However, when it comes to antiretroviral drugs (ARVs) used to treat HIV, there are prescription medications that can directly interfere with the activity and/or potency of the drug. They do so by either altering the drug’s pharmacodynamics (how the drug works) or the drug’s pharmacokinetics (how the drug moves through the body).
These can be serious concerns. Altering pharmacodynamics can increase or decrease the concentration of a drug, amplifying its toxic effects to intolerable and even dangerous levels.
Alternately, interfering with pharmacokinetics can affect how efficiently a drug is absorbed or metabolized by the body.
In either instance, interactions like these can undermine the effectiveness of antiretroviral therapy and lead to a multitude of concerns, including:
A rebound in the viral load The development of drug-resistant mutations Treatment failure
Although many prescription drugs are known to interact with ARVs, there are six classes that pose particular concerns, some of which are contraindicated for use with one or more ARVs.
Statin Drugs
Statin drugs are used to reduce cholesterol levels and work by blocking a liver enzyme responsible for producing cholesterol.
While most statins are not contraindicated for use with ARVs (or require a simple dose adjustment), there are two that are contraindicated for use with all protease inhibitors (PIs) and certain booster drugs. Taking them together may lead to severe muscle pain or weakness (myopathy) or the serious breakdown of muscle tissue (rhabdomyolysis).
Contraindicated drugs: Altoprev/Mevacor (lovastatin), Zocor (simvastatin) Cannot be used with the following ARVs: Aptivus (tipranavir), Invirase (saquinavir), Lexiva (fosamprenavir), Norvir (ritonavir), Prezista (darunavir), Reyataz (atazanavir), Tybost (cobicistat), and the combination drugs Evotaz, Genvoya, Kaletra, Prezcobix, Stribild, and Symtuza
Arrhythmia Medications
Some of the drugs used to treat an irregular heartbeat (arrhythmia) are contraindicated for use with PIs and certain booster drugs as they can increase the likelihood of liver inflammation or damage.
Contraindicated drugs: Multaq (dronedarone), Renexa (ranolazine) Cannot be used with the following ARVs: Aptivus, Invirase, Lexiva, Norvir, Prezista, Reyataz, Tybost, and the combination drugs Evotaz, Genvoya (Renexa only), Kaletra, Prezcobix, Prezista (Multaq only), Stribild (Renexa only), and Symtuza
Other cardiac medications have the same potential for liver injury and, while not contraindicated, should be avoided with PIs. They include the arrhythmia drugs Cordarone/Nexterone/Pacerone (amiodarone), Quinaglute (quinidine), Tambocor (flecainide), and Tikosyn (dofetilide), as well the tachycardia drug Lipopen (lidocaine).
Hepatitis C Drugs
The HIV and hepatitis C coinfection rate can run as high as 20% and 30% in parts of North America and Europe.
However, a number of these DAAs cannot be used with certain ARVs due to competing drug actions that can either increase or decrease drug pharmacokinetics.
Contraindicated drugs: Harvoni (ledipasvir + sofosbuvir), Mavyret (glecaprevir + pibrentasvir), Zepatier (elbasvir + grazoprevir) Cannot be used with the following ARVs: Aptivus (Harvoni only) and the combination drugs Atripla (Zepatier only), Evotaz (Mavyret only) Reyataz (Mavyret only) Prezcobix (Zepatier only), and Symtuza (Zepatier only)
Anti-Epilepsy Medications
Generally speaking, anticonvulsant drugs used to treat epilepsy are considered safe for use with your HIV drugs. A few, however, can affect some of the newer ARVs by competing for the same enzymes they use for metabolism. In doing so, the drug can decrease the concentration of the ARV in the bloodstream, lowering its efficacy.
Contraindicated drugs: Dilantin (phenytoin), Luminal (phenobarbital), Tegretol (carbamazepine) Cannot be used with the following ARVs: Edurant (rilpivirine), Pifeltro (doravirine), Rukubio (fostemsavir), Tybost, and the combination drugs Complera, Delstrigo, Evotaz, Genvoya, Juluca, Odefsey, Prezcobix, Stribild, and Symtuza
Tuberculosis Drugs
In certain parts of the developing world, tuberculosis (TB) co-infection is more common than not among people with HIV. Even in the United States and Europe, the rate of TB is far higher among people with HIV and a common feature in advanced HIV infection.
Two of the drugs commonly used to treat TB infection are also known to lower the drug concentration of certain ARVs when co-administered.
Contraindicated drugs: Priftin (rifapentine), Rifadin (rifampin)Cannot be used with the following ARVs: Aptivus (Rifadin only), Edurant, Invirase (Rifadin only), Lexiva (Rifadin only), Pifeltro, Prezista (Rifadin only), Reyataz (Rifadin only), Tybost (Rifadin only), and the combination drugs Biktarvy (Rifadin only), Complera, Delstrigo, Evotaz (Rifadin only), Genvoya (Rifadin only), Juluca, Kaletra (Rifadin only), Odefsey, Prezcobix (Rifadin only), Rekubia (Rifadin only), Stribild (Rifadin only), and Symtuza (Rifadin only)
Sedatives and Antipsychotics
A number of common sedatives—as well as two controlled drugs used to treat schizophrenia and Tourette’s syndrome—are also known to affect the concentration of certain ARV agents in the blood.
Contraindicated drugs: Halcion (triazolam), Latuda (lurasidone), Orap (pimozide), Versed (midazolam) Cannot be used with the following ARVs: Aptivus, Invirase, Lexiva, Prezista, Reyataz, and the combination drugs Evotaz, Genvoya, Kaletra, Prezcobix, Stribild, and Symtuza
