Single Tab Drug Components + Food and pH Interactions

Question 1

Atripla

Answer 1

[EFV/FTC/TDF] empty stomach

Question 2

Complera

Answer 2

[RPV/FTC/TDF] must be with meal

Question 3

Dovato

Answer 3

[DTG/3TC] w/wo

Question 4

Juluca

Answer 4

[DTG/RPV] must be with meal

Question 5

Stribild

Answer 5

[EVG/c/FTC/TDF] must be with meal

Question 6

Symfi Lo

Answer 6

[EFV/3TC/TDF] empty stomach

Question 7

Triumeq

Answer 7

[DTG/ABC/3TC] w/wo

Question 8

Biktarvy

Answer 8

[BIC/FTC/TAF] w/wo

Question 9

Delstrigo

Answer 9

[DOR/3TC/TDF] w/wo

Question 10

Genvoya

Answer 10

[EVG/c/FTC/TAF] must be with meal

Question 11

Odefsey

Answer 11

[RPV/FTC/TAF] must be with meal

Question 12

Symfi

Answer 12

[EFV/3TC/TDF] empty stomach

Question 13

Symtuza

Answer 13

[DRV/c/FTC/TAF] must be with meal

Question 14

All the single tab with or without food options

Answer 14

Biktarvy, Delstrigo, Dovato and Triumeq

Question 15

Acid-blocking medications contraindicated with?

Answer 15

RPV (no PPI), ATV (12 hr apart from PPI and max 20 mg omeprazole), DRV (must not exceed omep 40 mg qd)

Question 16

BIC and DTG: acid suppression interactions

Answer 16

w/ Mg or Al must be 2 hrs before or 6 hrs after. Ca2+ OK if taken together w/ food. If on empty stomach, 2 hrs before or 6hrs after Ca2+. No interactions with H2 blockers or PPIs

Question 17

EVG and RAL: acid suppression interactions

Answer 17

EVG should be separated from polyvalents by at least 2 hours.
RAL (400 mg once daily or 1200 mg twice daily) should not be coadministered with any Al- or Mg-containing antacid. RAL 400 mg twice daily can be given with Ca-containing antacids and no dosing separation is required. The RAL 1200 mg once daily dose is not recommended with calcium-containing acids.

Question 18

RIL: acid suppression interactions

Answer 18

(RIL is in Odefsy and Complera); PPIs completely contraindicated, others use caution. Needs acid for absorption. 4 hrs before or 2 hrs after antacid, 12 hrs before or 4 hrs after H2,

Question 19

CCBs

Answer 19

interaction with atazanavir and some NNRTIs esp EFV and NVP

Question 20

BBs

Answer 20

cobi and RTV interact with metop and carvedilol, consider atenolol, nadolo, labetolol and sotalol – all not CYP metabolize

Question 21

anti-arrythmics

Answer 21

CYP inhibitors so incr ARV leels with PI +/- booster is used. NNRTIs OK. BIC and DTG incr dofetilide and are contraindicated.

Question 22

rifampin, rifapentin etc

Answer 22

multiple interactions, check carefully before RX

Question 23

Nasal/inhaled fluticascorticosteroids

Answer 23

contracindicated in ritonavir-based and cobi-based (to a lesser degree) regimens

Question 24

Injectable corticosteroids

Answer 24

induce CYP3A4 and lower levels of all NNRTIs esp RVP. Dex also decr’s BIC and EVG/c

Question 25

Hep C meds

Answer 25

OK with INSTI-based regimens; caution in boosted PI or NNRTI-based regimens

Question 26

Harvoni

Answer 26

contraindicated with TDF-based regimens; OK with TAF

Question 27

Statin-ARV DDIs

Answer 27

LOVASTATIN and SIMVASTATIN are contraindicated if PI- or cobi-containing regimens. ATORVASTATIN no INSTI interactions, mild NNRTI (decreases atorva levels) and PI- cobi- (incr atorva levels) interactions. PRAVASTATIN safest but not with DRV. PITASTATIN OK with most. ROSUVASTATIN not a CYP3A4 substrate but interacts with PI- and cobi- so use lowest dose and do not exceed 10 mg. OK with NNRTI and INSTIs

Question 28

metformin

Answer 28

doubles with DTG

Question 29

Juluca vs. Dovato

Answer 29

For either: very reliable patient, no Hep B, no resistance. DOVATO (DTG/3TC) is approved as an initial or switch regimen if initial VL < 500,000. May be taken with or without food. JULUCA (DTG/RVP) only for switch therapy. Must be taken with food.