Sumatriptan; Naproxen: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with nephrotoxic agents, such as nonsteroidal antiinflammatory drugs (NSAIDs). Eliglustat: (Major) Coadministration of tenofovir alafenamide and eliglustat may result in increased concentrations of tenofovir. Coadministration of drugs that reduce renal function or compete for active tubular secretion, such as NSAIDs and emtricitabine, may increase the risk of adverse reactions. Thus, if therapy is deferred, resistance testing should still be performed during acute HIV infection with the genotypic resistance test result kept in the patient's medical record until it becomes clinically useful. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. In most patients, a simplified pangenotypic HCV regimen (i.e., glecaprevir; pibrentasvir or sofosbuvir; velpatasvir) may be an appropriate choice; however, these regimens are NOT recommended for use in persons with HCV and HIV coinfection who: are treatment-experience with HCV relapse (reinfection after successful therapy is not an exclusion); have decompensated cirrhosis; on a tenofovir disoproxil fumarate containing regimen with eGFR less than 60 mL/minute; on efavirenz, etravirine, nevirapine, or boosted protease inhibitor; have untreated chronic hepatitis B; are pregnant. Coadministration of drugs that reduce renal function or compete for active tubular secretion, such as NSAIDs and emtricitabine, may increase the risk of adverse reactions. Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs, thus, increasing the risk of adverse reactions. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Routine administration of bictegravir under fasting conditions simultaneously with, or 2 hours after, calcium supplements is not recommended. Celecoxib; Tramadol: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with nephrotoxic agents, such as nonsteroidal antiinflammatory drugs (NSAIDs). Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs, thus, increasing the risk of adverse reactions. Routine administration of bictegravir under fasting conditions simultaneously with, or 2 hours after, calcium supplements is not recommended. Using highly active antiretroviral combination therapy (HAART) to maximally suppress viral replication is the most effective strategy to prevent the development of resistance and to minimize the risk of perinatal transmission. Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs, thus, increasing the risk of adverse reactions. Coadministration of drugs that reduce renal function or compete for active tubular secretion, such as NSAIDs and emtricitabine, may increase the risk of adverse reactions. Inhibitors of the drug transporter P-glycoprotein (P-gp), such as carvedilol, may increase absorption of tenofovir alafenamide, a P-gp substrate. (Moderate) Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as aminoglycosides. Huashan 1914 Creative Park - . Cobicistat is an inhibitor of the drug transporters P-glycoprotein (P-gp), breast cancer resistance protein (BCRP), and organic anion transport protein (OATP1B1/1B3). Bictegravir is a substrate of CYP3A4; fosphenytoin is a strong inducer of CYP3A4. Sucralfate: (Moderate) Concomitant administration of bictegravir and sucralfate may result in decreased bictegravir plasma concentrations. Treatment with bictegravir; emtricitabine; tenofovir alafenamide should be suspended in any patient who develops clinical or laboratory findings suggestive of hepatotoxicity or lactic acidosis, which may include hepatomegaly and steatosis even in the absence of marked elevated hepatic enzymes. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Tenofovir alafenamide is a substrate for P-gp. Calcium is a polyvalent cation that can bind bictegravir in the GI tract. Concomitant use may increase NSAID or emtricitabine concentrations. Routine administration of bictegravir under fasting conditions simultaneously with, or 2 hours after, iron supplements is not recommended. In patients with chronic kidney disease, a serum phosphorus concentration should also be assessed. Tenofovir alafenamide is a P-gp substrate and lonafarnib is a P-gp inhibitor. Probenecid; Colchicine: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with a nephrotoxic agent, such as probenecid. Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs; thus, increasing the risk of developing renal-related adverse reactions. Avoid using single-drug therapy to treat HBV (i.e., lamivudine, emtricitabine, tenofovir, or entecavir as the only active agent) as this may result in HIV resistant strains. Sofosbuvir; Velpatasvir: (Moderate) Monitor patients for tenofovir-associated adverse reactions, such as renal toxicity, in patients receiving regimens containing tenofovir alafenamide and velpatasvir due to potential increases in tenofovir serum concentrations. Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs, thus, increasing the risk of adverse reactions. (Moderate) Monitor for nonsteroidal antiinflammatory drug (NSAID) or emtricitabine-related adverse events during concomitant use. Bictegravir inhibits common renal tubular transport systems involved in the renal elimination of metformin (e.g., organic cationic transporter-2 [OCT2]/multidrug and toxin extrusion [MATE1]). Gadobutrol: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with nephrotoxic agents, such as radiopaque contrast agents. Coadministration of drugs that reduce renal function or compete for active tubular secretion, such as NSAIDs and emtricitabine, may increase the risk of adverse reactions. Tenofovir alafenamide is a substrate for all three transporters. Foscarnet: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with a nephrotoxic agent, such as foscarnet. (Moderate) Monitor for nonsteroidal antiinflammatory drug (NSAID) or emtricitabine-related adverse events during concomitant use. (Moderate) Monitor for changes in serum creatinine and adverse reactions, such as lactic acidosis or hepatotoxicity if emtricitabine is administered in combination with nephrotoxic agents, such as cidofovir. Dosage: Adult and pediatric patients weighing 25 kg: 1 tablet containing 50 mg bictegravir (BIC), 200 mg emtricitabine (FTC), and 25 mg tenofovir alafenamide (TAF) taken once daily with or without food. CrCl 30 mL/minute or more: No dosage adjustment necessary.CrCl 15 to 29 mL/minute: Safety and efficacy have not been established.CrCl less than 15 mL/minute and not on hemodialysis: Safety and efficacy have not been established. Posaconazole is an inhibitor of the drug transporter P-glycoprotein (P-gp). Both emtricitabine and aminoglycosides are excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Bictegravir inhibits common renal tubular transport systems involved in the renal elimination of metformin (e.g., organic cationic transporter-2 [OCT2]/multidrug and toxin extrusion [MATE1]). Simultaneous coadministration of calcium carbonate (1200 mg single dose) and bictegravir (50 mg . Of note, when tenofovir alafenamide is administered as part of a cobicistat-containing product, its availability is increased by cobicistat and a further increase of tenofovir alafenamide concentrations is not expected upon coadministration of an additional P-gp inhibitor. Data involving first trimester exposures to bictegravir are insufficient to draw conclusions regarding the potential for birth defects; however, the APR has received reports of 2 CNS birth defects among 234 exposures to bictegravir-containing regimens (i.e., 2 of 165 periconception, 0 of 18 later first trimester, and 0 of 51 second/third trimesters). Diclofenac: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with nephrotoxic agents, such as nonsteroidal antiinflammatory drugs (NSAIDs). Nucleoside reverse transcriptase inhibitors (NRTIs) are known to induce mitochondrial dysfunction. Acetaminophen; Aspirin: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with nephrotoxic agents, such as salicylates. Aspirin, ASA; Caffeine; Orphenadrine: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with nephrotoxic agents, such as salicylates. Pregnant patients receiving nucleoside analogs should have LFTs and serum electrolytes assessed more frequently during the last trimester of pregnancy and any new symptoms should be evaluated thoroughly. Taking these drugs simultaneously without food results in reduced bioavailability of bictegravir. Routine administration of bictegravir under fasting conditions simultaneously with, or 2 hours after, calcium supplements is not recommended. Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs, thus, increasing the risk of adverse reactions. Pediatric patients weighing 14 kg to <25 kg: 1 tablet containing 30 mg BIC, 120 mg FTC, and 15 mg TAF taken once daily with or without food. Taking these drugs simultaneously without food results in reduced bioavailability of bictegravir. If concomitant use is unavoidable, closely monitor for adverse reactions. Dofetilide is a substrate of OCT2 and MATE1; bictegravir is an inhibitor of these drug transporters. (Major) Concomitant use of bictegravir and rifabutin is not recommended as coadministration may result in decreased bictegravir plasma concentrations, which may result in the loss of therapeutic efficacy and development of resistance. (Yintao Rd.) Pamidronate: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with a nephrotoxic agent, such as pamidronate. Tenofovir alafenamide is a substrate for the drug transporter organic anion transporting polypeptide (OATP1B1/1B3); lopinavir is an OATP1B1 inhibitor. Of note, when tenofovir alafenamide is administered as part of a cobicistat-containing product, its availability is increased by cobicistat and a further increase of tenofovir alafenamide concentrations is not expected upon coadministration of an additional