14
Treatment
Table 3. Select Antiretroviral and Non–rifamycin-based
Anti-tuberculosis Drug Overlapping Toxicities and
Potential Adverse Drug-drug Interactions
Potential
overlapping
toxicities and
drug-drug
interactions Antiretroviral drugs
Non-Rifamycin TB
drugs
Arrhythmias,
QT-interval
prolongation
Lopinavir/ritonavir, efavirenz
Note PR interval prolongation
a
with
atazanavir, lopinavir/ritonavir
Fluoroquinolones,
b
bedaquiline, delamanid,
clofazimine
Hepatic
cytochrome P450
enzyme system
metabolism
Induce CYP P450 metabolism:
efavirenz, etravirine and nevirapine
Impede CYP P450 metabolism:
Protease inhibitors, cobicistat
Bedaquiline, delamanid
Nephrotoxicity
Tenofovir
c
, atazanavir
Isolated creatinine elevation:
d
cobicistat, dolutegravir
Aminoglycosides,
capreomycin
Mental health
changes
(depression,
psychosis,
dizziness, etc.)
Efavirenz, rilpivirine; dolutegravir,
elvitegravir, raltegravir
Cycloserine, isoniazid,
ethionamide,
fluoroquinolones
b
Peripheral
neuropathy
Stavudine, zidovudine Aminoglycosides,
capreomycin,
linezolid, isoniazid,
ethionamide, cycloserine,
fluoroquinolones
b
Hepatoxicity Lactic acidosis with hepatic
steatosis higher risk with stavudine,
zidovudine; protease inhibitors;
nevirapine (higher risk in patients
with elevated CD4 cell counts); less
common with efavirenz, etravirine
and rilpivirine; maraviroc
Indirect hyperbilirubinemia:
e
atazanavir
Isoniazid, pyrazinamide,
ethionamide,
p-aminosalicylic acid,
clofazimine
