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Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis

Table 3. Recommendations for Coadministering Antiretroviral Drugs with RIFABUTIN – 2007

Non-nucleoside reverse-transcriptase inhibitors
  Antiretroviral dose change Rifabutin dose change Comments

Efavirenz

No change

to 450-600 mg (daily or intermittent)

Rifabutin AUC by 38%. Effect of efavirenz + protease inhibitor(s) on rifabutin concentration has not been studied. Efavrirenz should not be used during the 1st trimester of pregnancy.

Nevirapine

No change

No change (300 mg daily or thrice-weekly)

Rifabutin and nevirapine AUC not significantly changed.

Delavirdine

Rifabutin and delavirdine should not be used together

Delavirdine AUC by 80%; rifabutin AUC by 100%.

Etravirine

No change

No change (300 mg daily or thrice-weekly)

No clinical experience; etravirine Cmin by 45%, but this was not thought to warrant a change in dose

Single protease inhibitors
  Antiretroviral dose change Rifabutin dose change Comments

fos-Amprenavir

No change

to 150 mg/day

or

300 mg 3x/week

No published clinical experience

Atazanavir

No change

to 150 mg every other day or 3x/week

No published clinical experience. Rifabutin AUC by 250%

Indinavir

1000 mg every 8 hours

to 150 mg/day

or

300 mg 3x/week

Rifabutin AUC by 170%; indinavir concentrations by 34%

Nelfinavir

No change

to 150 mg/day

or

300 mg 3x/week

Rifabutin AUC by 207%; insignificant change in nelfinavir concentration

Dual protease inhibitor combinations
  Antiretroviral dose change Rifabutin dose change Comments

Lopinavir / ritonavir (Kaletra )

No change

to 150 mg every other day or 3x/week

Rifabutin AUC by 303%; 25-O-des-acetyl rifabutin AUC by 47.5 fold.

Ritonavir (any dose) with saquinavir, indinavir, amprenavir, fos-amprenavir, atazanavir, tipranavir or darunavir

No change

to 150 mg every other day or 3x/week

Rifabutin AUC and 25-O-des-acetyl rifabutin AUC , by varying degrees.

CCR-5 receptor antagonists

Maraviroc

No change

No change

No clinical experience; a significant interaction is unlikely, but this has not yet been studied

Integrase inhibitors

Raltegravir

No change

No change

No clinical experience; a significant interaction is unlikely, but this has not yet been studied

 


Released October 2008
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