Interactions between Antiretroviral and Antimalarial drugs

Antimalarial drug HIV Treatment Mechanisms Management

Inhibition of cytochrome P450. Do not coadminister. Reduce
Quinine PI, NNRTI High levels of quinine. More quinine doses. Cardiologic
cardiologic and other side effects monitoring.

Decreasing the levels of

dihydroartemisinin, an active
Artemether PI ?
metabolite. But increasing the
levels of, also active, parent drug.
Atovaquone . AZT Lower AZT clearance ?
Probable decreases in
““ Ritonavir, Lopinavir ?
atovaquone AUC.
Decreasing the metabolism of
Proguanil Ritonavir ?
proguanil and its effectiveness
Mefloquine Ritonavir Decreasing levels of ritonavir. ?
Chloroquine Indinavir, Ritonavir, Increasing the effect of PI ?
Increasing risk of severe adverse
Sulfadoxine-pyrimethamine Co-trimoxazole Avoid coadministration.
cutaneous or hepatic reactions.
Possibility of additive risk of
Do not initiate both drugs
““ Nevirapine severe adverse cutaneous or
simultaneously.
hepatic reactions.
Careful coadministration under
Higher risk of bone marrow
““ AZT strict watch, Haematologic
toxicity (anemia).
controls.
Decreasing clearance of
Co-trimoxazole Lamivudine No clinical relevance.
lamivudine.
Possibility of adverse cutaneous Do not initiate both drugs
““ Nevirapine
reactions. simultaneously.
More risk of anemia due to bone
““ AZT Hematologic controls.
marrow toxicity.
Halofantrine/Lumefantrine PI, NNRTI Potential risk of cardiotoxicity. Avoid coadministration.
PI: protease inhibitor; NNRTI: nonnucleoside reverse transcriptase inhibitor; AZT: zidovudine; AUC: area under the curve.