CARDIOVASCULAR

Z/Ks^h>ZZh'^͗ ^dd/E^E>/W/>KtZ/E''Ed^   /E^d/Ɛ EEZd/Ɛ W/Ɛ  x/d'Zs/Z ;ŝŬƚĂƌǀLJͿ  x>s/d'Zs/Zͬ x KZs/Z/E ;WŝĨĞůƚƌŽ͕ x &s/ZE ;^ƵƐƚŝǀĂ͕ ŽŽƐƚĞĚǁŝƚŚƌŝƚŽŶĂǀŝƌ xK>hd'Zs/Z ;dŝǀŝĐĂLJ͕ K//^dd ;^ƚƌŝďŝůĚ͕ ĞůƐƚƌŝŐŽͿ ƚƌŝƉůĂͿ ;EŽƌǀŝƌͿŽƌĐŽďŝĐŝƐƚĂƚ dƌŝƵŵĞƋ͕:ƵůƵĐĂ͕ŽǀĂƚŽͿ  'ĞŶǀŽLJĂͿ  x Z/>W/s/Z/E ;ĚƵƌĂŶƚ͕ x dZs/Z/E ;/ŶƚĞůĞŶĐĞͿ  xdEs/Z ;ZĞLJĂƚĂnj͕ xZ>d'Zs/Z ŽŵƉůĞƌĂ͕KĚĞĨƐĞLJ͕ x Es/ZW/E ǀŽƚĂnjͿ ;/ƐĞŶƚƌĞƐƐͿ  :ƵůƵĐĂͿ  ;sŝƌĂŵƵŶĞͿ xZhEs/Z ;WƌĞnjŝƐƚĂ͕ WƌĞnjĐŽďŝdž͕^LJŵƚƵnjĂͿ  x>KW/Es/Z ;<ĂůĞƚƌĂͿ 

^dd/E^      

xƚŽƌǀĂƐƚĂƚŝŶ  WŽƚĞŶƚŝĂůĨŽƌ nƐƚĂƚŝŶ   WŽƚĞŶƚŝĂůĨŽƌ pƐƚĂƚŝŶ  WŽƚĞŶƚŝĂůĨŽƌ nƐƚĂƚŝŶ͘hƐĞ ;>ŝƉŝƚŽƌͿ  ůŽǁĞƐƚƐƚĂƚŝŶĚŽƐĞƉŽƐƐŝďůĞ ;ŵĂdžŝŵƵŵϮϬŵŐ ĂƚŽƌǀĂƐƚĂƚŝŶĚĂŝůLJͿ͘

xZŽƐƵǀĂƐƚĂƚŝŶ  WŽƚĞŶƚŝĂůĨŽƌ nƐƚĂƚŝŶ   WŽƚĞŶƚŝĂůĨŽƌ nƐƚĂƚŝŶ͘hƐĞ ;ƌĞƐƚŽƌͿ  ůŽǁĞƐƚƐƚĂƚŝŶĚŽƐĞƉŽƐƐŝďůĞ ;ŵĂdžŝŵƵŵϭϬŵŐ ƌŽƐƵǀĂƐƚĂƚŝŶĚĂŝůLJͿ͘

xWŝƚĂǀĂƐƚĂƚŝŶ      ;>ŝǀĂůŽͿ 

xWƌĂǀĂƐƚĂƚŝŶ  WŽƚĞŶƚŝĂůĨŽƌ nƐƚĂƚŝŶ   WŽƚĞŶƚŝĂůĨŽƌ nƐƚĂƚŝŶ ;WƌĂǀĂĐŚŽůͿ 

x>ŽǀĂƐƚĂƚŝŶ  WŽƚĞŶƚŝĂůĨŽƌ nƐƚĂƚŝŶĂŶĚ  WŽƚĞŶƚŝĂůĨŽƌ pƐƚĂƚŝŶ WŽƚĞŶƚŝĂůĨŽƌ nƐƚĂƚŝŶĂŶĚ ;DĞǀĂĐŽƌͿ͕  ƚŽdžŝĐŝƚLJ ƚŽdžŝĐŝƚLJ ƐŝŵǀĂƐƚĂƚŝŶ ;ŽĐŽƌͿ  CARDIOVASCULAR

INSTIs NNRTIs PIs

xBICTEGRAVIR (Biktarvy) xELVITEGRAVIR/ x DORAVIRINE (Pifeltro, x EFAVIRENZ (Sustiva, Boosted with ritonavir xDOLUTEGRAVIR (Tivicay, COBICISTAT (Stribild, Delstrigo) Atripla) (Norvir) or cobicistat Triumeq, Juluca) Genvoya) x RILPIVIRINE (Edurant, x ETRAVIRINE (Intelence) xATAZANAVIR (Reyataz, xRALTEGRAVIR Complera, Odefsey, x NEVIRAPINE Evotaz) (Isentress) Juluca) (Viramune) xDARUNAVIR (Prezista, Prezcobix, Symtuza) xLOPINAVIR (Kaletra)

FIBRATES xFenofibrate, bezafibrate, gemfibrozil CHOLESTEROL ABSORPTION INHIBITOR xEzetimibe (Ezetrol)

GASTROINTESTINAL LIPASE INHIBITOR xOrlistat (Xenical) Potential for p ARV absorption

BILE ACID SEQUESTRANTS xCholestyramine Potential for p ARV absorption (Olestyr), colestipol (Colestid)

CARDIOVASCULAR

Mechanism of Drug Interactions, Management and Monitoring

Mechanism of Interaction Main Interacting ARVs Management Monitoring Hmg-Coa Reductase Inhibitors (Statins) Lovastatin, simvastatin Inhibition of CYP3A4 Ritonavir and cobicistat- Contraindicated. Use Statin toxicity: myalgia, boosted protease inhibitors alternate statin. rhabdomyolysis and elvitegravir Atorvastatin, rosuvastatin, Inhibition of CYP3A4, Ritonavir and cobicistat- Use lowest statin dose Statin toxicity: myalgia, pravastatin OATP1B1, BCRP boosted protease inhibitors possible and titrate to effect rhabdomyolysis and elvitegravir Pitavastatin Primarily cleared via UGT, None Most ARVs may be used Statin toxicity: myalgia, OATP1B1 rhabdomyolysis Orlistat Reduced absorption of ARVs All antiretrovirals, Take ARVs at least 2 hours Antiretroviral efficacy by decreasing dietary fat particularly lipophilic agents before/after orlistat absorption Bile acid sequestrants Reduced absorption of ARVs All antiretrovirals Take ARVs either 1 hour Antiretroviral efficacy before or 4-6 hours after bile acid sequestrants

Legend: No dose adjustment required.

Use combination with caution. Adjustment in drug dose or frequency or additional/more frequent monitoring may be required.

May wish to consult with a pharmacist knowledgeable in HIV drug interactions.

Contraindicated/avoid combination.

ô+ , %#+#,2ô2--*ô$-0 '«5 "03%̞"03%ô',2#0 !2'-,1

Printed with the assistance of an unrestricted educational grant from:

฀฀฀฀฀฀฀฀ ฀฀฀฀฀฀฀฀ ฀฀฀฀฀