ir-associated adverse reactions. ATRIPLA should be discontinued in patients who develop tenofovir-associated adverse reactions.
Protease inhibitor:
ritonavir ↑ ritonavir concentration
↑ efavirenz concentration When ritonavir 500 mg every 12 hours was coadministered with efavirenz 600 mg once daily, the combination was associated with a higher frequency of adverse clinical experiences (e.g., dizziness, nausea, paresthesia) and laboratory abnormalities (elevated liver enzymes). Monitoring of liver enzymes is recommended when ATRIPLA is used in combination with ritonavir.
Protease inhibitor:
saquinavir ↓ saquinavir concentration Should not be used as sole protease inhibitor in combination with ATRIPLA.
CCR5 co-receptor antagonist:
maraviroc ↓ maraviroc concentration Efavirenz decreases plasma concentrations of maraviroc. Refer to the full prescribing information for maraviroc for guidance on coadministration with ATRIPLA.
NRTI:
didanosine ↑ didanosine concentration Higher didanosine concentrations could potentiate didanosine-associated adverse reactions, including pancreatitis and neuropathy. In patients weighing >60 kg, the didanosine dose should be reduced to 250 mg if coadministered with ATRIPLA. Data are not available to recommend a dose adjustment of didanosine for patients weighing <60 kg. Coadministration of ATRIPLA and didanosine should be undertaken with caution and patients receiving this combination should be monitored closely for didanosine-associated adverse reactions. For additional information, please consult the Videx / Videx EC (didanosine) prescribing information.
Other agents
Anticoagulant:
warfarin ↑ or ↓ warfarin concentration Plasma concentrations and effects potentially increased or decreased by efavirenz.
Anticonvulsants:
carbamazepine ↓ carbamazepine concentration
↓ efavirenz concentration There are insufficient data to make a dose recommendation for ATRIPLA. Alternative anticonvulsant treatment should be used.
phenytoin
phenobarbital ↓ anticonvulsant concentration
↓ efavirenz concentration Potential for reduction in anticonvulsant and/or efavirenz plasma levels; periodic monitoring of anticonvulsant plasma levels should be conducted.
Antidepressants:
bupropion ↓ buproprion concentration The effect of efavirenz on bupropion exposure is thought to be due to the induction of bupropion metabolism. Increases in bupropion dosage should be guided by clinical response, but the maximum recommended dose of bupropion should not be exceeded.
sertraline ↓ sertraline concentration Increases in sertraline dose should be guided by clinical response.
Antifungals:
itraconazole ↓ itraconazole concentration
↓ hydroxy-itraconazole concentration Since no dose recommendation for itraconazole can be made, alternative antifungal treatment should be considered.
ketoconazole ↓ ketoconazole concentration Drug interaction trials with ATRIPLA and ketoconazole have not been conducted. Efavirenz has the potential to decrease plasma concentrations of ketoconazole.
posaconazole ↓ posaconazole concentration Avoid concomitant use unless the benefit outweighs the risks.
Anti-infective:
cl |
