Medications and cautions

• Daily dosing. Tenofovir disoproxil fumarate/emtricitabine or tenofovir with lamivudine have superior tolerability when compared to zidovudine/ lamivudine or stavudine with lamivudine.
• Use with caution or avoid in renal disease (eGFR <60), dose reduction required in renal impairment.
• Use zidovudine/lamivudine where tenofovir is directly contraindicated and seek expert advice.

• Daily dosing. Well tolerated when used in PEP with high rates of adherence and regimen completion rates.

Drugs that are contraindicated

• Dofetilide (not available in Australia).

Drugs that should be used with caution

• Phenytoin, phenobarbital, rifampicin, St John’s Wort, carbamazepine - increase dolutegravir dose to 50mg BD or stop St. John’s Wort.
• Antacids containing polyvalent cations e.g. Mg or Al – use at least 2 hours before or 6 hours after the dolutegravir dose.
• Products containing calcium or iron – use at least 2 hours before or 6 hours after the dolutegravir dose OR dose concomitantly with food.
• Metformin – increase monitoring of glycaemic control, adjustment in metformin dose may be required.

• BD dosing. Well tolerated when used in PEP with high rates of adherence and regimen completion rates.
• Small risk of rhabdomyolysis – inform patients about the potential for myalgia and the need to re-present if myalgia occurs.
• Advise against the use of statins while on PEP containing raltegravir.
• Caution patients who engage in heavy gym work about the increased risk of rhabdomyolysis, especially when anabolic steroids are used.
• Consider switching to dolutegravir or rilpivirine (see below) in patients who report myalgia on raltegravir.
• Check CK, renal function and urinary myoglobin in patients who report myalgia on raltegravir.

• MUST be taken with food. Rilpivirine taken without food results in at least a 40% drop in drug exposure.

Drugs that are contraindicated

• Carbamazepine, oxcarbazepine, phenobarbital, phenytoin
• Rifabutin, rifampicin, rifapentine
• Dexamethasone
• Omeprazole, lansoprazole, pantoprazole, esomeprazole
• St. John’s Wort.

Drugs that should be used with caution

• Famotidine, cimetidine, nizatidine, ranitidine – administer at least 4 hours after rilpivirine dose
• Aluminium or magnesium hydroxide, calcium carbonate – administer 2 hours before or 4 hours after rilpivirine dose.