GENITOURINARY DRUGS: PDE5 INHIBITORS FOR ERECTILE DYSFUNCTION (ED) or PULMONARY ARTERIAL HYPERTENSION (PAH)

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) TREATMENT OF ERECTILE DYSFUNCTION (ED)

xSildenafil (Viagra) Potential for n sildenafil. WŽƚĞŶƚŝĂůĨŽƌљƐŝůĚĞŶĂĨŝů Potential for n sildenafil. Decrease sildenafil dose Decrease sildenafil dose to to 25 mg every 48 hours. 25 mg every 48 hours.

xTadalafil (Cialis) Potential for n tadalafil. WŽƚĞŶƚŝĂůĨŽƌљƚĂĚĂůĂĨŝů Potential for n tadalafil. Decrease tadalafil dose to Decrease tadalafil dose to 10 mg every 72 hours, 10 mg every 72 hours, maximum 3 times per maximum 3 times per week. week.

xVardenafil Potential for n vardenafil WŽƚĞŶƚŝĂůĨŽƌљǀĂƌĚĞŶĂĨŝů Potential for n vardenafil (Levitra) and toxicity and toxicity TREATMENT OF PULMONARY ARTERIAL HYPERTENSION (PAH)

xSildenafil (Revatio) Potential for n sildenafil WŽƚĞŶƚŝĂůĨŽƌљƐŝůĚĞŶĂĨŝů Potential for n sildenafil and toxicity and toxicity

xTadalafil (Adcirca) Potential for n tadalafil. WŽƚĞŶƚŝĂůĨŽƌљƚĂĚĂůĂĨŝů Potential for n tadalafil. Start at 20 mg daily and Start at 20 mg daily and titrate to 40 mg daily titrate to 40 mg daily based based on tolerability. on tolerability.

GENITOURINARY Mechanism of Drug Interactions, Management and Monitoring

Class Mechanism of Interaction Main Interacting ARVs Management Monitoring PDE5 inhibitors (sildenafil, Inhibition of CYP3A4 Ritonavir and cobicistat- PAH: PDE5 toxicity: headache, tadalafil, vardenafil) boosted protease inhibitors x Sildenafil is flushing, dyspepsia, nasal and elvitegravir contraindicated congestion, flushing, x Tadalafil: start at 20 mg diarrhea, dizziness. daily and titrate to 40 mg daily based on tolerability

ED: x Vardenafil is contraindicated. x Sildenafil: use 25 mg every 48 hours. x Tadalafil: 10 mg every 72 hours, maximum 3 times per week. Induction of CYP3A4 Efavirenz, etravirine, Adjust dose according to PDE5 efficacy nevirapine efficacy/toxicity

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.

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