P-gp inhibitor. While the development of severe or fatal mitochondrial disease in exposed infants appears to be extremely rare, more intensive monitoring of hematologic and electrolyte parameters during the first few weeks of life is advised. While not reported during tenofovir alafenamide clinical trials, cases of osteomalacia secondary to proximal renal tubulopathy have been reported with tenofovir disoproxil fumarate. Concomitant use of fostamatinib with a BCRP or P-gp substrate may increase the concentration of the BCRP or P-gp substrate. Administering or prescribing the incorrect formulation may result in reduced antiretroviral efficacy, development of viral resistance, or adverse reactions. Gentamicin: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with nephrotoxic agents, such as aminoglycosides. (Major) Consider an alternative anticonvulsant during treatment with bictegravir. Therefore, patients coinfected with HBV and HIV who discontinue bictegravir; emtricitabine; tenofovir alafenamide should have transaminase concentrations monitored every 6 weeks for the first 3 months, and every 3 to 6 months thereafter. Iron is a polyvalent cation that can bind bictegravir in the GI tract. Abrocitinib: (Moderate) Coadministration of tenofovir alafenamide with abrocitinib may result in increased plasma concentrations of tenofovir leading to an increase in tenofovir-related adverse effects. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs, thus, increasing the risk of adverse reactions. Temsirolimus: (Moderate) Monitor for an increase in tenofovir alafenamide-related adverse reactions if coadministration with temsirolimus is necessary. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Aspirin, ASA; Omeprazole: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with nephrotoxic agents, such as salicylates. While no drug interactions due to competition for renal excretion have been observed, coadministration of these medications may increase concentrations of both drugs. Omeprazole; Amoxicillin; Rifabutin: (Major) Coadministration is not recommended. Grapefruit juice: (Moderate) Caution is advised when administering tenofovir, PMPA, a P-glycoprotein (P-gp) substrate, concurrently with inhibitors of P-gp, such as grapefruit juice. In clinical trials of bictegravir; emtricitabine; tenofovir alafenamide, less than 1% of drug recipients experienced a serious renal adverse event and no patient discontinued treatment due to renal events; however, cases of acute renal failure, acute tubular necrosis, proximal renal tubulopathy, and Fanconi syndrome have been reported during postmarketing use of tenofovir alafenamide-containing regimens. Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs, thus, increasing the risk of adverse reactions. The drug may be used without dose adjustments in patients with mild to moderate hepatic impairment (Child-Pugh Class A and B). Gilteritinib: (Moderate) Coadministration of tenofovir alafenamide with gilteritinib may result in increased plasma concentrations of tenofovir leading to an increase in tenofovir-related adverse effects. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. One study estimated exposures to emtricitabine in exclusively breast-fed infants at approximately 2% of the recommended infant dose. (Moderate) Tacrolimus therapeutic drug monitoring is recommended when administered concurrently with tenofovir alafenamide. Demonstrated Long-Term Safety and Tolerability Profile in Treatment-Nave Adults Through Week 1443,4 Consider the potential for drug interaction prior to and during concurrent use of these medications. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Tenofovir AF is a substrate for the drug transporters P-glycoprotein (P-gp), BCRP, OATP1B1, and OATP1B3. Empagliflozin; Metformin: (Moderate) Caution is advised when administering bictegravir with metformin, as coadministration may increase exposure to metformin and increase the risk for hypoglycemia, gastrointestinal side effects, and potentially increase the risk for lactic acidosis. (Moderate) Monitor for nonsteroidal antiinflammatory drug (NSAID) or emtricitabine-related adverse events during concomitant use. There are insufficient data to recommend the use of bictegravir; emtricitabine; tenofovir alafenamide in pregnant patients or patients who are trying to become pregnant. Aspirin, ASA; Butalbital; Caffeine; Codeine: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with nephrotoxic agents, such as salicylates. Ticagrelor: (Minor) Close clinical monitoring for adverse events is advised when administering tenofovir alafenamide with ticagrelor. In drug interaction studies, simultaneous administration of bictegravir with another calcium supplement under fasted conditions decreased the mean AUC of bictegravir by approximately 33%. The prevalence of transmitted drug resistance (TDR) in high-income countries ranges from 9% to 14% and varies by country. Polysaccharide-Iron Complex: (Moderate) Administer bictegravir with food at the same time as iron supplements. Tenofovir alafenamide is a substrate for P-gp. Product Labeling1 PK Data No dosage adjustment of BIC/FTC/TAF is recommended in patients with estimated CrCl 30 mL/min, or in virologically-suppressed adults with ESRD (estimated CrCl <15 mL/min) who are receiving chronic HD. However, when tenofovir alafenamide is administered as part of a cobicistat-containing product, its availability is increased by cobicistat and a further increase of tenofovir alafenamide concentrations is not expected upon coadministration of an additional P-gp inhibitor. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Close monitoring of blood glucose and patient clinical status is recommended. Gadoversetamide: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with nephrotoxic agents, such as radiopaque contrast agents. Dosage adjustments are not required for mild to moderate hepatic impairment (Child-Pugh Class A and B). In drug interaction studies, bictegravir increased both the Cmax and AUC of metformin at a metformin dose of 500 mg PO twice daily. Bictegravir is a substrate of CYP3A4 and UGT1A1; atazanavir is a strong inhibitor of CYP3A4 and an inhibitor of UGT1A1. As with other medications, Biktarvy can interact. Concomitant use may increase NSAID or emtricitabine concentrations. Antiretroviral therapy should be provided to all patients during pregnancy, regardless of HIV RNA concentrations or CD4 cell count. Concomitant use may increase NSAID or emtricitabine concentrations. Aluminum Hydroxide: (Moderate) Administer bictegravir on an empty stomach 2 hours before or 6 hours after taking antacids containing aluminum or magnesium. While no drug interactions due to competition for renal excretion have been observed, coadministration of these medications may increase concentrations of both drugs. Lonafarnib: (Moderate) Coadministration of tenofovir alafenamide with lonafarnib may result in increased plasma concentrations of tenofovir leading to an increase in tenofovir-related adverse effects. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Tenofovir is primarily excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Fenoprofen: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with nephrotoxic agents, such as nonsteroidal antiinflammatory drugs (NSAIDs). Bictegravir is a substrate of CYP3A4; rifabutin is an inducer of CYP3A4. 1 tablet/day PO (bictegravir 50 mg/day; emtricitabine 200 mg/day; tenofovir alafenamide 25 mg/day). Tenofovir alafenamide is a substrate for P-gp. Side effects of Triumeq that are different from Biktarvy include vomiting, fever, loss of appetite, low energy, abnormal body fat distribution, numbness and tingling, hypersensitivity reactions (fever, rash, shortness of breath, cough, or sore throat ), joint pain or swelling, muscle pain, extremity swelling, depression, and spinning sensation (. Tenofovir alafenamide is a P-gp and BCRP substrate and encorafenib is a BCRP inhibitor. Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs; thus, increasing the risk of developing renal-related adverse reactions. Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs; thus, increasing the risk of developing renal-related adverse reactions. Elacestrant: (Moderate) Coadministration of tenofovir alafenamide with elacestrant may result in increased plasma concentrations of tenofovir leading to an increase in tenofovir-related adverse effects. Ibuprofen; Pseudoephedrine: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with nephrotoxic agents, such as nonsteroidal antiinflammatory drugs (NSAIDs). Cobicistat is an inhibitor of the drug transporters P-glycoprotein (P-gp), breast cancer resistance protein (BCRP), and organic anion transport protein (OATP1B1/1B3). However, because pregnancy itself can mimic some early symptoms of the lactic acid/hepatic steatosis syndrome or be associated with other significant disorders of liver metabolism, clinicians need to be alert for early diagnosis of this syndrome. Health care providers are advised to reinitiate a complete and effective antiretroviral regimen as soon as possible after an interruption of therapy. Of note, when tenofovir alafenamide is administered as part of a cobicistat-containing product, its availability is increased by cobicistat and a further increase of tenofovir alafenamide concentrations is not expected upon coadministration of an additional P-gp inhibitor. Of note, when tenofovir alafenamide is administered as part of a cobicistat-containing product, its availability is increased by cobicistat and a further increase of tenofovir alafenamide concentrations is not expected upon coadministration of an additional P-gp inhibitor. Tenofovir alafenamide is a P-gp and BCRP substrate and maribavir is a P-gp and BCRP inhibitor. HIV treatment