Acid suppression agents |
Antacids | ↓ VEL – potential clinically significant interaction | Take SOF/VEL 4 h before antacid administration | Take SOF/VEL/VOX 4 h before antacid administration | No dose adjustment required | No dose adjustment required |
H2-receptor antagonists | ↓ VEL – clinically significant interaction ↓ GLE - weak interaction, not clinically significant | Max dose of famotidine 40 mg twice daily or equivalent Administer simultaneously with, or 12 h apart from H2-receptor antagonists | Max dose of famotidine 40 mg twice daily or equivalent Administer simultaneously with, or 12 h apart from H2-receptors antagonists | No dose adjustment required | No dose adjustment required |
Proton pump inhibitors | ↓ VEL – potential clinically significant interaction ↓ GLE – weak interaction, not clinically significant | Avoid if possible, Administer SOF/VEL with food and 4 h prior to PPI Max dose of omeprazole 20 mg daily | Avoid if possible, Administer SOF/VEL/VOX with food and 4 h prior to PPI Max dose of omeprazole 20 mg daily | No dose adjustment required | No dose adjustment required |
Anti-arrhythmics |
Amiodarone | ↑ Amiodarone – potential clinically significant interaction | Co-administration is not recommended | Co-administration is not recommended | Monitor for amiodarone adverse effects required | Monitor for amiodarone adverse effects required |
Digoxin | ↑ Digoxin – potential clinically significant interaction | Monitor digoxin level | Monitor digoxin level | Reduce digoxin dose by 50% | No dose adjustment required |
Anticoagulants |
Dabigatran etexilate | ↑ Dabigatran – potential clinically significant interaction | Monitoring of dabigatran adverse effects required | Co-administration is contraindicated | Co-administration is contraindicated | Monitoring of dabigatran adverse effects required |
Apixaban | ↑ Apixaban – potential clinically significant interaction | Monitoring of apixaban adverse effects required | Monitoring of apixaban adverse effects required | Monitoring of apixaban adverse effects required | Monitoring of apixaban adverse effects required |
Rivaroxaban | ↑ Rivaroxaban – potential clinically significant interaction | Monitoring of rivaroxaban adverse effects required | Monitoring of rivaroxaban adverse effects required | Monitoring of rivaroxaban adverse effects required | Monitoring of apixaban adverse effects required |
Edoxaban | ↑ Edoxaban – potential clinically significant interaction | Monitoring of edoxaban adverse effects required | Co-administration is not recommended | Monitoring of edoxaban adverse effects required | Monitoring of apixaban adverse effects required |
Vitamin K antagonist | ↑ Warfarin – potential clinically significant interaction | INR monitoring is required | INR monitoring is required | INR monitoring is required | INR monitoring is required |
Aromatic anticonvulsants |
Carbamazepine | ↓ VEL, VOX, GLE, PIB, EBR, GZR – potential clinically significant interaction | Co-administration is contraindicated | Co-administration is contraindicated | Co-administration is contraindicated | Co-administration is contraindicated |
Phenytoin | ↓ VEL, VOX, GLE, PIB, EBR, GZR - potential clinically significant interaction | Co-administration is contraindicated | Co-administration is contraindicated | Co-administration is contraindicated | Co-administration is contraindicated |
Phenobarbital | ↓ VEL, VOX, GLE, PIB, EBR, GZR – potential clinically significant interaction | Co-administration is contraindicated | Co-administration is contraindicated | Co-administration is contraindicated | Co-administration is contraindicated |
Anti-infective |
Ketoconazole | ↑ GLE, PIB, EBR, GZR – potential clinically significant interaction ↑ Ketoconazole - potential clinically significant interaction ↑ VEL, VOX - weak interaction, not clinically significant | No dose adjustment required | No dose adjustment required | Monitor for GLE/PIB and ketoconazole adverse effects required. LFT monitoring required | Co-administration is not recommended |
Voriconazole | ↑ VOX - weak interaction/clinically insignificant | No dose adjustment required | No dose adjustment required | No dose adjustment required | No dose adjustment required |
Posaconazole | ↑ Posaconazole – potential clinically significant interaction | No dose adjustment required | No dose adjustment required | Monitoring of posaconazole adverse effects required | No dose adjustment required |
Fluconazole | No interaction expected | No dose adjustment required | No dose adjustment required | No dose adjustment required | No dose adjustment required |
Rifampin | ↓ SOF, VEL, VOX, GLE, PIB, GZR – potential clinically significant interaction | Co-administration is not recommended | Co-administration is contraindicated | Co-administration is contraindicated | Co-administration is contraindicated |
Anti-retroviral |
Abacavir | No interaction expected | No dose adjustment required | No dose adjustment required | No dose adjustment required | No dose adjustment required |
Tenofovir disoproxil fumarate | ↑ Tenofovir – potential clinically significant interaction | Monitor for nephrotoxicity | Monitor for nephrotoxicity | No dose adjustment required | No dose adjustment required |
Tenofovir alafenamide | ↑ Tenofovir – weak interaction, not clinically significant | No dose adjustment required | No dose adjustment required | No dose adjustment required | No dose adjustment required |
Emtricitabine | No interaction expected | No dose adjustment required | No dose adjustment required | No dose adjustment required | No dose adjustment required |
