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
ä) |
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 |
|
Last Reviewed: 05/18/2008
Content Source: Division of Tuberculosis Elimination
National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention
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