January 10, 2011 

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents Page 37   

Table 16b.  Interactions between NNRTIs*, MVC, RAL, and PIs* (Updated January 10, 2011) Page 1 of 2  *DLV, IDV, and NFV are not included in this table. Refer to the FDA package insert for information regarding DLV, IDV, and NFV drug interactions.  

 EFV ETR NVP MVC RAL 

ATV 

PK data 

With unboosted ATV ATV: AUC ↓ 74% EFV: no significant change  With (ATV 300 mg + RTV 100 mg) once daily with food ATV concentrations similar to unboosted ATV without EFV 

With unboosted ATV ETR: AUC ↑ 50%, Cmax ↑ 47%, and Cmin ↑ 58% ATV: AUC ↓ 17% and Cmin ↓ 47%  With (ATV 300 mg + RTV 100 mg) once daily ETR: AUC, Cmax, and Cmin ↑ approximately 30% ATV: AUC ↓ 14% and Cmin ↓ 38%  

With (ATV 300 mg + RTV 100 mg) once daily ATV: AUC ↓ 42% and Cmin ↓ 72% NVP: AUC ↑ 25%  

With unboosted ATV MVC: AUC ↑ 257%  With (ATV 300 mg + RTV 100 mg) once daily MVC: AUC ↑ 388% 

With unboosted ATV RAL: AUC ↑ 72%  With (ATV 300 mg + RTV 100 mg) once daily RAL: AUC ↑ 41% 

Dose 

Do not coadminister with  unboosted ATV.  In ART-naïve patients (ATV 400 mg + RTV 100 mg) once daily  Do not coadminister in ART-experienced patients. 

Do not coadminister with  ATV +/− RTV. 

Do not coadminister with ATV +/− RTV. 

MVC 150 mg BID with ATV +/− RTV 

Standard 

DRV – always use with RTV 

PK data 

With (DRV 300 mg + RTV 100 mg) BID DRV: AUC ↓ 13%, Cmin ↓ 31% EFV: AUC ↑ 21% 

ETR 100 mg BID with (DRV 600 mg + RTV 100 mg) BID DRV: no significant change ETR: AUC ↓ 37%, Cmin ↓ 49% 

With (DRV 400 mg + RTV 100 mg BID) DRV: AUC ↑ 24%† NVP: AUC ↑ 27% and Cmin ↑ 47% 

With (DRV 600 mg + RTV 100 mg) BID MVC: AUC ↑ 305%  With (DRV 600 mg + RTV 100 mg) BID + ETR MVC: AUC ↑ 210% 

With (DRV 600 mg + RTV 100 mg) BID RAL: AUC ↓ 29% and Cmin ↑ 38% 

Dose 

Clinical significance unknown. Use standard doses and monitor closely. Consider monitoring levels. 

Standard (ETR 200 mg BID) Despite decreased ETR, safety and efficacy established with this combination in a clinical trial 

Standard MVC 150 mg BID Standard 

EFV PK data 

• 

↓ ETR possible NVP: no significant change EFV: AUC ↓ 22% 

MVC: AUC ↓ 45% EFV: AUC ↓ 36% 

Dose Do not coadminister. Do not coadminister. MVC: 600 mg BID Standard 

ETR PK data 

↓ ETR possible 

• 

↓ ETR possible MVC: AUC ↓ 53%, Cmax ↓ 60% 

ETR: Cmin ↓ 17% RAL: Cmin ↓ 34% 

Dose Do not coadminister. 

Do not coadminister. MVC 600 mg BID Standard 

FPV 

PK data 

With (FPV 1,400 mg + RTV 200 mg) once daily APV: Cmin ↓ 36% 

With (FPV 700 mg + RTV 100 mg) BID APV: AUC ↑ 69%, Cmin ↑ 77% 

With unboosted FPV 1,400 mg BID APV: AUC ↓ 33% NVP: AUC ↑ 29%  With (FPV 1,400 mg + RTV 100 mg) BID NVP: Cmin ↑ 19%  

Unknown; ↑ MVC possible No data 

Dose (FPV 1,400 mg + RTV 300 mg) once daily; or (FPV 700 mg + RTV 100 mg) BID EFV standard 

Do not coadminister with  FPV +/− RTV. 

