Table 4:

Drug-drug interactions between ARVs (CYP inhibitors) and other drugs

Class of drugs	ARVs	Outcomes (ARV drug levels)	Outcomes (co-administered drug levels)	Dosing Recommendation	Ref
Lipid-lowering (Statins)	All PIs, EVG/COBI	No effect	↑ simvastatin, ↑ lovastatin, ↑ fluvastatin, ↑ atorvastatin possible ↑ rosuvastatin possible	Do not co-administer simvastatin, lovastatin, fluvastatin with PIs and EVG/COBI; Dose adjustments for atorvastatin and rosuvastatin may be necessary.	[8, 50, 51] [52]
	EFV, ETR	No effect	↑ fluvastatin possible	Dose adjustments for fluvastatin may be necessary.	[8]
Anti-TB (Rifampin, rifabutin)	All PIs, EFV, ETR, EVG/COBI	↓ ARV levels when co-administered with rifampin.	No effect	Do not co-administer rifampin with PIs, EFV, ETR, and EVG/COBI. Rifabutin is a preferred regimen after dose-adjustment.	[8, 46]
Antifungals (Ketoconazole, itraconazole)	All PIs, PI/RTV, PI/COBI, EVG/COBI	↑ PIs,	↑ ketoconazole, ↑ itraconazole	Dose adjustments are needed. Doses >200mg/day of ketoconazole or itraconazole is not recommended.	[15] [21] [55] [56]
Anticonvulsants (Phenytoin, phenobarbital, carbamazepine)	PI/RTV, PI/COBI, EFV, ETR, EVG/COBI	↓ ARV levels	↑ carbamazepine with PI/RTV and PI/COBI	Do not co-administer phenytoin, phenobarbital and carbamazepine with PI/RTV, PI/COBI, ETR, and EVG/COBI. Monitor anticonvulsants and EFV concentrations for dose adjustments.	[8] [59] [10]
Ergot alkaloids	PI/RTV, PI/COBI, EFV, ETR, EVG/COBI	No effect	↑ ergotamine effects	Do not co-administer. Use alternative agents: 5-HT agonists (“triptans”).	[15] [64]

ARVs- Antiretroviral drugs; PIs, -Protease inhibtors; EVG-Elvitegravir; EFV-Efavirenz; COBI-Cobicistat; ETR- Etravirine; RTV- Ritonavir.