Acetaminophen Interactions with HIV Drugs

Key Interaction Considerations

• The American College of Physicians recommends that non-nucleoside reverse transcriptase inhibitors (NNRTIs), particularly nevirapine, are associated with hepatotoxicity with an incidence of 12.5% and risk of fulminant hepatic necrosis and death 1
• Efavirenz causes unique neuropsychiatric effects but also carries hepatotoxicity risk 1
• The Infectious Diseases Society of America suggests that integrase strand transfer inhibitors (INSTIs) have the most favorable safety profile with the fewest drug interactions and minimal hepatotoxicity 1, 2
• Bictegravir, dolutegravir, and raltegravir-based regimens are preferred when chronic acetaminophen use is anticipated, as they avoid the CYP3A4 inhibition seen with PIs and the hepatotoxicity concerns with NNRTIs 2, 3, 4
• In patients with hepatitis B or C co-infection, the American Association for the Study of Liver Diseases recommends selecting an ART regimen that treats both HIV and hepatitis B, and using acetaminophen with extreme caution and at reduced doses (≤2 grams daily) 2