(FPV 700 mg + RTV 100 mg) BID NVP standard 

MVC 150 mg BID Standard 

LPV/r 

PK data 

With LPV/r tablets 500/125 mg BID‡ + EFV 600 mg LPV levels similar to  LPV/r 400/100 mg BID without EFV 

With LPV/r tablets ETR: levels ↓ 30%–45% (comparable to the decrease with DRV/r) LPV: levels ↓ 13%–20% 

With LPV/r capsules LPV: AUC ↓ 27% and Cmin ↓51%  

MVC: AUC ↑ 295%  With LPV/r + EFV MVC: AUC ↑153% 

↓ RAL ↔ LPV/r 

Dose 

LPV/r tablets 500/125 mg‡ BID; LPV/r oral solution 533/133 mg BID  EFV standard 

Standard  LPV/r tablets 500/125 mg‡ BID; LPV/r oral solution 533/133 mg BID  NVP standard 

MVC 150 mg BID Standard 

January 10, 2011 

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents Page 38   

 EFV ETR NVP MVC RAL NVP 

PK data NVP: no significant change EFV: AUC ↓ 22% 

↓ ETR possible 

• 

No significant change No data 

Dose 

Do not coadminister. Do not coadminister. Without PI MVC 300 mg BID  With PI (except TPV/r) MVC 150 mg BID 

Standard 

RAL PK data 

RAL: AUC ↓ 36% ETR: Cmin ↑ 17% RAL: Cmin ↓ 34% 

No data RAL: AUC ↓ 37% MVC: AUC ↓ 21% 

• 

Dose Standard Standard No data Standard 

RTV PK data 

Refer to information for boosted PI Refer to information for boosted PI Refer to information for boosted PI 

With RTV 100 mg BID MVC: AUC ↑ 161% 

With RTV 100 mg BID RAL: AUC ↓ 16% 

Dose MVC 150 mg BID Standard 

SQV - always use with RTV 

PK data 

With SQV 1,200 mg TID SQV: AUC ↓ 62% EFV: AUC ↓ 12% 

With (SQV 1,000 mg + RTV 100 mg) BID SQV: AUC unchanged  ETR: AUC ↓ 33%, Cmin ↓ 29% Reduced ETR levels similar to reduction with DRV/r 

With SQV 600 mg TID SQV: AUC ↓ 38% NVP: no significant change 

With (SQV 1,000 mg + RTV 100 mg) BID MVC: AUC ↑ 877%  With (SQV 1,000 mg + RTV 100 mg) BID + EFV MVC: AUC ↑ 400% 

No data 

Dose 

(SQV 1,000 mg + RTV 100 mg) BID 

(SQV 1,000 mg + RTV 100 mg) BID 

(SQV 1,000 mg + RTV 100mg) BID 

MVC 150 mg BID Standard 

TPV – always use with RTV 

PK data 

With (TPV 500 mg + RTV 100 mg) BID  TPV: AUC ↓ 31%, Cmin ↓ 42% EFV: no significant change  With (TPV 750 mg + RTV 200 mg) BID TPV: no significant change EFV: no significant change 

With (TPV 500 mg + RTV 200 mg) BID ETR: AUC ↓ 76%, Cmin ↓ 82% TPV: AUC ↑ 18%, Cmin ↑ 24% 

With (TPV 250 mg + RTV 200 mg) BID and with (TPV 750 mg + RTV 100 mg) BID NVP: no significant change TPV: no data 

With (TPV 500 mg + RTV 200 mg) BID  MVC: no significant change in AUC TPV: no data 

With (TPV 500 mg + RTV 200 mg) BID RAL: AUC ↓ 24% 

Dose Standard Do not coadminister. Standard MVC 300 mg BID Standard 

 † Based on between-study comparison. ‡Use a combination of two LPV/r 200 mg/50 mg tablets + one LPV/r 100 mg/25 mg tablet to make a total dose of LPV/r 500 mg/125* mg. (* Error corrected  

January 18, 2011)  Acronyms: AUC = area under the curve, ATV = atazanavir, BID = twice daily, Cmax = maximum plasma concentration, Cmin = minimum plasma concentration,  DLV = delavirdine, DRV = darunavir, EFV = efavirenz, ETR = etravirine, FDA = Food and Drug Administration, FPV = fosamprenavir, IDV = indinavir,  LPV/r = lopinavir/ritonavir, MVC = maraviroc, NFV = nelfinavir, NNRTI = non-nucleoside reverse transcriptase inhibitor, NVP = nevirapine, PI = protease inhibitor,  PK = pharmacokinetic, RAL = raltegravir, RTV = ritonavir, SQV = saquinavir, TID = three times a day, TPV = tipranavir     

Table 16b. Interactions between NNRTIs*, MVC, RAL, and PIs* Page 2 of 2