Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) is indicated for use as a complete regimen for the treatment of HIV-1 infection. However, in specific clinical situations where an intensification of HIV treatment is needed, coadministration with abacavir would be possible from a pharmacokinetic standpoint. Based on metabolism and clearance a clinically significant interaction with abacavir and rilpivirine, emtricitabine or tenofovir alafenamide is unlikely.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Abatacept is a fusion protein consisting of the extracellular domain of human CTLA-4 linked to a modified Fc portion of human IgG1 and is likely to be eliminated via proteolytic catabolism throughout the body. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Abemaciclib is metabolized by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Rilpivirine is metabolized by CYP3A4 but abemaciclib has no inhibitory or inducing effects on CYPs. No interaction is expected with emtricitabine and tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Abiraterone is metabolized by CYP3A4 and SULT2A1. Rilpivirine, emtricitabine and tenofovir-alafenamide do not interact with these metabolic pathways.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Abrocitinib is mainly metabolized by CYP2C19 and CYP2C9, and to a lesser extent by CYP3A4 and CYP2B6. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP enzymes at clinically relevant concentrations. Abrocitinib does not inhibit or induce CYP3A4. No interaction is expected with emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Acalabrutinib is metabolized by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Rilpivirine is metabolized by CYP3A4. Acalabrutinib has no inhibitory or inducing effects on CYP3A4 at clinically relevant concentrations. No interaction is expected with emtricitabine and tenofovir alafenamide.

Coadministration has not been studied. Acamprosate is eliminated unchanged in the urine both via glomerular filtration and active secretion (renal transporter unknown, possibly OATs or OCTs). A clinically significant interaction with rilpivirine is unlikely. Tenofovir alafenamide is unlikely to compete with acamprosate for renal transporters as tenofovir alafenamide results in 90% lower systemic levels of tenofovir compared to tenofovir-DF. However, acamprosate and emtricitabine may compete for tubular secretion, which could lead to increased concentrations of either drug. The clinical relevance of this interaction is unknown.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. After ingestion of acarbose, the majority of active unchanged drug remains in the lumen of the gastrointestinal tract to exert its pharmacological activity and is metabolised by intestinal enzymes and by the microbial flora. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Acenocoumarol is mainly metabolized by CYP2C9 and to a lesser extent by CYP1A2 and CYP2C19. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied. Acetazolamide is predominantly excreted unchanged via active renal tubular secretion. In vitro studies have shown acetazolamide may competitively inhibit renal transporters OAT1, OAT3 and OAT4. Inhibition of these renal transporters is unlikely to lead to significant increase in tenofovir as tenofovir alafenamide results in 90% lower systemic levels of tenofovir compared to tenofovir-DF. No effect on emtricitabine exposure is expected. Rilpivirine does not interfere with acetazolamide elimination.

Coadministration has not been studied. Aciclovir is eliminated renally via glomerular filtration and active renal secretion by OAT1. Rilpivirine does not interfere with acyclovir elimination. Emtricitabine and tenofovir alafenamide are unlikely to compete with aciclovir for renal transporters as emtricitabine is eliminated by different renal transporters and tenofovir alafenamide results in 90% lower systemic levels of tenofovir compared to tenofovir-DF. 

Coadministration has not been studied but, based on metabolism and clearance, a clinically significant interaction is unlikely as acitretin undergoes isomerisation and glucuronidation. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Aclidinium bromide is rapidly and extensively hydrolyzed (non-enzymatic and enzymatic transformation by esterases and butylrylcholineesterases) to its pharmacologically inactive metabolites with only a minor role for CYP metabolism.

Coadministration has not been studied. Activated charcoal absorbs substances in the stomach and intestines and may decrease absorption of orally administered medicines. If coadministration is required, administration of activated charcoal and rilpivirine, emtricitabine, tenofovir alafenamide should be separated by 4 hours. [Note: this interaction is not specific for rilpivirine, emtricitabine, tenofovir alafenamide, but for any oral medication taken with activated charcoal.]

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Adalimumab is a monoclonal IgG antibody. Elimination is similar to endogenous IgG and occurs primarily via proteolytic catabolism throughout the body.

Coadministration has not been studied and is contraindicated. Odefsey contains tenofovir (derived from tenofovir alafenamide) which should not be used concomitantly with adefovir dipivoxil.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Adrenaline is rapidly inactivated, mostly in the liver by catechol-O-methyltransferase (COMT) and monoamine oxidase (MAO). 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Afatinib is mainly eliminated unchanged in the faeces and does not inhibit or induce CYP3A4. Rilpivirine is metabolized mainly by CYP3A4. Emtricitabine and tenofovir (derived from tenofovir alafenamide) are eliminated renally. No interaction is expected with emtricitabine. Afatinib is a moderate inhibitor of P-gp but is unlikely to significantly increase tenofovir alafenamide absorption.

Coadministration has not been studied. African potato was shown to inhibit CYP3A4 and P-gp in vitro and to activate PXR suggesting that inhibition may occur initially followed by induction of CYP3A4 and P-gp when used for extended periods.  Use with caution as African potato could decrease concentrations of rilpivirine (due to induction of CYP3A4) and absorption of tenofovir alafenamide (due to induction of intestinal P-gp). Therapeutic drug monitoring of rilpivirine is recommended. No effect on emtricitabine is expected.

Coadministration has not been studied, but based on metabolism and clearance a clinically significant interaction is unlikely as agomelatine is metabolised predominantly by CYP1A2. Rilpivirine at a dose of 25 mg once daily is not likely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. In vitro studies have shown that CYP3A4 and the flavine-containing monooxygenase system are involved in the formation of the active metabolite albendazole sulfoxide. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) is indicated for use as a complete regimen for the treatment of HIV-1 infection. However, in specific clinical situations where an intensification of HIV treatment is needed, coadministration with albuvirtide would be possible from a pharmacokinetic standpoint. Rilpivirine is metabolized primarily by CYP3A with potential contribution from CYP2C19; tenofovir alafenamide and emtricitabine are eliminated renally. Albuvirtide is a peptide which is eliminated by catabolism to its constituent amino acids. In vitro human microsomal studies and limited in vivo drug-drug interaction data indicate that albuvirtide has no inhibiting or inducing properties on P450 enzymes. No interaction is expected with rilpivirine, emtricitabine and tenofovir alafenamide.

Alcohol is metabolized by alcohol dehydrogenase and aldehyde dehydrogenase. The chronic use of alcohol may induce CYP2E1 and to a lesser extent CYP3A4. A clinically relevant drug-drug interaction is a priori not anticipated. 

Coadministration has not been studied. Alcuronium is predominantly eliminated unchanged via the kidneys. As there are no available data determining whether excretion is via active tubular secretion or glomerular filtration, there is some potential for competition with emtricitabine for active renal transport mechanisms, which may lead to increased levels of either drug. This mechanism of interaction is unlikely to be relevant for tenofovir alafenamide as this prodrug results in 90% lower systemic levels of tenofovir compared to tenofovir-DF. Rilpivirine is unlikely to significantly inhibit alcuronium renal elimination. 

Coadministration has not been studied. Alectinib is metabolised by CYP3A4 to an active metabolite (M4), which is also metabolised by CYP3A4. Alectinib does not inhibit CYP3A4 to a clinically relevant extent. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP enzymes at clinically relevant concentrations. Emtricitabine and tenofovir (derived from tenofovir alafenamide) are eliminated renally. No interaction is expected with emtricitabine. However, alectinib and M4 inhibit P-gp in vitro and have the potential to increase concentrations of tenofovir alafenamide, but the clinical relevance is unknown.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Alemtuzumab is a monoclonal IgG antibody. Elimination is similar to endogenous IgG and occurs primarily via proteolytic catabolism throughout the body. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. CYP-mediated drug interactions are not expected with alemtuzumab. Note, use of alemtuzumab (marketed as Lemtrada) for the treatment of relapsing remitting multiple sclerosis is contraindicated in patients with HIV infection as it causes prolonged reductions of CD4+ lymphocyte counts.

If taken at the same time, it is likely that food and beverages (including mineral water), calcium supplements, antacids, and some oral medicinal products will interfere with absorption of alendronate. Therefore, patients must wait at least 30 minutes after taking alendronate before taking any other oral medicinal product. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Alfentanil undergoes extensive CYP3A4 metabolism but rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Alfuzosin is metabolized by CYP3A. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. A clinically relevant effect on rilpivirine concentrations is unlikely as alfuzosin does not inhibit CYP3A4. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with alfuzosin. However, the product labels for rilpivirine indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Alfuzosin has a possible risk of QT prolongation and/or TdP on the CredibleMeds.org website. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Aliskiren is minimally metabolized and is mainly excreted unchanged in faeces. P-glycoprotein is a major determinant of aliskiren bioavailability. Significant interactions are not expected with emtricitabine, tenofovir alafenamide and rilpivirine. 

