Drug-drug Interactions

Several anti-hypertensive drugs may interact pharmacokinetically with a number of antiretroviral (ARV) agents.


Clinicians should also consider overlapping side effects of ARV and other medications with anti-hypertensive agents, and the effect of other existing co-morbidities. See the main Treatment section. 



Summary of drug-drug interactions between antiretrovirals and key anti-hypertensives2

  • Angiotensin-converting enzyme inhibitors (ACEIs): lisinopril, perindopril, and ramipril have no clinically significant known or predicted interactions with protease inhibitor (PIs), non-nucleoside reverse-transcriptase inhibitors (NNRTIs), nuceloside/nucleotide reverse transcriptase inhibitors (NRTIs), maraviroc, or raltegravir.
  • Angiotensin II receptor blockers (ARBs):
    • candesartan: no clinically significant interactions expected with PIs, NNRTIs, NRTIs, maraviroc, or raltegravir
    • losartan: potential interactions with all PIs, NNRTIs, abacavir, zidovudine, and maraviroc, but not with other NRTIs or raltegravir.
       
  • Calcium channel blockers (CCBs): amlodipine, diltiazem and verapamil have potential interactions with all PIs and NNRTIs. No data are available for NRTIs, maraviroc or raltegravir.
  • Diuretics:
    • bendroflumethiazide and chlorthalidone: no clinically significant interactions expected with PIs, NNRTIs, NRTIs, maraviroc, or raltegravir
    • indapamide: potential interactions with emtricitabine, lamivudine, and tenofovir. No clinically significant interactions expected with other NRTIs, PIs, NNRTIs, maraviroc, or raltegravir
    • spironolactone: no known or predicted interactions with PIs, NNRTIs, NRTIs, maraviroc, or raltegravir
       
  • Alpha blockers: doxazosin has potential interactions with all PIs and NNRTIs. No interactions expected with NRTIs, maraviroc, or raltegravir.
  • Beta blockers: atenolol has potential interactions with atazanavir, darunavir, lopinavir, ritonavir and tipranavir, but not with fosamprenavir, indinavir, nelfinavir, or saquinavir. No significant interactions are expected with NNRTIs. No data are available on interactions with NRTIs, maraviroc, or raltegravir.
     

References

  1. European AIDS Clinical Society (EACS). Guidelines. Version 6.0. Accessed 3 July 2012.
  2. University of Liverpool. The HIV drug interactions website. Accessed 21 March 2011.