Skip Nav

Clinical Guidelines Portal

Home > Guidelines > Adult and Adolescent ARV Guidelines > Interactions between Integrase Inhibitors or Maraviroc and Non-Nucleoside Reverse Transcriptase Inhibitors or Protease Inhibitors
Text Size

Updated Adult and Adolescent ARV Guidelines

The Adult and Adolescent ARV Guidelines were updated on February 12, 2013. 

Please send your comments with the subject line "Comments on Adult and Adolescent ARV Guidelines" to ContactUs@aidsinfo.nih.gov by February 26, 2013.

Search Search Help

Guideline Search

Type your search term(s) in the text box. Users can only search one guideline at a time. To search for an exact phrase, use quotation marks (i.e. "what to start"). To narrow your search, add additional relevant terms. If you are not finding what you need, try searching similar terms (i.e. perinatal OR pregnancy) to broaden your search.Close

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents

Drug Interactions

Interactions between Integrase Inhibitors or Maraviroc and Non-Nucleoside Reverse Transcriptase Inhibitors or Protease Inhibitors

(Last updated:2/12/2013; last reviewed:2/12/2013)

Printer-Friendly Files

Table 16c. Interactions between Integrase Inhibitors or Maraviroc and Non-Nucleoside Reverse Transcriptase Inhibitors or Protease Inhibitors*
Click here to view this table as an image

*Delavirdine (DLV), indinavir (IDV), and nelfinavir (NFV) are not included in this table. Refer to the DLV, IDV, and NFV Food and Drug Administration package inserts for information regarding drug interactions.

 

EVG/COBI/TDF/FTC

RAL

MVC
ATV
+/-
RTV 		 PK Data ↑ or ↓ EVG, COBI, ATV possible

With unboosted ATV
RAL: AUC ↑ 72%

With (ATV 300 mg + RTV 100 mg) once daily
RAL: AUC ↑ 41%

With unboosted ATV
MVC: AUC ↑ 257%

With (ATV 300 mg + RTV 100 mg) once daily
MVC: AUC ↑ 388%
Dose Do not co-administer. Standard MVC 150 mg BID with ATV +/− RTV
DRV
(always use with RTV)		 PK Data ↑ or ↓ EVG, COBI, DRV possible With (DRV 600 mg + RTV 100 mg) BID
RAL: AUC ↓ 29% and Cmin ↑ 38%

With (DRV 600 mg + RTV 100 mg) BID
MVC: AUC ↑ 305%

With (DRV 600 mg + RTV 100 mg) BID + ETR
MVC: AUC ↑ 210%
Dose Do not co-administer. Standard MVC 150 mg BID
EFV PK Data ↑ or ↓ EVG, COBI, EFV possible EFV: AUC ↓ 36% MVC: AUC ↓ 45%
Dose Do not co-administer. Standard MVC 600 mg BID
EVG/COBI/TDF/FTC PK Data

•

 No data ↑ MVC possible
Dose Do not co-administer. Do not co-administer. 
ETR PK Data ↑ or ↓ EVG, COBI, ETR possible ETR: Cmin ↓ 17%
RAL: Cmin ↓ 34%		 MVC: AUC ↓ 53%, Cmax ↓ 60%
Dose Do not co-administer. Standard MVC 600 mg BID in the absence of a potent CYP3A inhibitor
FPV PK Data ↑ or ↓ EVG, COBI, FPV possible No significant effect Unknown; ↑ MVC possible
Dose Do not co-administer. Standard MVC 150 mg BID
LPV/r PK Data

↑ or ↓ EVG, COBI, LPV possible

RTV and COBI have similar effects on CYP3A.

 ↓ RAL
↔ LPV/r

MVC: AUC ↑ 295%

With LPV/r + EFV
MVC: AUC ↑ 153%
Dose Do not co-administer. Standard MVC 150 mg BID
NVP PK Data ↑ or ↓ EVG, COBI, NVP possible No data MVC: AUC ↔ and Cmax ↑ 54%
Dose Do not co-administer. Standard

Without PI
MVC 300 mg BID

With PI (except TPV/r)
MVC 150 mg BID
RAL PK Data No data

•

 RAL: AUC ↓ 37%
MVC: AUC ↓ 21%
Dose Do not co-administer. Standard
RPV PK Data ↑ or ↓ EVG, COBI, RPV possible No data No data
Dose Do not co-administer. No data No data
RTV PK Data

↑ or ↓ EVG, COBI possible

RTV and COBI have similar effects on CYP3A.

 With RTV 100 mg BID
RAL: AUC ↓ 16%		 With RTV 100 mg BID
MVC: AUC ↑ 161%
Dose Do not co-administer. Standard MVC 150 mg BID
SQV
(always use with RTV)		 PK Data

↑ or ↓ EVG, COBI, SQV possible

RTV and COBI have similar effects on CYP3A.

 No data

With (SQV 1000 mg + RTV 100 mg) BID
MVC: AUC ↑ 877%

With (SQV 1000 mg + RTV 100 mg) BID + EFV
MVC: AUC ↑ 400%
Dose Do not co-administer. Standard MVC 150 mg BID
TPV
(always use with RTV)		 PK Data

↑ or ↓ EVG, COBI, TPV possible

RTV and COBI have similar effects on CYP3A.

 With (TPV 500 mg +
RTV 200 mg) BID
RAL: AUC ↓ 24%		 With (TPV 500 mg + RTV 200 mg) BID
MVC: No significant change in AUC
TPV: No data
Dose Do not co-administer. Standard MVC 300 mg BID
Key to Abbreviations: APV = amprenavir, ART = antiretroviral therapy, ATV = atazanavir, AUC = area under the curve, BID = twice daily, COBI = cobicistat, Cmax = maximum plasma concentration, Cmin = minimum plasma concentration, CYP = cytochrome P, DLV = delavirdine, DRV = darunavir, DRV/r = darunavir/ritonavir, EFV = efavirenz, EVG = elvitegravir, ETR = etravirine, FDA = Food and Drug Administration, FPV = fosamprenavir, IDV = indinavir, LPV = lopinavir, LPV/r = lopinavir/ritonavir, MVC = maraviroc, NFV = nelfinavir, NVP = nevirapine, PI = protease inhibitor, PK = pharmacokinetic, RAL = raltegravir, RPV = rilpivirine, RTV = ritonavir, SQV = saquinavir, SQV/r = saquinavir/ritonavir, TID = three times a day, TPV = tipranavir