Coadministration has not been studied but based on the metabolism and clearance a clinically significant interaction is unlikely. Allopurinol is converted to oxipurinol by xanthine oxidase and aldehyde oxidase. Rilpivirine, emtricitabine and tenofovir alafenamide do not interfere with this metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Almotriptan is partly eliminated unchanged in the urine and partly metabolized mainly via monoamine oxidase-A and to a lesser extent by CYP3A4, CYP2D6 and flavin monooxygenase. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance, a clinically significant interaction is unlikely. Aloe vera is only a weak inhibitor of CYPs in vitro and therefore is unlikely to cause clinically significant interactions. It does not inhibit P-gp and there is no evidence to suggest it impacts UGTs.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Alogliptin is primarily excreted unchanged in the urine and undergoes negligible CYP-mediated metabolism. Alogliptin was shown to have no inhibitory or inducing effect on CYPs at concentrations achieved with the recommended dose of 25 mg alogliptin. Furthermore, alogliptin was shown to be neither a substrate nor an inhibitor of the renal transporters OAT1, OAT3 or OCT2 and to cause no interactions with P-glycoprotein substrates.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. In vitro data indicate that alosetron is metabolized by CYPs 2C9, 3A4 and 1A2. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Alpelisib is primarily metabolized by enzymatic hydrolysis to an inactive metabolite, with a minor contribution from CYP3A4. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally.

Coadministration has not been studied but based on the metabolism and clearance a clinically significant interaction is unlikely. Alprazolam is mainly metabolized by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with alprazolam metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Following administration, ~80% of circulating alprostadil is rapidly metabolised in the lungs primarily by beta- and omega- oxidation and the resulting metabolites are mainly excreted in urine. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. Alprostadil is unlikely to affect CYP enzymes. No interaction is expected with emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on the metabolism and clearance a clinically significant interaction is unlikely. Amantadine is mainly eliminated in the kidney by glomerular filtration and active secretion via OCT2. Rilpivirine is unlikely to significantly inhibit amantadine renal elimination. Emtricitabine and tenofovir derived from tenofovir alafenamide are unlikely to interfere with amantadine renal elimination as they are eliminated by different renal transporters.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ambrisentan is mainly glucuronidated by UGT1A9, UGT2B7, UGT1A3 and is metabolized to a lesser extent by CYP3A4. Ambrisentan is also a substrate of P-gp and OATP1B1. Rilpivirine, emtricitabine and tenofovir alafenamide do not interfere with ambrisentan metabolism.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as amikacin is eliminated renally by glomerular filtration. Coadministration with nephrotoxic agents is unlikely to be of concern for tenofovir alafenamide which results in 90% lower systemic levels of tenofovir compared to tenofovir-DF.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Amiloride is eliminated unchanged in the kidney. In vitro data indicate that amiloride is a substrate of OCT2. Rilpivirine is unlikely to significantly inhibit amiloride renal elimination. Emtricitabine and tenofovir derived from tenofovir alafenamide are unlikely to compete for renal elimination as they are eliminated by other renal transporters. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Aminophylline is a complex of theophylline and ethylenediamine and is given for its theophylline activity. Theophylline is mainly metabolized by CYP1A2. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway.

Coadministration has not been studied. Amiodarone is metabolized by CYP2C8 and CYP3A4; in vitro data suggest it is only a weak inhibitor of CYP3A4. Rilpivirine, emtricitabine and tenofovir alafenamide are not expected to inhibit or induce CYP enzymes at clinically relevant concentrations. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with amiodarone. However, given the QT prolongation risk associated with amiodarone, caution is recommended. In addition, tenofovir alafenamide (the prodrug of tenofovir) is a substrate of P-gp and inhibitors of P-gp such as amiodarone are expected to increase the absorption of tenofovir alafenamide and thereby increase the systemic concentration. The recommended dose of 10 mg tenofovir alafenamide with P-gp inhibitors is not possible with Odefsey which is only available as a fixed dose combination containing 25 mg tenofovir alafenamide but it should be noted that tenofovir alafenamide has been associated with a large clinical safety profile.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Amisulpride is weakly metabolized and is primarily eliminated renally (possibly via OCT). Rilpivirine, emtricitabine and tenofovir derived from tenofovir alafenamide are unlikely to significantly impair amisulpride elimination. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Amitriptyline is metabolised predominantly by CYP2D6 and CYP2C19. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Amivantamab is a monoclonal IgG1 and is eliminated primarily via intracellular catabolism similarly to endogenous IgG. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Amlodipine is metabolized by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with amlodipine metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Amodiaquine is metabolized mainly by CYP2C8. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as amoxicillin is mainly excreted in the urine by glomerular filtration and tubular secretion. In vitro data indicate that amoxicillin is a substrate of OAT3. Emtricitabine and tenofovir derived from tenofovir alafenamide are secreted by other renal transporters. Rilpivirine is unlikely to interfere with amoxicillin renal elimination.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Amphetamine is metabolized by CYP2D6. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as amphotericin is not appreciably metabolized and is eliminated to a large extent in the bile. Coadministration with nephrotoxic agents is unlikely to be of concern for tenofovir alafenamide which results in 90% lower systemic levels of tenofovir compared to tenofovir-DF. Rilpivirine does not interfere with amphotericin B elimination pathway.

Coadministration has not been studied. Renal clearance of ampicillin occurs partly by glomerular filtration and partly by tubular secretion; it is reduced by probenecid. About 20 to 40% of an oral dose may be excreted unchanged in the urine in 6 hours. After parenteral use about 60-80% is excreted in the urine within 6 hours. Rilpivirine is unlikely to significantly inhibit ampicillin renal elimination. No interaction is expected with tenofovir alafenamide as it results in 90% lower systemic levels of tenofovir compared to tenofovir-DF. However, as emtricitabine is eliminated by renal tubular secretion, there is potential for competition with ampicillin for renal transporters, which could lead to increased levels of either drug when ampicillin is administered intravenously. When administered orally, there is little potential for significant interaction. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Anakinra is an IL-1 receptor antagonist which is predominantly cleared renally by glomerular filtration and subsequent tubular metabolism. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. Patients requiring treatment with anakinra may have elevated levels of cytokines (e.g., TNF-alpha, IL-1, IL-6, IL-10, IFN) which have been shown to suppress expression/activity of CYP3A4, CYP2C19, CYP2C9 and CYP1A2. Anakinra, per se, has no inhibitory or inducing effects on cytochromes. Anakinra will normalize cytochrome activity (via inhibition of IL-1) but no significant effect on rilpivirine is expected and no a priori dose adjustment is required. No interaction is expected with emtricitabine and tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Anastrozole is mainly oxidized to hydroxyanastrozole by CYP3A4 (major) and glucuronidated via UGT1A4. Rilpivirine at a dose of 25 mg once daily does not inhibit or induce CYPs or UGTs. Emtricitabine and tenofovir alafenamide do not interact with anastrozole metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as anidulafungin is not metabolised hepatically but undergoes chemical degradation at physiological temperature. 

Coadministration has not been studied. The combination of rilpivirine and antacids should be used with caution as coadministration may cause significant decreases in rilpivirine plasma concentrations due to an increase in gastric pH. Antacids should only be administered either at least 2 hours before or at least 4 hours after rilpivirine. Antacids do not interfere with emtricitabine and tenofovir alafenamide absorption.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Thymoglobulins are cleared by the reticuloendothelial system.

