Drug Interactions and Management

Antiretroviral Interactions

Non-nucleoside reverse transcriptase inhibitors (NNRTIs) like efavirenz can induce CYP3A4, potentially decreasing tramadol effectiveness, as recommended by the American Association for the Study of Liver Diseases 1
HIV protease inhibitors are metabolized by and inhibit CYP3A4, creating potential for interaction with tramadol, according to the American Association for the Study of Liver Diseases 1
Darunavir and atazanavir, when boosted with ritonavir, require careful monitoring if used with tramadol, as noted by the American Association for the Study of Liver Diseases 1
Integrase inhibitors like raltegravir and dolutegravir (unboosted) have fewer interactions with tramadol, as stated by the American Association for the Study of Liver Diseases 1
Nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) such as tenofovir, emtricitabine, lamivudine, and abacavir generally have minimal interactions with tramadol, as recommended by the American Association for the Study of Liver Diseases 1
Rilpivirine has fewer interactions compared to other NNRTIs, according to the American Association for the Study of Liver Diseases 1
Maraviroc and enfuvirtide generally have minimal interactions with tramadol, as noted by the American Association for the Study of Liver Diseases 1

Patients on efavirenz, etravirine, or nevirapine require monitoring for reduced analgesic effect and consideration of alternative pain management if inadequate response, as recommended by the American Association for the Study of Liver Diseases 1
A complete medication review is recommended before prescribing medications like Paxlovid to identify potential drug interactions, considering the patient's prescription medications, OTC drugs, and supplements, according to the American College of Cardiology and other guideline societies 2
Careful consideration and management of interactions is necessary for medications such as alpha-1 adrenoreceptor antagonists, antianginals, antiarrhythmics, anticancer drugs, and anticoagulants, as recommended by guideline societies 2

Rosuvastatin is contraindicated with Paxlovid due to a 19-fold increase in exposure, as recommended by the American Heart Association 2
Sildenafil for pulmonary arterial hypertension is contraindicated with Paxlovid, while sildenafil for erectile dysfunction should be limited to 25 mg in a 48-hour period, according to the American Urological Association 2
Warfarin, apixaban, and dabigatran require careful management and dose adjustments when co-administered with Paxlovid, considering the patient's renal function and indication for anticoagulation, as recommended by the American College of Clinical Pharmacy 2
Tacrolimus and cyclosporine require dose adjustments or discontinuation when co-administered with Paxlovid, as recommended by the American Society of Transplantation 2
Other statins may require temporary discontinuation or significant dose reduction when co-administered with Paxlovid, according to the American College of Cardiology 2

Elderly patients require additional caution due to reduced clearance of interacting medications, as recommended by the American Geriatrics Society 2
Patients with renal impairment may require dose adjustments, according to the National Kidney Foundation 2
Patients with hepatic impairment have altered clearance of many medications, necessitating careful consideration and management of interactions, as recommended by the American Association for the Study of Liver Diseases 2
HIV-infected patients have complex interactions with antiretroviral medications, requiring careful management and consideration of potential interactions, as recommended by the Infectious Diseases Society of America 3

Paxlovid can be administered with raltegravir, rilpivirine, maraviroc, enfuvirtide, tenofovir, emtricitabine, lamivudine, abacavir, and dolutegravir, as recommended by the Infectious Diseases Society of America 3
Efavirenz, etravirine, nevirapine, cobicistat, and HIV protease inhibitors should be avoided due to potential interactions, as recommended by the Infectious Diseases Society of America 3