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Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis

Table 2. Recommendations for Coadministering Antiretroviral Drugs with RIFAMPIN – 2007

Non-nucleoside reverse transcriptase inhibitors
  Recommended change in dose of antiretroviral drug Recommended change in dose of rifampin Comments

Efavirenz

None (some experts recommend 800 mg for patients > 60 kg)

No change

(600 mg/day)

Efavirenz AUC   by 22%; no change in rifampin concentration. Efavrirenz should not be used during the 1st trimester of pregnancy.

Nevirapine

No change

No change

(600 mg/day)

Nevirapine AUC 37-58% and Cmin 68% with 200 mg 2x/day dose.

Delavirdine

Rifampin and delavirdine should not be used together

Delavirdine AUC by 95%

Etravirine

Etravirine and rifampin should not be used together

Marked decrease in etravirine predicted, based on data on the interaction with rifabutin

Single protease inhibitors
  Recommended change in dose of antiretroviral drug Recommended change in dose of rifampin Comments

Ritonavir

No change

No change

(600 mg/day)

Use with caution. Ritonavir AUC by 35%; no change in rifampin concentration. Monitor for antiretroviral activity of ritonavir.

fos-Amprenavir

Rifampin and fos-amprenavir should not be used together

 

Atazanavir

Rifampin and atazanavir should not be used together

Atazanavir AUC by >95%

Indinavir

Rifampin and indinavir should not be used together

Indinavir AUC by 89%.

Nelfinavir

Rifampin and nelfinavir should not be used together

Nelfinavir AUC 82%

Saquinavir

Rifampin and saquinavir should not be used together

Saquinavir AUC by 84%

Dual protease-inhibitor combinations
  Recommended change in dose of antiretroviral drug Recommended change in dose of rifampin Comments

Saquinavir / ritonavir

Saquinavir 400 mg + ritonavir 400 mg twice-daily

No change

(600 mg/day)

Use with caution; the combination of saquinavir (1000 mg twice-daily), ritonavir (100 mg twice-daily), and rifampin caused unacceptable rates of hepatitis among healthy volunteers

Lopinavir / ritonavir (Kaletra )

Increase the dose of lopinavir / ritonavir (Kaletra ) to 4 tablets (200 mg of lopinavir with 50 mg of ritonavir) twice-daily

No change

(600 mg/day)

Use with caution; this combination resulted in hepatitis in all adult healthy volunteers in an initial study.

“Super-boosted” lopinavir / ritonavir (Kaletra )

Lopinavir / ritonavir (Kaletra ) – 2 tablets (200 mg of lopinavir with 50 mg of ritonavir) + 300 mg of ritonavir twice-daily

No change

(600 mg/day)

Use with caution; this combination resulted in hepatitis among adult healthy volunteers. However, there are favorable pharmacokinetic and clinical data among young children

Atazanavir / ritonavir

The standard dose of ritonavir-boosted atazanavir (300 mg once daily with 100 mg of ritonavir) should not be used with rifampin

Atazanavir trough concentration by > 90%

Tipranavir / ritonavir

Rifampin and tipranavir/ritonavir should not be used together

 

Darunavir / ritonavir

Rifampin and darunavir/ritonavir should not be used together

 
CCR-5 receptor antagonists
  Recommended change in dose of antiretroviral drug Recommended change in dose of rifampin Comments
Maraviroc Increase maraviroc to 600 mg twice-daily

No change

(600 mg/day)

Maraviroc Cmin by 78%. No reported clinical experience with increased dose of maraviroc with rifampin

Integrase inhibitors
  Recommended change in dose of antiretroviral drug Recommended change in dose of rifampin Comments
Raltegravir

No change

No change

(600 mg/day)

No clinical experience; raltegravir concentrations by 40-61%

 


Released October 2008
Centers for Disease Control and Prevention
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
Division of Tuberculosis Elimination - http://www.cdc.gov/tb

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