Coadministration has not been studied but is not recommended. Apalutamide is primarily metabolized by CYP2C8 and CYP3A4 and is a strong inducer of CYP3A4. Rilpivirine is metabolized by CYP3A4 but has no inducing effects on CYPs. Coadministration is expected to significantly reduce rilpivirine concentrations which may result in loss of therapeutic effect and development of resistance. Apalutamide has a long half-life (3 days), therefore a minimum of 2 weeks, but preferably 4 weeks, cessation period is recommended prior to initiation of rilpivirine due to the persisting inducing effect upon discontinuation of a strong inducer. Furthermore, rilpivirine has been associated with prolongation of the QT interval at supra-therapeutic doses and androgen deprivation therapy may prolong the QT interval. No interaction is expected with emtricitabine and tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Apixaban is metabolized by CYP3A4 and to a lesser extent by CYP1A2, CYP2C8, CYP2C9 and CYP2C19. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interfere with apixaban metabolic pathway.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely as apomorphine is metabolized by several pathways including glucuronidation, sulfation and to a lesser extent N-demethylation. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with apomorphine. However, the product labels for rilpivirine indicate that rilpivirine/emtricitabine/tenofovir alafenamide should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Apomorphine has a possible risk of QTc prolongation on the CredibleMeds.org website. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Apremilast is metabolized by multiple pathways involving hydrolysis, glucuronidation and oxidation by CYP3A4. Rilpivirine is metabolized by CYP3A4, however, apremilast has no inhibitory or inducing effects on CYPs or drug transporters. Emtricitabine and tenofovir alafenamide do not interfere with apremilast’s elimination pathways. Note: severe diarrhoea, nausea and vomiting can occur within the first few weeks after initiating apremilast treatment. Patients should be instructed to contact their healthcare provider if they experience severe diarrhoea, nausea or vomiting as this could potentially alter the absorption of orally administered antiretroviral drugs.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Aprepitant is mainly metabolized by CYP3A4 and to a lesser extent by CYPs 1A2 and 2C19. Rilpivirine is metabolized by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Aprepitant shows an initial inhibitory effect on CYP3A4 followed by a weak inducing effect from day 8 which is clinically insignificant by two weeks. Any transient change in rilpivirine exposure is unlikely to be clinically significant. No interaction is expected with emtricitabine or tenofovir alafenamide which are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Argatroban undergoes metabolism in the liver via hydroxylation and aromatization. Drug-drug interactions studies performed with substrates of different cytochromes and P-glycoprotein (i.e., acetaminophen, lidocaine, warfarin, digoxin) indicate that argatroban has a low potential to cause drug-drug interactions and therefore is unlikely to alter the exposure of rilpivirine, emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Aripiprazole is metabolized by CYP3A4 and CYP2D6. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with aripiprazole metabolic pathway. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with aripiprazole. However, the product labels for rilpivirine/emtricitabine/tenofovir alafenamide indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Aripiprazole has a possible risk of QT prolongation and/or TdP on the CredibleMeds.org website.

Coadministration has not been studied. Artemisinins undergo rapid metabolism via several CYP450 (CYP3A4, 2A6, 2B6) and the active metabolite (dihydroartemisinin, which has greater potency than the parent drug) is further metabolised via UGT1A9 and 2B7. A clinically significant effect of rilpivirine, emtricitabine or tenofovir alafenamide on artemisinins is unlikely. However, artemisinins induce CYP3A4 and/or CYP2C19 and could potentially decrease rilpivirine concentrations, but this is unlikely to be clinically relevant due to the short treatment duration for artemisinins. Emtricitabine and tenofovir alafenamide are unlikely to be impacted.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Asciminib is metabolised by several pathways, including CYP3A4, UGT2B7 and UGT2B17. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP3A4 or UGTs at clinically relevant concentrations. Asciminib is a weak inhibitor of CYP3A4 but is unlikely to cause a clinically significant increase in rilpivirine exposure. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses, but these are unlikely to occur with asciminib. The product labels for rilpivirine indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. QT prolongation has been reported in patients receiving asciminib. No interaction is expected with emtricitabine and tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ascorbic acid is oxidised to dehydroascorbic acid where some is metabolised to oxalic acid and the inactive ascorbate-2-sulphate. Large doses are rapidly excreted in the urine when in excess of the requirements of the body. Significant interactions are not expected with rilpivirine, emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ascorbic acid is oxidised to dehydroascorbic acid where some is metabolised to oxalic acid and the inactive ascorbate-2-sulphate. Large doses are rapidly excreted in the urine when in excess of the requirements of the body. Significant interactions are not expected with vitamin C given alone or in multivitamins and rilpivirine, emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Asenapine is metabolized by glucuronidation (UGT1A4) and oxidative metabolism (CYP1A2 (major) and CYP3A4, 2D6 (minor). Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with asenapine metabolic pathway. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with asenapine. However, the product labels for rilpivirine/emtricitabine/tenofovir alafenamide indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Asenapine has a possible risk of QT prolongation and/or TdP on the CredibleMeds.org website.

Coadministration has not been studied but based on metabolism and clearance, a clinically significant interaction is unlikely. Ashwagandha extracts had no effect on CYP enzymes in vitro.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Limited data suggest that asparaginase is likely to be eliminated by the reticulo-endothelial system. Less than 0.1% of a total injected dose is recovered in urine. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Aspirin is rapidly deacetylated to form salicylic acid and then further metabolized by glucuronidation (by several UGT, major UGT1A6). In addition, coadministration with an NSAID is unlikely to be of concern for nephrotoxicity as tenofovir alafenamide results in 90% lower systemic levels of tenofovir compared to tenofovir-DF. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Aspirin is rapidly deacetylated to form salicylic acid which is further glucuronidated by several UGTs (major UGT1A6). Coadministration is unlikely to be of concern for nephrotoxicity as tenofovir alafenamide results in 90% lower systemic levels of tenofovir compared to tenofovir-DF.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Astemizole is metabolized by CYPs 2D6, 2J2 and 3A4 but rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with astemizole. However, given the known QT prolongation risk associated with astemizole, caution is recommended.

Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) is indicated for use as a complete regimen for the treatment of HIV-1 infection. However, in specific clinical situations where an intensification of HIV treatment is needed, coadministration with atazanavir/ritonavir would be possible from a pharmacokinetic standpoint. Atazanavir/ritonavir may increase rilpivirine concentrations but not to a clinically relevant extent. Note, both drugs have risks of QT prolongation and/or TdP on the CredibleMeds.org website (conditional risk for atazanavir; possible risk for rilpivirine). Although the product label for atazanavir advises caution when prescribing atazanavir with medicinal products which have the potential to increase the QT interval, there is no anticipated increased risk of QT prolongation when combining these drugs. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but equivalent rilpivirine concentrations are unlikely to occur during coadministration with atazanavir/ritonavir. Tenofovir alafenamide is dosed 25 mg in Odefsey whereas the recommended dose of tenofovir alafenamide is 10 mg with P-gp inhibitors such as atazanavir/ritonavir, but it should be noted that tenofovir alafenamide has been associated with a large clinical safety profile.

Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) is indicated for use as a complete regimen for the treatment of HIV-1 infection. However, in specific clinical situations where an intensification of HIV treatment is needed, coadministration with atazanavir would be possible from a pharmacokinetic standpoint. Atazanavir may increase rilpivirine concentrations, though not to a clinically relevant extent. Note, both drugs have risks of QT prolongation and/or TdP on the CredibleMeds.org website (conditional risk for atazanavir; possible risk for rilpivirine). Although the product label for atazanavir advises caution when prescribing atazanavir with medicinal products which have the potential to increase the QT interval, there is no anticipated increased risk of QT prolongation when combining these drugs. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but equivalent rilpivirine concentrations are unlikely to occur during coadministration with atazanavir. Tenofovir alafenamide is dosed 25 mg in Odefsey whereas the recommended dose of tenofovir alafenamide is 10 mg with P-gp inhibitors such as atazanavir, but it should be noted that tenofovir alafenamide has been associated with a large clinical safety profile.

Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) is indicated for use as a complete regimen for the treatment of HIV-1 infection. However, in specific clinical situations where an intensification of HIV treatment is needed, coadministration with atazanavir/cobicistat would be possible from a pharmacokinetic standpoint. Atazanavir/cobicistat may increase rilpivirine concentrations but not to a clinically relevant extent. Note, both drugs have risks of QT prolongation and/or TdP on the CredibleMeds.org website (conditional risk for atazanavir; possible risk for rilpivirine). Although the product label for atazanavir advises caution when prescribing atazanavir with medicinal products which have the potential to increase the QT interval, there is no anticipated increased risk of QT prolongation when combining these drugs. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but equivalent rilpivirine concentrations are unlikely to occur during coadministration with atazanavir/cobicistat. Tenofovir alafenamide is dosed 25 mg in Odefsey whereas the recommended dose of tenofovir alafenamide is 10 mg with P-gp inhibitors such as atazanavir/cobicistat, but it should be noted that tenofovir alafenamide has been associated with a large clinical safety profile.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as atenolol is mainly eliminated unchanged in the kidney, both by glomerular filtration and active secretion via the renal transporters OCT2 and MATE1.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Atezolizumab is eliminated through catabolism. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir (derived from tenofovir alafenamide) are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Atogepant is metabolized primarily by CYP3A4 and is a substrate of OATP. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP enzymes at clinically relevant concentrations. Atogepant is not expected to have a clinically relevant effect on drugs metabolized by CYP enzymes. No interaction is expected with emtricitabine and tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Atomoxetine is metabolized by CYP2D6. Rilpivirine does not inhibit or induce CYP enzymes. Atomoxetine does not interact with emtricitabine or tenofovir alafenamide. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with atomoxetine. However, the product labels for rilpivirine indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Atomoxetine has a possible risk of QT prolongation and/or TdP on the CredibleMeds.org website.

