Potential Clinically Relevant Interactions between Antimalarial and Antiretroviral Drugs^*

Antimalarial Drug	Protease Inhibitors	NRTI	NNRTI
Quinine	PIs: increase quinine levels	No available data	Efavirenz, Nevirapine: reduces quinine levels
Atovaquone/Proguanil	Lopinavir/Ritonavir:, Atazanavir/Ritonavir reduces atovaquone and proguanil levels		Efavirenz reduces atovaquone and proguanil levels
Mefloquine	Ritonavir reduces ritonavir levels		Efavirenz, Nevirapine: reduces mefloquine levels
Lumefantrine, Halofantrine	PIs: increase lumefantrine or halofantrine levels, which can prolong QT interval		Efavirenz, Nevirapine: increases lumefantrine or halofantrine levels, which can prolong QT interval
Amodiaquine plus Artesunate			Efavirenz: increases amodiaquine concentration which can increase hepatic toxicity; do not co-administer
Chloroquine, Pyrimethamine, Sulfadoxine-Pyrimethamine	Ritonavir: alters anti-malarial drug metabolism, may increase chloroquine levels
Sulfadoxine-Pyrimethamine		Zidovudine: possibly increases risk of anemia	Nevirapine: possibly increases adverse skin or liver adverse reactions; do not start both drugs simultaneously
Artemisinin	PIs: alter artemisinin metabolism		Nevirapine: may decrease artemisinin levels
Dapsone	Saquinavir: alters dapsone metabolism

Key to Acronyms: NRTI=nucleoside reverse transcriptase inhibitor; NNRTI=non-nucleoside reverse transcriptase inhibitor; PI= protease inhibitor

^*Modified from: Flateau, C., G. Le Loup, et al. Consequences of HIV infection on malaria and therapeutic implications: a systematic review. Lancet Infect Dis. 2011. 11(7);541-556.