Bronchodilators & ARVs

Drug-drug interactions between bronchodilators (for COPD) & ARVs

 Legend

↑                  Potential elevated exposure of the bronchodilator
↓                  Potential decreased exposure of the bronchodilator
↔                No significant effect
D                  Potential decreased exposure of ARV drug
E                  Potential elevated exposure of ARV drug

ATV/c         ATV co-formulated with COBI (300/150 mg qd)
DRV/c         DRV co-formulated with COBI (800/150 mg qd)
CAB/RPV   CAB and RPV im long acting injections (PK and/or QT interactions shown are with RPV)

Numbers refer to increased or decreased AUC as observed in drug-drug interaction studies

ICS        inhaled corticosteroids
LABA    long-acting β2 agonists
LAMA   long-acting muscarinic antagonists
MX        methylxanthines
PD4       phosphodiesterase 4 inhibitors
SABA    short-acting β2 agonists
SAMA   short-acting muscarinic antagonists

 

Interactions with ABC, FTC, 3TC, ZDV

ABC, FTC, 3TC, ZDV: no clinically relevant interactions expected.

 

Interactions with ibalizumab

None

 

Comments

  1. Caution as both drugs can induce QT interval prolongation.
  2. Exposure can be increased up to 2-fold however this increase does not raise any concerns based on indacaterol's safety data.
  3. Increase in concentration of active metabolite observed with RTV 100 mg bid alone but without significant effect on adrenal function. Caution is still warranted, use the lowest possible corticosteroid dose and monitor for corticosteroid side effects.
  4. DRV/r decreased the exposure of active metabolite (beclometasone- 17-monopropionate), no significant effect on adrenal function was seen.
  5. Risk of having elevated corticosteroid levels, Cushing's syndrome and adrenal suppression. This risk is present for oral and injected corticosteroid but also for topical, inhaled or eye drops administration.
  6. No dose adjustment required but monitor closely, especially for signs of Cushing's syndrome when using a high dose or prolonged administration.

 

Further Information

For additional drug-drug interactions and for more detailed pharmacokinetic interaction data and dosage adjustments, please refer to: http://www.hiv-druginteractions.org (University of Liverpool)

 

Note

Fixed dose combinations are available for LAMA + LABA + ICS, e.g.,
-  mometasone + indacaterol + glycopyrronium
-  fluticasone + umeclidinium + vilanterol
-  formoterol + glycopyrronium + beclometasone
-  budesonide + formoterol + glycopyrronium