Coadministration with rilpivirine/emtricitabine/tenofovir alafenamide has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Coadministration of rilpivirine (150 mg once daily) and atorvastatin (40 mg once daily) decreased rilpivirine Cmax, AUC and Cmin by 9%, 10% and 10%, respectively. Atorvastatin Cmax and AUC increased by 35% and 4%; Cmin decreased by 15%. Cmax, AUC and Cmin of 2-hydroxy atorvastatin increased by 58%, 39% and 32%, whilst Cmax and AUC of 4-hydroxy atorvastatin increased by 28% and 23%. No dose adjustment is needed for either drug. [Note: this interaction study has been performed with a dose higher than the licensed dose for rilpivirine assessing the maximal effect on the co-administered drug. The dosing recommendation is applicable to the licensed dose of rilpivirine 25 mg once daily.] Emtricitabine and tenofovir alafenamide do not interact with atorvastatin metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Atovaquone is mainly eliminated unchanged in the faeces. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely when atropine is used either systemically or as eye drops. Although metabolism of atropine is not fully elucidated, up to 50% is excreted unchanged via the kidneys. There is therefore little potential for clinically significant interactions with rilpivirine, emtricitabine and tenofovir alafenamide via modulation of, or competition for, metabolic pathways. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Avanafil is primarily metabolized by CYP3A4 and does not inhibit or induce CYPs. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway.

Coadministration has not been studied. Rilpivirine is metabolized by CYP3A4. Avapritinib is predominantly mediated by CYP3A4 and to a minor extent by CYP2C9. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP3A4. Avapritinib was shown to inhibit and induce CYP3A4 in vitro but the net effect in vivo has not been studied. The clinical relevance is unknown. No interaction is expected with emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Avatrombopag is mainly metabolized by CYP2C9 and CYP3A4. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP enzymes at clinically relevant concentrations. Avatrombopag does not inhibit or induce CYP3A. No interaction is expected with emtricitabine or tenofovir-alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Avelumab is primarily metabolized through catabolic pathways and drug-drug interactions are not expected.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Axitinib is metabolized primarily by CYP3A4 and to a lesser extent by CYP1A2, CYP2C19 and UGT1A1. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYPs or UGTs at clinically relevant concentrations. No interaction is expected with emtricitabine or tenofovir alafenamide. Axitinib does not inhibit or induce CYP3A4.

Coadministration has not been studied. In vitro data suggest that some harma alkaloids found in ayahuasca preparations have a weak/moderate inhibitory effect on CYP3A4 and could potentially increase the exposure of rilpivirine. However, no a priori dosage adjustment of rilpivirine is recommended. No interaction is expected with emtricitabine or tenofovir alafenamide.

Coadministration has not been studied. Azacitidine undergoes spontaneous hydrolysis and deamination mediated by cytidine deaminase. Urinary excretion is the primary route of elimination of azacitidine and/or its metabolites. Following cellular uptake, azacitidine is sequentially phosphorylated via phosphokinases activities to azacitidine triphosphate which is able to incorporate into DNA and RNA. Phosphorylation of emtricitabine occurs via the same enzymes and competition may occur for this activation path. However, the clinical relevance of this interaction is unknown. Rilpivirine is metabolised by CYP3A4. Azacitidine does not inhibit or induce CYP enzymes. No interaction is expected with tenofovir alafenamide.

Coadministration has not been studied, but based on metabolism and clearance a clinically significant interaction is unlikely. Azathioprine is converted to 6-mercaptopurine which is metabolized analogously to natural purines. Rilpivirine, emtricitabine and tenofovir alafenamide do not interfere with this metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Azilsartan is metabolized mainly by CYP2C9. Rilpivirine does not inhibit or induce CYP2C9. No interaction is expected with emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Azithromycin is mainly eliminated via biliary excretion and animal data suggest this may occur via P-glycoprotein and MRP2. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with azithromycin. However, given the known QT prolongation risk associated with azithromycin, caution is recommended.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Baclofen is primarily eliminated by glomerular filtration. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Baricitinib is mainly eliminated renally through glomerular filtration and active secretion via OAT3, P-gp, BCRP and MATE2-K, with CYP3A4 metabolism representing less than 10% of its overall metabolism. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. Baricitinib is not expected to have a clinically relevant effect on drugs metabolised by CYP enzymes. No interaction is expected with emtricitabine and tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Basiliximab is a monoclonal IgG antibody. Elimination is similar to endogenous IgG and occurs primarily via proteolytic catabolism throughout the body.

Coadministration with bazedoxifene alone or coformulated with conjugated estrogens as hormone replacement therapy (HRT) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bazedoxifene is glucuronidated by UGT1A1/8/10 and conjugated estrogens are metabolized by CYP3A4, CYP1A2 and are glucuronidated. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with these metabolic pathways.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Beclometasone is a pro-drug which is not metabolised by CYP450, but is hydrolysed via esterase enzymes to the highly active metabolite beclometasone -17-monopropionate. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with beclometasone metabolism. 

Coadministration has not been studied. Bedaquiline is metabolised by CYP3A4, but rilpivirine, emtricitabine and tenofovir alafenamide are not expected to inhibit or induce CYP enzymes at clinically relevant concentrations. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with bedaquiline. However, bedaquiline has a possible risk or QT prolongation and/or TdP on the CredibleMeds.org website therefore caution is recommended. When bedaquiline is coadministered with other medicinal products that prolong the QTc interval, an additive or synergistic effect on QT prolongation cannot be excluded. If coadministration is necessary, clinical monitoring including frequent electrocardiogram assessment is recommended. There are no clinical data on the safety and efficacy of bedaquiline when co-administered with antiretroviral agents. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Belatacept is a protein that undergoes non-CYP mediated metabolism in the liver.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Belimumab is a monoclonal IgG antibody. Elimination is similar to endogenous IgG and occurs primarily via proteolytic catabolism throughout the body. Rilpivirine is metabolized by CYP3A4. Patients requiring treatment with belimumab may have elevated levels of cytokines (e.g., TNF-alpha, IL-1, IL-6, IL-10, IFN) which have been shown to suppress expression/activity of CYP3A4, CYP2C19, CYP2C9 and CYP1A2. Belimumab was shown to lower IFN and IL-6/10 and is expected to normalize metabolism but no significant effect on rilpivirine is expected and no a priori dose adjustment is required when initiating or discontinuing belimumab. Emtricitabine and tenofovir alafenamide are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bempedoic acid is glucuronidated by UGT2B7 and also converted to an active metabolite by aldo-keto reductase. Rilpivirine is metabolized by CYP3A4. Bempedoic acid does not inhibit or induce CYP3A4. No interaction is expected with emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Benazepril is rapidly hydrolyzed to its active metabolite benazeprilat which is eliminated predominantly renally.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Bendamustine is metabolised by multiple routes including hydrolysis (main), glutathione conjugation and hepatic metabolism via CYP1A2. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP enzymes at clinically relevant concentrations. Bendamustine does not inhibit or induce CYP enzymes. Emtricitabine and tenofovir (derived from tenofovir alafenamide) are eliminated renally. However, rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses, but these are unlikely to occur with bendamustine. The product labels for rilpivirine indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Bendamustine has a possible risk of QT prolongation and/or TdP on the CredibleMeds.org website.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bendroflumethiazide is mainly eliminated by hepatic metabolism (70%, exact pathway not known) and excreted unchanged in the urine (30%) via OAT1 and OAT3. In vitro data indicate that bendroflumethiazide inhibits these renal transporters but a clinically relevant drug interaction is unlikely in the range of observed clinical concentrations with emtricitabine and tenofovir derived from tenofovir alafenamide. There is no evidence that bendroflumethiazide inhibits or induces CYP450 enzymes and therefore is unlikely to impact rilpivirine.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as benserazide is hydrolysed to trihydroxybenzylhydrazine. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Available information on the metabolism of benzatropine is limited but no clinically significant interactions are expected. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Benznidazole undergoes non-CYP mediated metabolism and partly CYP mediated metabolism. Renal elimination of unchanged benznidazole appears to be minimal and there is little potential for an interaction via competition for renal elimination pathways.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Bepridil is metabolized by CYP2D6 (major) and CYP3A4. Rilpivirine, emtricitabine and tenofovir alafenamide are not expected to inhibit or induce CYP enzymes at clinically relevant concentrations. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with bepridil. However, given the known QT prolongation risk associated with bepridil, caution is recommended.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Beta-alanine is a non-essential amino acid and dietary supplements enter the same physiological processes as endogenous beta-alanine. Excess beta-alanine is excreted in the urine by the kidneys. Rilpivirine is metabolized by CYP3A4. Beta-alanine is unlikely to affect CYP3A4. No interaction is expected with emtricitabine and tenofovir alafenamide which are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Betahistine is metabolized by monoamine oxidase. Betahistine does not induce or inhibit CYP450 enzymes.