Lamivudine | No interaction expected | No dose adjustment required | No dose adjustment required | No dose adjustment required | No dose adjustment required |
Entecavir | No interaction expected | No dose adjustment required | No dose adjustment required | No dose adjustment required | No dose adjustment required |
Efavirenz | ↓ VEL, VOX, GLE, PIB, EBR, GZR – potential clinically significant interaction | Co-administration is not recommended | Co-administration is not recommended | Co-administration is not recommended | Co-administration is contraindicated |
Rilpivirine | No interaction expected | No dose adjustment required | No dose adjustment required | No dose adjustment required | No dose adjustment required |
Atazanavir/ ritonavir | ↑ VOX, GLE, EBR, GZR – potential clinically significant interaction | No dose adjustment required | Co-administration is not recommended | Co-administration is contraindicated | Co-administration is contraindicated |
Darunavir/ ritonavir | ↑ GLE, EBR, GZR – potential clinically significant interaction ↑ VOX – potential clinically significant interaction | No dose adjustment required | Max darunavir/ritonavir 800 mg/100 mg once daily | Co-administration is not recommended | Co-administration is contraindicated |
Dolutegravir | No interaction expected | No dose adjustment required | No dose adjustment required | No dose adjustment required | No dose adjustment required |
Elvitegravir/cobicistatin combination with tenofovir and emtricitabine | ↑ EBR, GZR, potential clinically significant interaction ↑ VOX, GLE, PIB, weak interaction, not clinically significant | No dose adjustment required | No dose adjustment required | No dose adjustment required, LFT monitoring required | Co-administration is not recommended |
Raltegravir | ↑ Raltegravir - weak interaction, not clinically significant | No dose adjustment required | No dose adjustment required | No dose adjustment required | No dose adjustment required |
HMG-CoA inhibitor |
Atorvastatin | ↑ Atorvastatin – potential clinically significant interaction | Monitor for myopathy / rhabdomyolysis | Max dose of atorvastatin 10 mg | Co-administration is contraindicated | Max dose of atorvastatin 20 mg |
Lovastatin | ↑ Lovastatin – potential clinically significant interaction | Monitor for myopathy / rhabdomyolysis | Use lowest dose possible | Co-administration is not recommended | Use lowest dose possible |
Simvastatin | ↑ Simvastatin – potential clinically significant interaction | Monitor for myopathy / rhabdomyolysis | Use lowest dose possible | Co-administration is contraindicated | Use lowest dose possible |
Pravastatin | ↑ Pravastatin – potential clinically significant interaction | No dose adjustment required | Max dose of pravastatin 40 mg | Reduce dose of pravastatin by 50% | No dose adjustment required |
Rosuvastatin | ↑ Rosuvastatin – potential clinically significant interaction | Max dose of rosuvastatin 10 mg | Co-administration is contraindicated | Max dose of rosuvastatin 5 mg | Max dose of rosuvastatin 10 mg |
Immunosuppression |
Cyclosporine | ↑ VOX, GLE, GZR – potential clinically significant interaction ↑ SOF, VEL – weak interaction, not clinically significant | No dose adjustment required | Co-administration is not recommended | Max dose of cyclosporine 100 mg daily | Co-administration is contraindicated |
Tacrolimus | ↑ Tacrolimus – potential clinically significant interaction | Monitor tacrolimus level | Monitor tacrolimus level | Monitor tacrolimus level | Monitor tacrolimus level |
Sirolimus | Sirolimus â potential clinically significant interaction | Monitor sirolimus level | Monitor sirolimus level | Monitor sirolimus level | Monitor sirolimus level |
Prednisone | No interaction expected | No dose adjustment required | No dose adjustment required | No dose adjustment required | No dose adjustment required |
Mycophenolate | No interaction expected | No dose adjustment required | No dose adjustment required | No dose adjustment required | No dose adjustment required |
Oral contraceptive |
Ethinyl estradiol containing contraceptives | Increased risk of ALT elevation | No dose adjustment required | Co-administration is contraindicated | Co-administration is contraindicated | No dose adjustment required |
Norethindrone | No interaction expected | No dose adjustment required | No dose adjustment required | No dose adjustment required | No dose adjustment required |
Opioid agonists and antagonist |
Methadone | ↑ Methadone – weak interaction, potentially clinically significant | Monitor for decrease in level of consciousness and respiratory depression | Monitor for decrease in level of consciousness and respiratory depression | Monitor for decrease in level of consciousness and respiratory depression | Monitor for decrease in level of consciousness and respiratory depression |
Buprenorphine | ↑ Buprenorphine – weak interaction, potentially clinically significant | Monitor for decrease in level of consciousness and respiratory depression | Monitor for decrease in level of consciousness and respiratory depression | Monitor for decrease in level of consciousness and respiratory depression | Monitor for decrease in level of consciousness and respiratory depression |
Naloxone | No interaction expected | No dose adjustment required | No dose adjustment required | No dose adjustment required | No dose adjustment required |
Fentanyl | ↑ Fentanyl – weak interaction, potentially clinically significant | No dose adjustment required | No dose adjustment required | Monitor for decrease in level of consciousness and respiratory depression | Monitor for decrease in level of consciousness and respiratory depression |