = enfuvirtide; TAF = tenofovir alafenamide; TPV/r = tipranavir/ritonavir

Back to Top