Anti-HIV drugs (anti-HIV) reduce morbidity and mortality from HIV infection and reduce transmission of the virus. The number of people taking anti-HIV drugs is increasing, and patients may have other diseases that require other drugs to be used at the same time, so will the drugs "fight" with each other in the body?
The following is a recommended drug interaction applet for you to use
Anti-HIV drugs available in the country.
Nucleoside reverse transcriptase inhibitors (NRTIs) include:
tenofovir disoproxil (TDF), lamivudine (3TC), zidovudine (AZT), and abacavir (ABC);
Non-nucleoside reverse transcriptase inhibitors (NRTIs) include:
Efavirenz (EFV), nevirapine (NVP), and rilpivirine (RPV), protease inhibitors (PI) include:
Lopinavir ritonavir (LPV R), darunavir cobicistat (DRV C).
Integrase inhibitors (INSTIs) include:
dolutegravir (DTG) and raltegravir (RAL), averelvir cobicistat (EVG C), bictegravir (BIC).
Anti-HIV drugs and gastrointestinal drugs
Antacids (e.g., aluminum hydroxide or magnesium, calcium carbonate, etc.) can reduce the area under the plasma concentration-time curve (AUC) of RPV in integrase inhibitors DTG, RAL, EVG C, BIC, and non-nucleoside reverse transcriptase inhibitors, and it is recommended to adjust the dosing time. For multivalent ionic drugs containing magnesium, aluminum, and calcium, integrase inhibitors should be given at least 2 hours before or 6 hours after these drugs are given.
H2 receptor antagonists (eg, cimetidine, ranitidine, and famotidine) and proton pump inhibitors (eg, omeprazole and rabeprazole) can also decrease the AUC of RPV. RPV cannot be used concomitantly with proton pump inhibitors.
Anti-HIV drugs and traditional Chinese medicine
St. John's wort (St. John's wort) has no significant interaction with ABC, 3TC, TDF, and AZT, and may reduce the levels of all protease inhibitors, non-nucleoside reverse transcriptase inhibitors, and integrase inhibitor drugs, and should be avoided concomitantly. There are relatively few research data on traditional Chinese medicine, so consult medical professionals when using it.
Anti-moxa drugs and methadone
1.NRTI: No dose adjustment is required when TDF, 3TC, and ABC are used concomitantly with methadone. When AZT and methadone are used together, the AUC of AZT increases, and it is necessary to pay attention to the toxicity such as the myelosuppressive effect of AZT.
2.NNRTI: NVP and EFV can decrease methadone AUC, and methadone doses are often increased. RPV can reduce methadone blood levels by 16%, but no dose adjustment is required.
3.PI: LPV R and reduced methadone AUC by 26% to 53%, but withdrawal symptoms are uncommon, pay attention to clinical monitoring, and increase the methadone dose if necessary. When DRV C and methadone are used at the same time, there is no need to adjust the dose, and attention should be paid to monitoring.
4.INSTI: The integrase inhibitors DTG, RAL, BIC, or EVG C do not require dose adjustment when used concomitantly with methadone.
Anti-HIV drugs and anti-tuberculosis drugs
1.NRTI: When TDF, 3TC, and ABC are used with the antituberculous drugs rifampicin (R), isoniazid (H), pyrazinamide (Z), and ethambutol (E), neither class of drugs requires dose adjustment. Rifampicin reduced the AUC of AZT by 43% and required monitoring or dose adjustment.
2.NNRTI: rifampicin can reduce EFV levels by 20% to 30%, both at standard doses; Rifampicin reduces the blood concentration levels of NVP and RPV by more than 58% and should not be used at the same time. EFV reduced rifabutin levels by 38%, and when used simultaneously, rifabutin was increased to 450 mg per day and the standard dose of EFV was 600 mg. When NVP and rifabutin are used at the same time, rifabutin AUC is mildly elevated and NVP levels decrease by 16%, but dose adjustment is usually not necessary. Rifabutin reduces the AUC of RPV by 42% and should not be used at the same time, if combined, the dose of RPV should be increased from 25 mg once daily to 50 mg once daily.
3.PI: Rifampicin can reduce the AUC of DRV C and LPV R, and it is not recommended to use it at the same time. If LPV R and rifampicin must be used together, a double dose is used for LPV R. When rifabutin is used with LPV R, the AUC of rifabutin increases and the dose needs to be reduced to 150 mg daily. When rifabutin and DRV C are used together, the blood level of rifabutin increases, the AUC of DRV C decreases, and the dose is adjusted closely or as appropriate.
4.INSTI: Combined with rifampicin, the level of DTG and RAL drugs decreased, and the dose of DTG was increased to 50mg 2 times a day; The RAL dose is increased to 800 mg twice a day. Rifampicin can cause a significant decrease in the AUC of BIC and EVG C, so it should not be used at the same time. There was no significant interaction between DTG and rifabutin. RAL can increase the AUC level of rifabutin, and the dose of rifabutin needs to be reduced to 150 mg per day; When rifabutin is used in combination with EVG C, the AUC of EVG C decreases and the level of rifabutin increases, so it is not recommended to use it together, and it should be monitored when it is used together, and the dosage of rifabutin should be reduced if necessary. Rifabutin reduced the AUC of BIC by 38%, and BIC was composed of a single tablet compound preparation with FTC and TAF, and rifabutin would affect TAF absorption and could not be used together.
Among rifamycin, rifampicin reduces the AUC of polyanti-moxa drugs, and rifabutin has a relatively small effect on anti-moxa. When anti-HIV drugs or anti-tuberculosis** are also required, rifabutin can be used instead of rifampicin to form an intensification** regimen or an antituberculous regimen without rifamycin.
Anti-HIV drugs and hepatitis C direct antivirals (DAAs).