Coadministration has not been studied. Betamethasone is metabolized by CYP3A4 and is a moderate inducer of CYP3A4. Coadministration could significantly decrease rilpivirine concentrations particularly if betamethasone is administered at high doses or for a long duration, in which case coadministration should be avoided. The rilpivirine dose should be increased from 25 mg once daily to 50 mg once daily in the presence of moderate inducers. Due to the persisting inducing effect upon stopping an inducer, it is recommended to maintain rilpivirine 50 mg once daily for at least 2 weeks following cessation of betamethasone and then to decrease the rilpivirine dose to 25 mg once daily. Rilpivirine is not expected to inhibit or induce CYP enzymes at clinically relevant concentrations. Emtricitabine and tenofovir alafenamide do not interact with betamethasone metabolism.

Coadministration has not been studied but no clinically relevant drug interactions are expected with the topical use of betamethasone (for example, ointment, cream, lotion, emollient, foam).

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Betrixaban is largely eliminated unchanged through biliary secretion via P-gp and rilpivirine, emtricitabine or tenofovir alafenamide does not inhibit or induce P-gp. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with betrixaban. However, the product labels for rilpivirine/emtricitabine/tenofovir alafenamide indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Betrixaban has a possible risk or QT prolongation and/or TdP on the CredibleMeds.org website.

Coadministration has not been studied but based on metabolism and clearance a clinically significant pharmacokinetic interaction is unlikely as bevacizumab is metabolized via proteolytic catabolism. 

Coadministration has not been studied. Bexarotene is mainly metabolized by CYP3A4 and induces CYP3A4 (after repeated administration and especially at doses greater than 300 mg/m2/day). Bexarotene could potentially decrease rilpivirine exposure. Perform TDM of rilpivirine if available. Emtricitabine and tenofovir alafenamide do not interfere with bexarotene metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as half of bezafibrate dose is eliminated unchanged in the urine. In vitro data suggest that bezafibrate inhibits the renal transporter OAT1 but a clinically relevant drug interaction with tenofovir derived from tenofovir alafenamide is unlikely in the observed range of clinical concentrations. 

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Bicalutamide is metabolized by CYP3A4 and UGT1A9. Rilpivirine is metabolized by CYP3A4 but has no inducing effects on CYPs. Emtricitabine and tenofovir alafenamide are eliminated renally. Bicalutamide is a weak inhibitor of CYP3A4 but is unlikely to have a clinically significant effect on rilpivirine. No interaction is expected with emtricitabine. Bicalutamide is a weak inhibitor of P-gp in vitro but is unlikely to significantly alter tenofovir alafenamide exposure. Note, androgen deprivation treatment may prolong the QT interval. Caution should be taken when using with antiretroviral drugs that can potentially prolong the QT interval such as rilpivirine (although at supra-therapeutic concentrations).

Biktarvy (bictegravir, emtricitabine, tenofovir alafenamide) and Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) are indicated for use as complete regimens for the treatment of HIV-1 infection and should not be administered with other antiretroviral products. Furthermore, both products contain emtricitabine and tenofovir alafenamide and must not be administered with other products containing emtricitabine and tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bilastine is mainly excreted unchanged and is a substrate of P-gp and OATP1A2. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. Bilastine is unlikely to affect CYP3A4. No interaction is expected with emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bimekizumab is an IgG1 monoclonal antibody and is likely to be eliminated via intracellular catabolism, similarly to endogenous IgG. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Binimetinib is primarily metabolised by UGT1A1 and the active metabolite M3 is metabolised by CYP1A2 and CYP2C19. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce UGTs or CYP enzymes at clinically relevant concentrations. Binimetinib is unlikely to affect CYP3A4. Emtricitabine and tenofovir (derived from tenofovir alafenamide) are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Following absorption, vitamin B7 is stored in the liver, kidney and pancreas.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Following absorption, vitamin B7 is stored in the liver, kidney and pancreas.

Coadministration has not been studied but based on limited information concerning the metabolism and clearance of biperiden, there is little potential for clinically significant interaction. Limited human data suggest biperiden undergoes hydroxylation in the liver.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bisacodyl is converted to an active metabolite by intestinal and bacterial enzymes. Absorption from the gastrointestinal tract is minimal and the small amount absorbed is excreted in the urine as the glucuronide. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bismuth subsalicylate is largely hydrolysed in the stomach to form salicylic acid, which is rapidly absorbed, and insoluble bismuth salts, which are excreted unchanged in faeces. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. Bismuth subsalicylate is unlikely to affect CYP3A4. Significant interactions are not expected with emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bisoprolol is partly metabolized by CYP3A4 and CYP2D6 and partly eliminated unchanged in the urine. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir are not expected to significantly interfere with bisoprolol elimination. 

Coadministration has not been studied but based on metabolism and clearance, a clinically significant interaction is unlikely. No effect on rilpivirine, emtricitabine or tenofovir alafenamide is expected as black cohosh had no significant effect on the pharmacokinetics of midazolam (a CYP3A4 substrate) or digoxin (a P-gp substrate).

Coadministration has not been studied but based on the metabolism and clearance a clinically significant interaction is unlikely. Bleomycin is inactivated by a cytosolic enzyme, bleomycin hydrolase, and two thirds of the administered drug is excreted unchanged in urine, probably by glomerular filtration.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. An indirect effect of blinatumomab on CYPs may occur due to transient release of cytokines during the first days of therapy which can inhibit CYP450 metabolism, however, this is unlikely to be clinically relevant. The metabolic pathway of blinatumomab has not been characterised. Like other protein therapeutics, blinatumomab is expected to be degraded into small peptides and amino acids via catabolic pathways.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Bortezomib is mainly metabolized by CYP3A4 and 2C19 and to a lesser extent CYP1A2, 2D6 and 2C9. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. In addition, a clinically relevant effect on rilpivirine concentrations is unlikely as bortezomib is a weak inhibitor of CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with bortezomib metabolic pathway. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses, but equivalent rilpivirine concentrations are unlikely to occur with bortezomib. However, the product labels for rilpivirine/emtricitabine/tenofovir alafenamide indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Bortezomib has a possible risk or QT prolongation and/or TdP on the CredibleMeds.org website.

Coadministration has not been studied. Bosentan is a substrate and inducer of CYP3A4 and CYP2C9. Bosentan could potentially decrease rilpivirine exposure. Patients should be monitored carefully regarding their HIV infection. Bosentan does not impact emtricitabine and tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Bosutinib is metabolized by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Rilpivirine is metabolized by CYP3A4. Bosutinib has no inhibitory or inducing effects on CYP3A4. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses, but these are unlikely to occur with bosutinib. However, the product labels for rilpivirine indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Bosutinib has a possible risk of QTc prolongation and/or TdP on the CredibleMeds.org website. No interaction is expected with emtricitabine and tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Branched chain amino acids (BCAAs) mainly undergo intracellular catabolism in skeletal muscle. Excess BCAAs and BCAA-derived metabolic products are excreted in the urine by the kidneys. Rilpivirine is metabolized by CYP3A4. BCAAs are unlikely to affect CYP3A4. No interaction is expected with emtricitabine and tenofovir alafenamide which are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Brentuximab vedotin is an antibody-drug conjugate comprising a monoclonal antibody and monomethyl auristatin E (MMAE), a potent chemotherapeutic agent. The monoclonal antibody undergoes elimination via intracellular catabolism and does not interact with rilpivirine. MMAE is a substrate of CYP3A4 and P-gp but no interaction is expected as both rilpivirine and MMAE have no inhibitory or inducing effects on CYPs. Brentuximab vedotin does not interact with emtricitabine and tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Brexpiprazole is predominantly metabolised by CYP3A4 and CYP2D6. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP enzymes at clinically relevant concentrations. Brexpiprazole is unlikely to have a clinically relevant effect on drugs metabolised by CYP enzymes. No interaction is expected with emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Brigatinib is metabolised by CYP2C8 and CYP3A4. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP enzymes at clinically relevant concentrations. Brigatinib is a weak inhibitor of CYP3A4 but is unlikely to cause a clinically significant increase in rilpivirine exposure. Emtricitabine and tenofovir (derived from tenofovir alafenamide) are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Brimonidine is metabolized mainly by aldehyde oxidase.

