DRUGS THAT INDUCE CYP3A ACTIVITY ARE EXPECTED TO INCREASE THE CLEARANCE OF ELVITEGRAVIR.
ACID REDUCING AGENTS:
ANTACIDS (FOR EXAMPLE ALUMINUM AND MAGNESIUM HYDROXIDE) REDUCES ELVITEGRAVIR CONCENTRATION. SEPARATE STRIBILD AND ANTACID ADMINISTRATION BY AT LEAST 2 HOURS.
ANTIARRHYTHMICS: E.G., AMIODARONE, BEPRIDIL, DIGOXIN, DISOPYRAMIDE, FLECAINIDE, SYSTEMIC LIDOCAINE, MEXILETINE, PROPAFENONE, QUINIDINE CONCENTRATION IS INCREASED WITH COADMINISTRATION.
ANTICONVULSANTS: OXCARBAZEPINE, CLONAZEPAM, ETHOSUXIMIDE, CARBAMAZEPINE,PHENOBARBITAL,
PHENYTOIN MAY REDUCE PLASMA CONCENTRATION OF ELVITEGRAVIR.
ANTIDEPRESSANTS: SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS) E.G., PAROXETINE TRICYCLIC ANTIDEPRESSANTS (TCAS) E.G., AMITRIPTYLINE, DESIPRAMINE, IMIPRAMINE, NORTRIPTYLINE, BUPROPION,
TRAZODONE CONCENTRATION IS INCREASED WITH COADMINISTRATION.
ANTIFUNGALS: ( ITRACONAZOLE, KETOCONAZOLE, VORICONAZOLE ) WHEN COADMINISTERED, THE MAXIMUM DAILY DOSE OF KETOCONAZOLE OR ITRACONAZOLE SHOULD NOT EXCEED 200 MG PER DAY. BOTH ELVITEGRAVIR & ANTIFUNGALS DRUGS PLASMA CONC. IS INCREASED.
COLCHICINE: IT IS NOT RECOMMENDED TO BE COADMINISTERED WITH COLCHICINE TO PATIENTS WITH RENAL OR HEPATIC IMPAIRMENT. DOSE OF ELVITEGRAVIR IS REDUCED BY HALF IN PATIENTS WITH NORMAL RENAL & HEPATIC FUNCTION.
COADMINISTRATION WITH RIFABUTIN, RIFAMPIN OR RIFAPENTINE IS NOT RECOMMENDED SINCE IT DECREASES PLASMA CONC.
BETA-BLOCKERS: (METOPROLOL,TIMOLOL) PLASMA CONC. IS INCREASED DURING COADMINISTRATION SO DOSE IS TO BE REDUCED WITH GOOD MONITORING.
CALCIUM CHANNEL BLOCKERS: (AMLODIPINE, DILTIAZEM, FELODIPINE, NICARDIPINE, NIFEDIPINE, VERAPAMIL) PLASMA CONC IS INCREASED DURING COADMINISTRATION.
CORTICOSTEROID: SYSTEMIC: (DEXAMETHASONE) IT REDUCES PLASMA CONC. OF ELVITEGRAVIR.
CORTICOSTEROID: INHALED/NASAL: (FLUTICASONE) SERUM CONC. OF INHALED STEROIDS IS INCREASED WHICH LOWERS SERUM CORTISOL LEVELS IN PATIENTS ON LONG TERM USE.
ENDOTHELIN RECEPTOR ANTAGONISTS: BOSENTAN CONC. IS INCREASED ON COADMINISTRATION.
HMG-COA REDUCTASE INHIBITORS: ATORVASTATIN, LOVASTATIN, SIMVASTATIN) START WITH LOWEST DOSE & TITRATE CAREFULLY BECAUSE OF INCREASED RISK OF SIDE EFFECTS.
HORMONAL CONTRACEPTIVES: (NORGESTIMATE/ETHINYL ESTRADIOL) NORGESTIMATE CONC IS INCREASED WHICH MAY HAVE INCREASED RISK FOR VENOUS THROMBOSIS, INSULIN RESISTANCE, DYSLIPIDEMIA, ACNE.
IMMUNO- SUPPRESSANTS: (CYCLOSPORINE, SIROLIMUS, TACROLIMUS) SERUM CONC OF THESE AGENTS IS INCREASED.
INHALED BETA AGONIST: (SALMETEROL) INCREASED RISK OF CARDIOVASCULAR ADVERSE EVENTS ASSOCIATED WITH SALMETEROL, INCLUDING QT PROLONGATION, PALPITATIONS, AND SINUS TACHYCARDIA SINCE ITS PLASMA CONC. IS INCREASED.
NEUROLEPTICS: (PERPHENAZINE RISPERIDONE THIORIDAZINE, PIMOZIDE) DOSE OF THESE AGENTS SHOULD BE DECREASED.
PHOSPHODIESTERASE-5 (PDE-5) INHIBITORS: (SILDENAFIL, TADALAFIL, VARDENAFIL) PLASMA CONC. OF THESE AGENTS IS INCREASED.
SEDATIVE/HYPNOTICS: BENZODIAZEPINES: (PARENTERALLY ADMINISTERED MIDAZOLAM, CLORAZEPATE, DIAZEPAM, ESTAZOLAM, FLURAZEPAM, BUSPIRONE, ZOLPIDEM) CLOSE MONITORING IS ADVISED SINCE INCREASED SEDATION MAY BE OBSERVED.
COADMINISTRATION WITH ST. JOHN'S WORT MAY RESULT IN REDUCED PLASMA CONCENTRATIONS OF ELVITEGRAVIR
CISAPRIDE : POTENTIAL FOR SERIOUS AND/OR LIFE-THREATENING EVENTS SUCH AS CARDIAC ARRHYTHMIAS.
ERGOT DERIVATIVES: (DIHYDROERGOTAMINE, ERGOTAMINE, METHYLERGONOVINE) POTENTIAL FOR SERIOUS AND/OR LIFE-THREATENING EVENTS SUCH AS ACUTE ERGOT TOXICITY CHARACTERIZED BY PERIPHERAL VASOSPASM AND ISCHEMIA OF THE EXTREMITIES AND OTHER TISSUES.