CDC | TB | Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis Table 3

Managing Drug Interactions in the Treatment of HIV-Related Tuberculosis

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 1^st 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