ART Drug Interaction Checker
Check Medication Interactions
Select your HIV medication and other drugs to see potential interactions
Interaction Results
Nearly half of older adults living with HIV take five or more medications daily. This polypharmacy creates a hidden danger: dangerous drug interactions that can lead to treatment failure or life-threatening side effects. Antiretroviral Therapy (ART) is a combination of medications used to treat HIV infection that saves lives, but when combined with common drugs like statins, blood pressure medications, or herbal supplements, it can cause serious complications. Understanding these interactions is critical for staying healthy and avoiding dangerous outcomes.
Why ART Drug Interactions Matter Now
According to the CDC's 2022 HIV Surveillance Report, 52% of people diagnosed with HIV in the United States are aged 50 or older-up from just 12% in 2005. This demographic shift means more people with HIV are managing multiple health conditions, leading to polypharmacy. A 2022 study in Medicina e Pharmacia Romania found that ART drugs account for 37% of the most frequent drugs involved in potential clinically significant drug interactions (CSDIs). For every additional medication taken, the risk of harmful interactions increases by 18%. This isn't just a theoretical risk; it's a daily reality for many.
How Different ART Classes Interact Differently
ART drugs don't all interact the same way. The risk depends heavily on the specific class of antiretroviral you're taking. Here's how they compare:
| ART Class | Key Drugs | Interaction Risk Level | Common Interactions |
|---|---|---|---|
| Protease Inhibitors (boosted) | ritonavir, cobicistat, darunavir | Very High | Simvastatin (contraindicated), amlodipine (hypotension risk), SSRIs (serotonin syndrome) |
| Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) | efavirenz, rilpivirine | Moderate | St. John's Wort (reduces efavirenz by 60%), antifungals, some antibiotics |
| Integrase Strand Transfer Inhibitors (INSTIs) | dolutegravir, bictegravir | Low | Metformin (reduces concentration by 33%), rifampin (reduces bictegravir by 71%) |
Ritonavir-boosted protease inhibitors are the most problematic. Ritonavir alone has over 217 documented interactions, while bictegravir has only seven. For example, combining ritonavir with simvastatin can increase statin levels by 20-30 times, causing muscle damage. However, INSTIs like dolutegravir are much safer-only 8.3% of common medications interact significantly with it. But even INSTIs aren't completely risk-free; dolutegravir reduces metformin effectiveness by 33%, which matters for people with diabetes.
Top 5 High-Risk Interactions to Watch For
Here are five dangerous combinations that require immediate attention:
- Simvastatin or lovastatin with boosted protease inhibitors: These statins can become toxic when combined with ritonavir or cobicistat. Dr. David Alain Wohl warns this combination is 'absolutely contraindicated' due to the risk of life-threatening rhabdomyolysis. Safer alternatives include pitavastatin or fluvastatin.
- SSRIs with ritonavir: Combining ritonavir with antidepressants like fluoxetine can cause serotonin syndrome-a potentially fatal condition. In documented cases, fluoxetine doses needed to be reduced by 50% or ritonavir discontinued.
- Inhaled corticosteroids with boosted PIs: Medications like fluticasone or budesonide nasal spray can cause adrenal insufficiency when used with ritonavir. The University of Washington reports 17% of patients on boosted regimens who used these steroids required hospitalization.
- Calcium channel blockers like amlodipine: Ritonavir increases amlodipine concentrations by 1.6-fold, leading to severe low blood pressure. Dose adjustments are necessary.
- St. John's Wort with efavirenz: This herbal supplement reduces efavirenz levels by 50-60%, risking treatment failure and drug resistance. Patients must avoid it entirely.
Managing Interactions: Practical Steps for Patients and Providers
Managing these risks starts with transparency. 'Conduct a thorough medication history at every visit, including prescription, over-the-counter, herbal, and recreational drugs,' advises the University of Washington HIV Education materials. Over a third of significant interactions involve non-prescription substances.
Use trusted tools like the University of Liverpool HIV Drug Interactions Checker, which has over 347 antiretrovirals and 1,267 non-antiretroviral medications with evidence-based recommendations. If you're switching ART regimens-for example, from a ritonavir-boosted PI to dolutegravir-your doctor may need to adjust doses of other medications. Tacrolimus, an immunosuppressant, typically requires a 75% dose reduction in this scenario.
The American Academy of HIV Medicine recommends clinicians complete their 8-hour Drug Interaction Management certification course. A 2021 study in Clinical Infectious Diseases showed this reduces interaction-related adverse events by 42%. For patients, always ask: 'Is this medication safe with my HIV drugs?' and bring a complete list of everything you take to appointments.
New Developments and Future Solutions
Newer treatments are making interactions easier to manage. The March 2023 HHS Guidelines introduced specific recommendations for lenacapavir, a long-acting injectable that inhibits CYP3A and requires avoiding certain medications like colchicine. The University of Liverpool's Drug Interaction Checker updated in January 2023 added 47 new antiretrovirals and 182 non-antiretroviral medications.
The National Institutes of Health allocated $12.7 million in 2024 specifically to develop 'interaction-proof' ART regimens. By 2030, experts predict next-generation treatments will have 80% fewer clinically significant interactions than current boosted PI regimens. This progress is crucial as the HIV population ages and faces more complex medication needs.
Can I take statins with antiretroviral therapy?
Yes, but not all statins are safe. Simvastatin and lovastatin are absolutely contraindicated with boosted protease inhibitors due to dangerously high levels. Safer options include pitavastatin (4mg daily) and fluvastatin (80mg daily), which have minimal interactions. Always consult your doctor before starting any statin while on ART.
What should I do if I'm taking multiple medications for HIV and other conditions?
First, create a complete list of all medications-including prescription, over-the-counter, herbal supplements, and recreational drugs. Use the University of Liverpool HIV Drug Interactions Checker to identify potential risks. Schedule a medication review with your HIV specialist and pharmacist. They can adjust doses or switch medications to avoid dangerous interactions. Never stop or change doses without professional guidance.
Is it safe to take St. John's Wort with HIV medications?
No. St. John's Wort significantly reduces the effectiveness of many HIV drugs, especially efavirenz. It can lower efavirenz levels by 50-60%, risking treatment failure and drug resistance. Avoid this herbal supplement entirely if you're on ART. Always discuss any supplements with your healthcare provider before taking them.
How do I know if my ART is interacting with another medication?
Symptoms of interactions can include muscle pain (from statin toxicity), dizziness (from blood pressure changes), or unusual fatigue (from adrenal issues). However, many interactions have no obvious symptoms. The best approach is proactive: use the Liverpool Drug Interaction Checker, maintain a medication list, and discuss all drugs with your healthcare team at every visit. Regular blood tests can also help monitor for issues like elevated creatinine kinase (for muscle damage) or altered drug levels.
Are newer HIV medications safer in terms of drug interactions?
Yes. Integrase inhibitors like dolutegravir and bictegravir have significantly fewer interactions than older protease inhibitors. For example, dolutegravir has only eight major documented interactions compared to ritonavir's 217. Newer drugs like lenacapavir (a capsid inhibitor) are designed with minimal enzyme effects, reducing interaction risks. However, no medication is completely interaction-free, so vigilance is still necessary.