Skip Nav

Clinical Guidelines Portal

Home > Guidelines > Adult and Adolescent ARV Guidelines > Drug Interactions between Nucleoside Reverse Transcriptase Inhibitors and Other Drugs (Including Antiretroviral Agents)
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

Drug Interactions between Nucleoside Reverse Transcriptase Inhibitors and Other Drugs (Including Antiretroviral Agents)

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

Printer-Friendly Files

Table 15c. Drug Interactions between Nucleoside Reverse Transcriptase Inhibitors and Other Drugs (Including Antiretroviral Agents)
Click here to view this table as an image 

Concomitant Drug
Class/Name

NRTI

Effect on NRTI or Concomitant Drug Concentrations

Dosage Recommendations and Clinical Comments
Antivirals
Adefovir TDF No data Do not co-administer. Serum concentrations of TDF and/or other renally eliminated drugs may be increased.
Boceprevir TDF No significant PK effects No dose adjustment necessary.
Ganciclovir
Valganciclovir		 TDF No data Serum concentrations of these drugs and/or TDF may be increased. Monitor for dose-related toxicities.
ZDV No significant PK effects Potential increase in hematologic toxicities
Ribavirin ddI ↑ intracellular ddI Contraindicated. Do not co-administer. Fatal hepatic failure and other ddI-related toxicities have been reported with co administration.
ZDV Ribavirin inhibits phosphorylation of ZDV. Avoid co-administration if possible, or closely monitor virologic response and hematologic toxicities.
Telaprevir TDF TDF AUC ↑ 30%, Cmin ↑ 6%–41% Monitor for TDF-associated toxicity.
Integrase Inhibitor
RAL TDF RAL AUC ↑ 49%, Cmax ↑ 64% No dosage adjustment necessary.
Narcotics/Treatment for Opioid Dependence
Buprenorphine 3TC, ddI, TDF, ZDV No significant effect No dosage adjustment necessary.
Methadone ABC methadone clearance ↑ 22% No dosage adjustment necessary.
d4T d4T AUC ↓ 23%, Cmax ↓ 44% No dosage adjustment necessary.
ZDV ZDV AUC ↑ 29%–43% Monitor for ZDV-related adverse effects.
NRTIs
ddI d4T No significant PK interaction Do not co-administer. Additive toxicities of peripheral neuropathy, lactic acidosis, and pancreatitis seen with this combination.
TDF ddI-EC AUC and Cmax ↑ 48%–60% Avoid co-administration.
Other
Allopurinol ddI ddI AUC ↑ 113%
In patients with renal impairment:
ddI AUC ↑ 312% 		Contraindicated. Potential for increased ddI-associated toxicities.
PIs
ATV ddI With ddI-EC + ATV (with food): ddI AUC ↓ 34%; ATV no change Administer ATV with food 2 hours before or 1 hour after ddI.
TDF ATV AUC ↓ 25% and Cmin ↓ 23%–40% (higher Cmin with RTV than without RTV)

TDF AUC ↑ 24%–37%

Dose: ATV/r 300/100 mg daily co-administered with TDF 300 mg daily. Avoid concomitant use without RTV. If using TDF and H2 receptor antagonist in ART-experienced patients, use ATV/r 400 mg/100 mg daily.

Monitor for TDF-associated toxicity.

ZDV ZDV Cmin ↓ 30%, no change in AUC Clinical significance unknown.
DRV/r TDF TDF AUC ↑ 22%, Cmax ↑ 24%, and
Cmin ↑ 37%		 Clinical significance unknown. Monitor for TDF toxicity.
LPV/r TDF LPV/r AUC ↓15%
TDF AUC ↑ 34%		 Clinical significance unknown. Monitor for TDF toxicity.
TPV/r ABC ABC AUC ↓ 35%–44% Appropriate doses for this combination have not been established.
ddI ddI-EC AUC ←→ and Cmin ↓ 34%
TPV/r ↔		 Separate doses by at least 2 hours.
TDF TDF AUC ←→
TPV/r AUC ↓ 9%–18% and
Cmin ↓ 12%–21%		 No dosage adjustment necessary.
ZDV ZDV AUC ↓ 35%
TPV/r AUC ↓ 31%–43% 		Appropriate doses for this combination have not been established.
Key to Abbreviations: 3TC = lamivudine, ABC = abacavir, ART = antiretroviral, ATV = atazanavir, ATV/r = atazanavir/ritonavir, AUC = area under the curve, Cmax  = maximum plasma concentration, Cmin = minimum plasma concentration, d4T = stavudine, ddI = didanosine, DRV/r = darunavir/ritonavir, EC = enteric coated, LPV/r = lopinavir/ritonavir, NRTI = nucleoside reverse transcriptase inhibitor, PI = protease inhibitor, PK = pharmacokinetic, RAL = raltegravir, TDF = tenofovir, TPV/r = tipranavir/ritonavir, ZDV = zidovudine