guidelines recommend all patients presenting with HIV infection undergo routine screening for hepatitis C virus (HCV). Taipei City (/tape/; [tipi]; Chinese: or ; pinyin: Tibi Sh) is the capital of the Republic of China (Taiwan). Fostamatinib is a P-gp inhibitor, and the active metabolite of fostamatinib, R406, is a BCRP inhibitor; tenofovir alafenamide is a substrate for BCRP and P-gp. Apalutamide: (Moderate) Concomitant use of bictegravir and apalutamide may result in decreased bictegravir plasma concentrations, which may result in the loss of therapeutic efficacy and development of resistance. Routine administration of bictegravir simultaneously with, or 2 hours after, antacids containing aluminum or magnesium is not recommended as the bioavailability of bictegravir may be reduced. Carbamazepine: (Major) Administering tenofovir alafenamide with carbamazepine is not recommended. Concomitant use may increase NSAID or emtricitabine concentrations. The median terminal plasma half-life is approximately 10 hours. Tenofovir alafenamide is a BCRP substrate and leniolisib is a BCRP inhibitor. In drug interaction studies, simultaneous administration of bictegravir and ferrous fumarate under fasted conditions decreased the mean AUC of bictegravir by approximately 63%. Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs, thus, increasing the risk of adverse reactions. Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs, thus, increasing the risk of adverse reactions. These mutations confer cross-resistance with abacavir, didanosine, emtricitabine, and lamivudine. Dolutegravir; Lamivudine: (Major) Do not coadminister lamivudine, 3TC-containing products and emtricitabine-containing products due to similarities between emtricitabine and lamivudine. This product is a combination of 3 different drugs: bictegravir, emtricitabine, and tenofovir alafenamide. (Moderate) Use caution when administering dofetilide concurrently with emtricitabine as both drugs are actively secreted via cationic secretion and could compete for common renal tubular transport systems. Tenofovir alafenamide is a P-gp and BCRP substrate and enasidenib is a P-gp and BCRP inhibitor. Vancomycin: (Moderate) Monitor for changes in renal function if tenofovir alafenamide is administered in combination with a nephrotoxic agent, such as vancomycin. Discontinue BIKTARVY if clinical or laboratory findings suggestive of lactic acidosis or pronounced hepatotoxicity develop, including hepatomegaly and steatosis in the absence of marked transaminase elevations. May administer under fasting conditions 2 hours before antacids containing these cations.May administer simultaneously with supplements containing calcium or iron together with food; however, administration under fasting conditions simultaneously with, or 2 hours after, supplements containing calcium or iron is not recommended. Bictegravir is a substrate of CYP3A4; carbamazepine is a strong inducer of CYP3A4. Seventh Deanery. Of note, when tenofovir alafenamide is administered as part of a cobicistat-containing product, its availability is increased by cobicistat and a further increase of tenofovir alafenamide concentrations is not expected upon coadministration of an additional P-gp inhibitor. Clindamycin: (Moderate) Concomitant use of tenofovir alafenamide and clindamycin may result in additive nephrotoxicity. MRP2 inhibitors have the potential to increase plasma concentrations of cabozantinib. The recommended dosage of BIKTARVY is one tablet taken orally once daily with or without food in: adults and pediatric patients weighing at least 25 kg and estimated creatinine Coadministration of tenofovir alafenamide with a drug that reduces renal function or competes for active tubular secretion may increase concentrations of tenofovir and other renally eliminated drugs, thus, increasing the risk of adverse reactions. While no drug interactions due to competition for renal excretion have been observed, coadministration of these medications may increase concentrations of both drugs. Tenofovir alafenamide is a substrate for the drug transporter organic anion transporting polypeptide (OATP1B1/1B3); atazanavir is an OATP1B1 inhibitor. Consider the potential for drug interaction prior to and during concurrent use of these medications. Bictegravir is a substrate of CYP3A4; rifampin is a potent inducer of this isoenzyme. Although these adverse events may occur in any drug recipient, some risk factors include impaired hepatic function (e.g., alcoholism), obesity, and prolonged nucleoside exposure. Canagliflozin; Metformin: (Moderate) Caution is advised when administering bictegravir with metformin, as coadministration may increase exposure to metformin and increase the risk for hypoglycemia, gastrointestinal side effects, and potentially increase the risk for lactic acidosis. [61413] [62852]. 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