Coadministration has not been studied. Brincidofovir is a prodrug converted to cidofovir which is eliminated renally via glomerular filtration and active renal secretion by OAT1 and OAT3. Rilpivirine is metabolized mainly by CYP3A4. Brincidofovir does not inhibit or induce CYP3A4. No interaction is expected with emtricitabine. Tenofovir alafenamide is unlikely to compete with cidofovir for renal transporters or to be of concern when coadministered with nephrotoxic agents such as cidofovir as tenofovir alafenamide results in 90% lower systemic levels of tenofovir compared to tenofovir-DF. Brincidofovir inhibits BCRP (but not P-gp) and therefore could increase tenofovir alafenamide although to an extent that would not warrant a dose adjustment of tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Brinzolamide is mainly metabolised by CYP3A4, and to a lesser extent by CYPs 2A6, 2C8 and 2C9. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. Rilpivirine at 25 mg once daily is unlikely to inhibit or induce CYPs. Brinzolamide does not inhibit or induce CYP3A4. No interaction is expected with emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on the metabolism and clearance a clinically significant interaction is unlikely. Bromazepam undergoes oxidative biotransformation. Drug-drug interaction studies indicate that CYP3A4 plays a minor role in bromazepam metabolism, but other cytochromes such as CYP2D6 or CYP1A2 may play a role. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this bromazepam metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bromocriptine is metabolised by CYP3A4. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. Rilpivirine at 25 mg once daily is unlikely to inhibit or induce CYPs to a clinically relevant extent. Bromocriptine is unlikely to affect CYP3A4 at clinically relevant concentrations. No interaction is expected with emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Budesonide is metabolized by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with budesonide metabolism. 

Coadministration has not been studied. Bulevirtide is catabolized by peptidases and elimination occurs through binding to NTCP (a bile salt liver transporter serving as HDV/HBV entry receptor). Rilpivirine, emtricitabine and tenofovir alafenamide do not interfere with this elimination pathway. In a clinical study, bulevirtide at high dose (10 mg) modestly inhibited CYP3A4, however, no dose adjustment is required for rilpivirine when coadministered with bulevirtide. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bumetanide is hepatically metabolized and approximately 50-80% of bumetanide is excreted in the urine by OAT1 and OAT3, mainly as unchanged drug (~50%). Rilpivirine is metabolized by CYP3A4. In vitro data suggest that bumetanide inhibits OAT1. No interaction is expected with emtricitabine as it is eliminated by other renal transporters. Coadministration is unlikely to lead to a significant increase in tenofovir as tenofovir alafenamide results in 90% lower systemic levels of tenofovir compared to tenofovir-DF.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bupivacaine is predominantly metabolized by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. In addition, renal excretion of unchanged bupivacaine is thought to account for approximately 1% of a dose therefore there is little potential for interaction with emtricitabine and tenofovir derived from tenofovir alafenamide. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Buprenorphine undergoes both N-dealkylation to form norbuprenorphine (via CYP3A4) and glucuronidation (via UGT2B7 and UGT1A1). Norbuprenorphine, an active metabolite, can further undergo glucuronidation (via UGT1A3 and UGT1A1). Rilpivirine at a dose of 25 mg once daily does not inhibit or induce CYPs or UGTs. Emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Bupropion is primarily metabolized by CYP2B6. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway.

Coadministration has not been studied but based on the metabolism and clearance a clinically significant interaction is unlikely. Buspirone is metabolized by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with buspirone metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Busulfan is metabolised through conjugation with glutathione (spontaneous and GST-mediated) and then by hepatic oxidation (likely CYP3A4-mediated). Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. Rilpivirine at 25 mg once daily is unlikely to affect busulfan metabolism. Busulfan is unlikely to affect CYP3A4. No interaction is expected with emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cabazitaxel is metabolized by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Rilpivirine is metabolized by CYP3A4, however, cabazitaxel has no inhibitory or inducing effects on CYP3A4 at clinically relevant concentrations. No interaction is expected with emtricitabine and tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cabergoline is extensively metabolized by the liver predominantly via hydrolysis (non-CYP mediated metabolism) and does not inhibit or induce drug metabolizing enzymes. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cabergoline is extensively metabolized by the liver predominantly via hydrolysis (non-CYP mediated metabolism) and does not inhibit or induce drug metabolizing enzymes. 

Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) is indicated for use as a complete regimen for the treatment of HIV-1 infection. Coadministration of oral cabotegravir (30 mg) and oral rilpivirine (25 mg) did not significantly alter cabotegravir and rilpivirine pharmacokinetics. Cabotegravir Cmax, AUC and Ctau increased by 5%, 12% and 14%, respectively; rilpivirine Cmax, AUC and Ctau decreased by 4%, 1% and 8%, respectively. No interaction is expected with emtricitabine and tenofovir alafenamide. Note, cabotegravir used as PrEP is not expected to be coadministered with antiretrovirals except in the case of breakthrough infection when an antiretroviral treatment should be initiated. Residual concentrations of cabotegravir may remain in the systemic circulation for prolonged periods (up to 12 months or longer) but are not expected to affect the exposure of antiretroviral drugs initiated after discontinuation of Apretude.

Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) is indicated for use as a complete regimen for the treatment of HIV-1 infection. However, in specific clinical situations where intensification of HIV treatment is needed, coadministration with cabotegravir would be possible from a pharmacokinetic standpoint. Coadministration of oral cabotegravir (30 mg once daily) and oral rilpivirine (25 mg once daily) did not significantly alter cabotegravir and rilpivirine pharmacokinetics. Cabotegravir Cmax, AUC and Ctau increased by 5%, 12% and 14%, respectively; rilpivirine Cmax, AUC and Ctau decreased by 4%, 1% and 8%, respectively. No interaction is expected with emtricitabine and tenofovir alafenamide. No dose adjustment is required.

Cabenuva (cabotegravir LA, rilpivirine LA) is indicated for use as complete regimens for the treatment of HIV-1 infection and should not be administered with other antiretroviral products. Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) contains rilpivirine and must not be coadministered with additional rilpivirine. Residual concentrations of cabotegravir and rilpivirine may remain in the systemic circulation of patients for a prolonged period after discontinuation of intramuscular cabotegravir/rilpivirine but are not expected to affect exposure of antiretroviral drugs.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Cabozantinib is metabolized by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Rilpivirine is metabolized by CYP3A4, however, cabozantinib has no inhibitory or inducing effects on CYP3A4. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses, but these are unlikely to occur with cabozantinib. The product labels for rilpivirine indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Cabozantinib has a possible risk of QTc prolongation and/or TdP on the CredibleMeds.org website. No interaction is expected with emtricitabine and tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Caffeine is mainly metabolised by CYP1A2. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP1A2. Caffeine is unlikely to affect CYP3A4. No interaction is expected with emtricitabine and tenofovir alafenamide which are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Caffeine is mainly metabolized by CYP1A2. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Calcitonin is primarily metabolized via proteolysis in the kidney. Rilpivirine, emtricitabine and tenofovir alafenamide do not interfere with this pathway.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely.

Coadministration has not been studied. Calcium is eliminated through faeces, urine and sweat. Coadministration with calcium supplements containing calcium carbonate may decrease rilpivirine concentrations due to reduced absorption due to gastric pH increase. Calcium supplements containing calcium carbonate should be administered at least 2 h before or 4 h after rilpivirine. Calcium carbonate is unlikely to interfere with emtricitabine and tenofovir alafenamide absorption.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Canagliflozin is primarily metabolised by UGT1A9 and UGT2B4 which are not affected by rilpivirine, emtricitabine or tenofovir alafenamide. Canagliflozin is a weak P-gp inhibitor but is unlikely to affect tenofovir alafenamide concentrations to a significant extent. Although an increased risk for bone fractures has been reported with canagliflozin (particularly in patients with a history of, or at high risk of, cardiovascular disease), coadministration with tenofovir alafenamide is unlikely to be problematic in terms of additive bone toxicity as tenofovir alafenamide results in 90% lower systemic exposure of tenofovir compared to tenofovir-DF.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Canakinumab is an IL-1 beta monoclonal antibody and is eliminated via intracellular catabolism. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. Patients requiring treatment with anakinra may have elevated levels of cytokines (e.g., TNF-alpha, IL-1, IL-6, IL-10, IFN) which have been shown to suppress expression/activity of CYP3A4, CYP2C19, CYP2C9 and CYP1A2. Canakinumab, per se, has no inhibitory or inducing effects on cytochromes. Canakinumab will normalize cytochrome activity (via inhibition of IL-1) but no significant effect on rilpivirine is expected and no a priori dose adjustment is required. No interaction is expected with emtricitabine and tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Candesartan is mainly eliminated unchanged via urine and bile. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cannabidiol is mainly metabolized by CYP3A4 and CYP2C19 and is unlikely to significantly inhibit CYP3A4 or intestinal transporters in the range of doses in clinical use. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolized by CYP enzymes.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Tetrahydrocannabinol (THC, the psychoactive component of cannabis) is metabolized mainly by CYP2C9 and to a lesser extent by CYP3A4. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied. Capecitabine is activated by sequential enzyme reactions to fluorouracil. Dihydropyrimidine dehydrogenase plays a role in fluorouracil metabolism. Rilpivirine does not interfere with these metabolic pathways. However, nucleoside/tide analogues such as emtricitabine and tenofovir alafenamide may compete for these metabolic pathways. The clinical relevance of this interaction is unknown. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses, but equivalent rilpivirine concentrations are unlikely to occur with capecitabine. However, the product labels for rilpivirine indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Capecitabine has a possible risk or QT prolongation and/or TdP on the CredibleMeds.org website.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Capmatinib is primarily metabolized by CYP3A4. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP enzymes at clinically relevant concentrations. Capmatinib is unlikely to have a clinically relevant effect on CYP3A4. Emtricitabine and tenofovir (derived from tenofovir alafenamide) are eliminated renally.

