6 Prescription Drugs to Avoid If Taking HIV Therapy

James Myhre & Dennis Sifris, MD
·5 min read

Combined use can increase side effects, diminish drug effectiveness

Medically reviewed by Latesha Elopre, MD, MSPH

Drug interactions are possible whenever one medication is prescribed alongside another.

In most cases, the interaction won't require a person to stop one drug or the other.

Often, the dosage can be increased, decreased, or staggered to avoid toxicity or ensure the drugs retain their expected potency. At other times, a drug substitution can be made with an equivalent agent.

Peter Dazeley / Photographer's Choice / Getty Images
Peter Dazeley / Photographer's Choice / Getty Images

However, when it comes to antiretroviral drugs (ARVs) used to treat HIV, there are prescription medications that can directly interfere with the activity and/or potency of the drug.

They do so by altering the drug's pharmacodynamics (how the drug works) or its pharmacokinetics (how the drug moves through the body).

These can be serious concerns. Altering pharmacodynamics can increase or decrease the concentration of a drug, amplifying its toxic effects to intolerable and even dangerous levels.

Alternately, interfering with pharmacokinetics can affect how efficiently the body absorbs or metabolizes a drug.

In either instance, interactions like these can undermine the effectiveness of antiretroviral therapy and lead to a multitude of concerns, including:

Although many prescription drugs are known to interact with ARVs, six classes pose particular concerns, some of which are contraindicated for use with one or more ARVs.



Takeaway

To avoid interactions, always advise your healthcare provider about any drugs you take, whether they are prescription, over-the-counter, herbal, nutritional, or recreational.



Related: List of Approved HIV Antiretroviral Drugs

Statin Drugs

Statin drugs are used to reduce cholesterol levels and work by blocking a liver enzyme responsible for producing cholesterol.

While most statins are not contraindicated for use with ARVs (or require a simple dose adjustment), there are two that are contraindicated for use with all protease inhibitors (PIs) and certain booster drugs.

Taking them together may lead to severe muscle pain or weakness (myopathy) or the serious breakdown of muscle tissue (rhabdomyolysis).

  • Contraindicated drugs: Most statins interact with these medications, some less than others. These include Altoprev/Mevacor (lovastatin), Zocor (simvastatin), and Lipitor (atorvastatin).

  • Cannot be used with the following ARVs: Aptivus (tipranavir), Invirase (saquinavir), Lexiva (fosamprenavir), Norvir (ritonavir), Prezista (darunavir), Reyataz (atazanavir), Tybost (cobicistat), and the combination drugs Evotaz, Genvoya, Kaletra, Prezcobix, Stribild, and Symtuza

Arrhythmia Medications

Some of the drugs used to treat an irregular heartbeat (arrhythmia) are contraindicated for use with PIs and certain booster drugs as they can increase the likelihood of liver inflammation or damage.

  • Contraindicated drugs: Multaq (dronedarone). Ranexa (ranolazine) is an anti-anginal drug that is also contraindicated.

  • Cannot be used with the following ARVs: Aptivus, Invirase, Lexiva, Norvir, Prezista, Reyataz, Tybost, and the combination drugs Evotaz, Genvoya (Renexa only), Kaletra, Prezcobix, Prezista (Multaq only), Stribild (Renexa only), and Symtuza

Other cardiac medications have the same potential for liver injury and, while not contraindicated, should be avoided with PIs.

They include the arrhythmia drugs Cordarone/Nexterone/Pacerone (amiodarone), Quinaglute (quinidine), Tambocor (flecainide), and Tikosyn (dofetilide), as well the tachycardia drug Lipopen (lidocaine).

Hepatitis C Drugs

The HIV and hepatitis C coinfection rate can run as high as 20% and 30% in parts of North America and Europe.



Takeaway

With newer hepatitis C drugs (called direct-acting antivirals, or DAAs) delivering cure rates of up to 99%, greater emphasis is being placed on treating HIV/hepatitis C coinfection more aggressively than in years past.



However, a number of these DAAs cannot be used with certain ARVs due to competing drug actions that can either increase or decrease drug pharmacokinetics.

  • Contraindicated drugs: Harvoni (ledipasvir + sofosbuvir), Mavyret (glecaprevir + pibrentasvir), Zepatier (elbasvir + grazoprevir)

  • Cannot be used with the following ARVs: Aptivus (Harvoni only) and the combination drugs Atripla (Zepatier only), Evotaz (Mavyret only), Reyataz (Mavyret only), Prezcobix (Zepatier only), and Symtuza (Zepatier only)

Related: How Hepatitis C Is Treated

Anti-Epilepsy Medications

Generally speaking, anticonvulsant drugs used to treat epilepsy are considered safe for use with HIV drugs.

A few, however, can affect some of the newer ARVs by competing for the same enzymes they use for metabolism.

In doing so, the drug can decrease the concentration of the ARV in the bloodstream, lowering its efficacy.

  • Contraindicated drugs: Dilantin (phenytoin), Luminal (phenobarbital), Tegretol (carbamazepine)

  • Cannot be used with the following ARVs: Edurant (rilpivirine), Pifeltro (doravirine), Rukubio (fostemsavir), Tybost, and the combination drugs Complera, Delstrigo, Evotaz, Genvoya, Juluca, Odefsey, Prezcobix, Stribild, and Symtuza

Tuberculosis Drugs

In certain parts of the developing world, tuberculosis (TB) co-infection is more common than not among people with HIV.

Even in the United States and Europe, the rate of TB is far higher among people with HIV, and a common feature in advanced HIV infection.

Two of the drugs commonly used to treat TB infection are also known to lower the drug concentration of certain ARVs when co-administered.

  • Contraindicated drugs: Priftin (rifapentine), Rifadin (rifampin)

  • Cannot be used with the following ARVs: Aptivus (Rifadin only), Edurant, Invirase (Rifadin only), Lexiva (Rifadin only), Pifeltro, Prezista (Rifadin only), Reyataz (Rifadin only), Tybost (Rifadin only), and the combination drugs Biktarvy (Rifadin only), Complera, Delstrigo, Evotaz (Rifadin only), Genvoya (Rifadin only), Juluca, Kaletra (Rifadin only), Odefsey, Prezcobix (Rifadin only), Rekubia (Rifadin only), Stribild (Rifadin only), and Symtuza (Rifadin only)



Takeaway

In cases of HIV/TB co-infection, the drug Mycobutin (rifabutin) can generally be substituted with Priftin or Rifadin.



Related: List of AIDS-Defining Conditions

Sedatives and Antipsychotics

Several common sedatives—as well as two controlled drugs used to treat schizophrenia and Tourette's syndrome—are also known to affect the concentration of specific ARV agents in the blood.

  • Contraindicated drugs: Halcion (triazolam), Latuda (lurasidone), Orap (pimozide), Versed (midazolam)

  • Cannot be used with the following ARVs: Aptivus, Invirase, Lexiva, Prezista, Reyataz, and the combination drugs Evotaz, Genvoya, Kaletra, Prezcobix, Stribild, and Symtuza

Read Next: 3 Over-the-Counter Drugs Than Can Undermine HIV Therapy

Read the original article on Verywell Health.