18
Treatment
Table 8. Clinically Significant Drug–Drug Interactions
Involving the Rifamycins
a
Drug Class
Drugs Whose
Concentrations
Are Substantially
Decreased by
Rifamycins Comments
Antiretroviral
agents
HIV-1 protease
inhibitors (lopinavir/
ritonavir, darunavir/
ritonavir, atazanavir,
atazanavir/ritonavir)
RFB preferred with protease
inhibitors. For ritonavir-boosted
regimens, give RFB 150 mg daily.
Double-dose lopinavir/ritonavir can be
used with RIF but toxicity increased.
Do not use RIF with other protease
inhibitors.
NNRTIs
Nevirapine
Efavirenz
Rilpivirine
Complera ( fixed-
dose combination
tablet containing
emtricitabine,
rilpivirine, TDF)
Etravirine
RIF decreases exposure to all NNRTIs.
If nevirapine is used with RIF, lead-in
nevirapine dose of 200 mg daily
should be omitted and 400 mg daily
nevirapine dosage given. With RIF,
many experts advise that efavirenz be
given at standard dosage of 600 mg
daily, although FDA recommends
increasing efavirenz to 800 mg daily
in persons >60 kg. In young children
double-dose lopinavir/ritonavir
given with RIF results in inadequate
concentrations – super-boosted
Lopinavir/ritonavir is advised (if
available) by some experts. Rilpivirine
and etravirine should not be given
with RIF. RFB can be used with
nevirapine and etravirine at usual
dosing. Efavirenz and RFB use requires
dose increase of RFB to 600 mg daily,
as such RIF is preferred. Rilpivirine
should not be given with RFB.
INSTIs
Raltegravir
Dolutegravir
Elvitegravir
(coformulated with
cobicistat, tenofovir and
emtricitabine as Stribild)
Genvoya (fixed-dose
combination tablet
containing elvitegravir,
cobicistat, emtricitabine,
and tenofovir
alafenamide)
Increase dose of raltegravir to 800 mg
twice daily with RIF, although clinical
trial data show similar efficacy using
400 mg twice daily. Dolutegravir dose
should be increased to 50 mg every
12 h with RIF. Do not use RIF with
elvitegravir. RFB can be used with all
INSTIs.