Coadministration has not been studied. Capreomycin is predominantly excreted via the kidneys as unchanged drug. As capreomycin may potentially compete with emtricitabine for renal elimination transport mechanisms, levels of either drug may increase. Renal function should be monitored as clinically appropriate. Note, coadministration with nephrotoxic agents is unlikely to be of concern for tenofovir alafenamide which results in 90% lower systemic levels of tenofovir compared to tenofovir-DF. In addition, rilpivirine does not interfere with capreomycin renal elimination.

Coadministration has not been studied. Captopril is largely excreted in the urine by OAT1. Emtricitabine and tenofovir alafenamide are unlikely to compete with captopril for renal transporters as emtricitabine is eliminated by different renal transporters and tenofovir alafenamide results in 90% lower systemic levels of tenofovir compared to tenofovir-DF. Rilpivirine does not interfere with captopril elimination.

Coadministration is contraindicated as it may cause significant decreases in the plasma concentrations of rilpivirine (induction of CYP3A4) and tenofovir alafenamide (induction of P-glycoprotein).

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Carbidopa is partly metabolized and partly eliminated unchanged (30% of the total urinary excretion). 

Coadministration has not been studied. Carbimazole is a pro-drug which undergoes rapid and virtually complete metabolism to the active metabolite, thiamazole (also known as methimazole). Despite this potential hepatic metabolism very few data exist on carbimazole drug interactions. Thiamazole has been shown to have inhibitory effects on CYP3A4 in vitro, however, the clinical relevance of this for rilpivirine is unclear. No interaction is expected with emtricitabine and tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Carbocisteine is metabolized in the liver via acetylation, decarboxylation and sulfoxidation with up to 60% excreted unchanged in the urine. The likelihood of a clinically significant drug interaction is low and no studies have been performed. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Carboplatin is excreted primarily by renal glomerular filtration and therefore there is little potential for a pharmacokinetic interaction. Rilpivirine and emtricitabine do not interfere with carboplatin elimination pathway. Coadministration with nephrotoxic agents is unlikely to be of concern for tenofovir alafenamide which results in 90% lower systemic levels of tenofovir compared to tenofovir-DF.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Carfilzomib is rapidly metabolized, mainly by peptidase cleavage and epoxide hydrolysis with CYP-mediated metabolism representing a minor pathway. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP enzymes at clinically relevant concentrations. Carfilzomib is not expected to have a clinically relevant effect on drugs metabolised by CYPs. No interaction is expected with emtricitabine and tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Metabolism of cariprazine and its major active metabolites is mediated mainly by CYP3A4 with a minor contribution from CYP2D6. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. Rilpivirine at 25 mg once daily is unlikely to inhibit or induce CYPs to a clinically relevant extent. Cariprazine is unlikely to affect CYP3A4. No interaction is expected with emtricitabine and tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Carvedilol undergoes glucuronidation via UGTs 1A1, 2B4 and 2B7, and additionally metabolism via CYP2D6 and to a lesser extent CYPs 2C9 and 1A2. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Caspofungin undergoes spontaneous chemical degradation and metabolism via a non-CYP-mediated pathway. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied. Cat’s claw is an inhibitor of CYP3A4 in vitro but has also been shown to induce CYP3A4 activity in vitro. Increased concentrations of atazanavir, saquinavir and ritonavir were reported in a patient receiving Cat’s claw. Similarly, concentrations of rilpivirine may also increase, but to a limited extent and no dose adjustment is required for rilpivirine. No effect on emtricitabine or tenofovir alafenamide is expected.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cedazuridine is eliminated renally and converted to its epimer (which is then renally excreted). Rilpivirine is metabolised by CYP3A4. Cedazuridine does not inhibit or induce CYP enzymes. No interaction is expected with emtricitabine or tenofovir alafenamide which are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cefalexin is predominantly eliminated unchanged renally by glomerular filtration and tubular secretion via OAT1 and MATE1. Rilpivirine does not interfere with cefalexin renal elimination. Emtricitabine and tenofovir alafenamide are unlikely to compete with cephalexin for renal transporters as emtricitabine is eliminated by different renal transporters and tenofovir alafenamide results in 90% lower systemic levels of tenofovir compared to tenofovir-DF. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cefazolin is predominantly excreted unchanged in the urine, mainly by glomerular filtration with some renal tubular secretion via OAT3. Rilpivirine does not interfere with cefazolin renal elimination. OAT3 does not play a major role in tenofovir and emtricitabine renal elimination. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as cefixime is renally excreted predominantly by glomerular filtration. Rilpivirine does not interfere with cefixime renal elimination.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cefotaxime is partially metabolized by non-specific esterases. Most of a dose of cefotaxime is excreted in the urine - about 60% as unchanged drug and a further 24% as desacetyl-cefotaxime, an active metabolite. In vitro studies indicate that OAT3 participates in the renal elimination of cefotaxime. Rilpivirine does not interfere with cefotaxime renal elimination. Emtricitabine and tenofovir derived from tenofovir alafenamide are eliminated by other renal transporters. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as ceftazidime is excreted predominantly by renal glomerular filtration. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ceftriaxone is eliminated mainly as unchanged drug, approximately 60% of the dose being excreted in the urine predominantly by glomerular filtration and the remainder via the biliary and intestinal tracts. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cefuroxime is not metabolised and is excreted predominantly by renal glomerular filtration, with no significant active renal tubular secretion. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Celecoxib is primarily metabolized by CYP2C9. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. In addition, coadministration with an NSAID is unlikely to be of concern for nephrotoxicity as tenofovir alafenamide results in 90% lower systemic levels of tenofovir compared to tenofovir-DF. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cemiplimab is primarily metabolised through catabolic pathways and drug-drug interactions are not expected. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir (derived from tenofovir alafenamide) are eliminated renally.

Coadministration has not been studied and is not recommended. Cenobamate is primarily glucuronidated by UGT2B7 and to a lesser extent by UGT2B4. CYP3A4 contributes to cenobamate metabolism but to a minor extent. Rilpivirine is primarily metabolized by CYP3A4 and has no inhibitory or inducing effects on drug metabolizing enzymes. Cenobamate is dose-titrated until the 200 mg maintenance dose is reached. Cenobamate at a daily dose of 200 mg or greater could significantly decrease rilpivirine exposure and efficacy and coadministration is not recommended. Cenobamate inhibits OAT3 but this does not impact emtricitabine elimination. Tenofovir is mainly eliminated by OAT1 and to a lesser extent by OAT3. Cenobamate is unlikely to cause a significant increase in tenofovir exposure given that OAT3 has a minor role in tenofovir elimination and given that tenofovir alafenamide results in 90% lower systemic levels of tenofovir compared to tenofovir-DF.