AZT, 3TC and ABC in NRTI and DTG and RAL in INSTI have no or only minor interactions with all DAAs and do not require dose adjustment when used simultaneously; When TDF is combined with three combination drug regimens: sofosbuvir ledipavir, sofosbuvir vepatasvir or sofosbuvir vepatasvir or sofosbuvir vepatasvir and vorcirelvir, it may be necessary to strengthen the monitoring of renal function and other indicators, and change the dose or time of administration. The interaction between LPV R and daratasvir, sofosbuvir and sofosbuvir vipatasvir has no clinical significance and does not require adjustment of drug methods, and the interaction with other DAAs is obvious, so it is not suitable to be used at the same time (see the table below). Because anti-HIV drugs are combined with more than 3 kinds of drugs, there are individual differences in infected people, and they are seriously uncomfortable in the process of taking DAA, so they should seek medical attention in time and consult professionals for treatment opinions.
Interactions between drugs for various common diseases and self-financed antivirals
This article summarizes the interactions between drugs for various common diseases, including antibacterial, antifungal, antituberculosis, antiviral (except HIV) drugs, antipyretic analgesics, lipid-lowering drugs, hypoglycemic drugs, antihypertensive drugs, anticonvulsants, antiarrhythmics, antipsychotics, and antidepressants, and the self-financed ARV drugs mentioned above.
Red means that it is forbidden to use it.
Orange indicates the presence of a potential interaction that may require dose adjustment.
Yellow indicates that there may be some interaction and that additional monitoring or dose adjustment may be less necessary.
Green indicates that there is no interaction between the two and no additional testing or dose adjustment is required.
1.Antimicrobial drugs interact with ARV drugs.
Remarks: Amoxillin: Amoxicillin;azithromycin: azithromycin;ciprofloxacin: ciprofloxacin;clindamycin: clindamycin;imipenem cilastatin: imipenem cilastatin;meropenem: meropenem;metronidazole: metronidazole;Trimethoprim sulfamethoxazole: trimethoprim sulfamethoxazole;vancomycin: vancomycin.
2.Antifungal drugs interact with ARV drugs.
Remarks: Amphotericin B: Amphotericin B;caspofungin: caspofungin;fluconazole;flucytosine: flucytosine;itraconazole: itraconazole;ketoconazole: ketoconazole;voriconazole: voriconazole.
3.Anti-tuberculosis drugs interact with ARV drugs.
Remarks: ethambutol: ethambutol;isoniazid: isoniazid;pyrazinamide: pyrazinamide;rifabutin: rifabutin;rifampicin: rifampicin;rifapentine: rifapentine;Streptomycin: Streptomycin.
4.Antiviral drugs interact with ARV drugs.
Remarks: Aciclovir: Acyclovir;famciclovir: famciclovir;ganciclovir: ganciclovir;Glecaprevir pibrentasvir: gleprelvir perentasvir;ledipasvir sofosbuvir: Radipavir sofosbuvir;oseltamivir: oseltamivir; rib**irin: ribavirin; sofosbuvir: sofosbuvir; sofosbuvir velpatasvir: sofosbuvir vepatasvir; sofosbuvir velpatasvir voxilaprevir: sofosbuvir vepatasvir vorcirapuevir; Valaciclovir: Valacyclovir.
5.Antipyretic analgesics interact with ARV drugs.
Remarks: Aspirin: Aspirin; codeine: codeine; fentanyl; ibuprofen: ibuprofen; methadone: methadone; morphine: morphine; paracetamol: acetaminophen.
6.Lipid-lowering drugs interact with ARV drugs.
Remarks: atorvastatin; fluvastatin: fluvastatin; lovastatin; pit**astatin; pr**astatin: pravastatin; rosuvastatin: rosuvastatin; simvastatin: simvastatin.
7.Hypoglycemic drugs interact with ARV drugs.
Remarks: glibenclamide (glyburide): glibenclamide (excellent hypoglycemic depletion); gliclazide: gliclazide; metformin: metformin
8.Antihypertensive drugs interact with ARV drugs.
Remarks: amlodipine: amlodipine; diltiazem: diltiazem; felodipine: felodipine; nicardipine: nicardipine; nifedipine: nifedipine; nisoldipine: nisoldipine; nitrendipine: nitrendipine; Verapamil: Verapamil.
9.Anticonvulsants interact with ARV medications.
Remarks: diazepam: diazepam; gabapentin: gabapentin; phenobarbital: phenobarbital.
10.Antiarrhythmic drugs interact with ARV drugs.
Remarks: amiodarone: amiodarone; beprodil: benzylprodil; Disopyramide: disopyramide; dofetilide: Dofetilide; lidocaine: lidocaine; mexiletine: mexiletine; propafenone: propylamine phenylacetone; Quinidine: quinidine.
11.Antipsychotics interact with ARV medications.
Remarks: amisulpride: amisulpride; aripiprazole: aripiprazole; asenapine: asenapine; fluphenazine: flufenazine; perazine: piperazine; pimozide: pimozide; Sulpiride: Shupiline.
12.Antidepressants interact with ARV medications.
Remarks: Bupropion: bupropion; doxepin: doxepin; Sertraline: Sertraline.
With the increasing incidence of non-HIV-defining diseases, combination of drugs is inevitable, and the importance of drug interactions in the long-term management of HIV patients should be fully recognized, in addition to early initiation of ART** to avoid infection.
References:
1] Chinese Center for Disease Control and Prevention, Center for STD and AIDS Prevention and Control. National Free HIV Antiretroviral Drugs** Handbook. (4th Edition).Beijing People's Medical Publishing House, 2016
2]eacs guidelines version 10.0, november 2019
3]eacs guidelines version 9.0, october 2017
The following is a recommended drug interaction applet for you to use
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