Coadministration has not been studied. Ceritinib is metabolized by CYP3A4 and is a strong inhibitor of CYP3A4. Rilpivirine is metabolized by CYP3A4 and concentrations may increase due to inhibition of CYP3A4 by ceritinib, however, no dose adjustment is needed. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses, but these are unlikely to occur with ceritinib. The product labels for rilpivirine indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Ceritinib has a possible risk of QT prolongation and/or TdP on the CredibleMeds.org website. No interaction is expected with emtricitabine and tenofovir alafenamide

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Certolizumab pegol is an antibody Fab’ fragment conjugated with polyethylene glycol (PEG). The Fab’ fragment is expected to be degraded to peptides and amino acids by proteolysis; the PEG moiety is mainly excreted in urine without further metabolism. Rilpivirine is metabolized by CYP3A4. Patients requiring treatment with certolizumab pegol may have elevated levels of cytokines (e.g., TNF-alpha, IL-1, IL-6, IL-10, IFN) which have been shown to suppress expression/activity of CYP3A4, CYP2C19, CYP2C9 and CYP1A2. Certolizumab pegol will normalize cytochrome activity (via reduction of cytokines) but no significant effect on rilpivirine is expected and no a priori dose adjustment is required when initiating or discontinuing certolizumab pegol. Emtricitabine and tenofovir alafenamide are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cetirizine is only metabolised to a limited extent and is eliminated unchanged in the urine through both glomerular filtration and tubular secretion. In vitro data indicate that cetirizine inhibits OCT2. Rilpivirine is unlikely to significantly inhibit cetirizine renal elimination. Emtricitabine and tenofovir derived from tenofovir alafenamide are not transported by OCT2 and therefore no pharmacokinetic interaction is expected. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cetuximab is a monoclonal IgG antibody. Elimination is similar to endogenous IgG and occurs primarily via proteolytic catabolism throughout the body.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Chlorambucil is almost completely metabolized (little is known about chlorambucil metabolism in humans, most probably non-CYP mediated) and has extremely low urinary excretion. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Chloramphenicol is predominantly metabolised via UGTs (in particular UGT2B7) which are not affected by rilpivirine; emtricitabine and tenofovir alafenamide do not interfere with this metabolic pathway. Rilpivirine is metabolized by CYP3A4. In vitro studies have shown that chloramphenicol can inhibit metabolism mediated by CYP3A4 but this is unlikely to cause a clinically significant interaction with rilpivirine.

Coadministration has not been studied but based on the metabolism and clearance a clinically significant interaction is unlikely. Chlordiazepoxide is extensively metabolized by hepatic microsomal enzymes but does not inhibit cytochromes and therefore does not impact rilpivirine exposure. Emtricitabine and tenofovir alafenamide do not interfere with chlordiazepoxide metabolic pathway. 

Coadministration with a chlormadinone-containing combined oral contraceptive (COC) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Chlormadinone undergoes extensive hepatic metabolism by hydroxylation (likely CYP mediated). Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Compared to historical controls, coadministration of rilpivirine (25 mg once daily) and a COC containing ethinylestradiol/norethindrone had no significant effect on rilpivirine or ethinylestradiol pharmacokinetics. No interaction is expected with emtricitabine and tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Chloroquine undergoes CYP mediated metabolism by CYPs 2C8, 3A4 and 2D6, and is also eliminated unchanged via the kidney (50%). Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with chloroquine elimination pathway. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with chloroquine. However, given the known QT prolongation risk associated with chloroquine, caution is recommended. Due to the very long half-life, the risk of QT prolongation may persist even after discontinuation of chloroquine. ECG monitoring is advised. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Chlorphenamine is predominantly metabolized in the liver by CYP2D6. Rilpivirine, emtricitabine and tenofovir derived from tenofovir alafenamide are unlikely to interact with chlorphenamine. 

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Chlorpromazine is metabolized mainly by CYP2D6, but also by CYP1A2. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with chlorpromazine. However, given the known QT prolongation risk associated with chlorpromazine, caution is recommended.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Chlortalidone is mainly excreted unchanged in the urine and faeces. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ciclesonide is a pro-drug activated by esterases in the lungs to des-ciclesonide which then undergoes CYP3A4-mediated metabolism. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with ciclesonide metabolism.

Coadministration has not been studied and is not recommended in the European Summary of Product Characteristics. Rilpivirine is metabolised mainly by CYP3A4 and is transported by OATP1B1. Ciclosporin inhibits CYP3A4 and OATP1B1 and is a potent inhibitor of P-gp. Coadministration could potentially increase rilpivirine concentrations, but to a limited extent and no dose adjustment is required for rilpivirine. Although, ciclosporin can impair renal function this is unlikely to be problematic as tenofovir alafenamide results in 90% lower systemic levels of tenofovir compared to tenofovir-DF. However, coadministration is expected to increase plasma concentrations of tenofovir alafenamide due to inhibition of P-gp. The recommended dose of 10 mg tenofovir alafenamide with P-gp inhibitors is not possible with Odefsey which is only available as a fixed dose combination containing 25 mg tenofovir alafenamide, but it should be noted that tenofovir alafenamide has been associated with a large clinical safety profile.

Coadministration has not been studied but based on the metabolism and clearance a clinically significant interaction is unlikely. Cidofovir is eliminated renally via glomerular filtration and active renal secretion by OAT1, OAT3. Rilpivirine does not interfere with cidofovir elimination. Tenofovir alafenamide is unlikely to compete with cidofovir for renal transporters or to be of concern when coadministered with nephrotoxic agents such as cidofovir as tenofovir alafenamide results in 90% lower systemic levels of tenofovir compared to tenofovir-DF. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cilazapril is mainly eliminated unchanged by the kidneys. 

Coadministration has not been studied. Use with caution as coadministration may decrease rilpivirine concentrations. Only H2-receptor antagonists that can be dosed once daily should be used. Administer at least 12 h before or 4 h after Odefsey. In vitro data indicate that cimetidine inhibits OAT1 and OCT2 but at concentrations much higher than the observed clinical concentrations. No interaction is expected with tenofovir derived from tenofovir alafenamide or emtricitabine. 

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Cinacalcet is metabolized by multiple CYP enzymes, mainly CYP3A4, CYP2D6 and CYP1A2. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP enzymes at clinically relevant concentrations. Emtricitabine and tenofovir (derived from tenofovir alafenamide) are eliminated renally. Cinacalcet does not inhibit or induce CYP3A4. Note, decreases in serum calcium may prolong the QT interval. Caution should be taken when using with antiretroviral drugs that can potentially prolong the QT interval such as rilpivirine (although at supra-therapeutic concentrations).

Coadministration has not been studied. Ciprofloxacin is primarily eliminated unchanged by the kidneys by glomerular filtration and tubular secretion via OAT3. It is also metabolized and partially cleared through the bile and intestine. Rilpivirine, emtricitabine and tenofovir derived from tenofovir alafenamide do not interfere with ciprofloxacin elimination. Ciprofloxacin is a moderate inhibitor of CYP3A4 and could increase rilpivirine exposure but to a limited extent and no dose adjustment is required for rilpivirine. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses, but equivalent rilpivirine concentrations are unlikely to occur with ciprofloxacin. However, given the known QT prolongation risk associated with ciprofloxacin, caution is recommended.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Cisapride is metabolized by CYP3A4. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with cisapride metabolism. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with cisapride. However, given the known QT prolongation risk associated with cisapride, caution is recommended.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cisatracurium undergoes mainly (80% of overall elimination) spontaneous degradation in plasma and tissues at physiological pH and temperature. 

Coadministration has not been studied. Cisplatin is eliminated renally via OCT2 and MATE1. Rilpivirine does not interfere with cisplatin elimination pathway. Tenofovir alafenamide is unlikely to cause a pharmacokinetic interaction as it is eliminated renally by other renal transporters. However, cisplatin and emtricitabine could potentially compete for MATE1 which could slow their elimination. Close monitoring of renal function is recommended. 

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Citalopram is metabolized by CYP2C19 (38%), 2D6 (31%) and 3A4 (31%). Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with citalopram. However, given the known QT prolongation risk associated with citalopram, caution is recommended.

Coadministration has not been studied and is not recommended. Where possible, alternatives such as azithromycin should be considered. Clarithromycin may increase rilpivirine concentrations due to inhibition of CYP3A4. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses, but equivalent rilpivirine concentrations are unlikely to occur with clarithromycin. However, given the known QT prolongation risk associated with clarithromycin, caution is recommended. In addition, tenofovir alafenamide (the prodrug of tenofovir) is a substrate of P-gp and inhibitors of P-gp such as clarithromycin are expected to increase the absorption of tenofovir alafenamide and thereby increase the systemic concentration. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Clavulanic acid is extensively metabolized (likely non-CYP mediated pathway) and excreted in the urine by glomerular filtration. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Clindamycin is metabolized by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interfere with this metabolic pathway. 

Coadministration has not been studied. Clobazam is metabolised by CYP3A4 (major) and CYP2B6 and CYP2C19 (minor) to the active metabolite N-desmethylclobazam, which is metabolised by CYP2C19. Clobazam is a weak inducer and could potentially decrease rilpivirine exposure although to a limited extent. Emtricitabine and tenofovir alafenamide do not interfere with these metabolic pathways.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely with the topical use of clobetasol.

Coadministration has not been studied. Clofazimine is largely excreted unchanged in the faeces, both as unabsorbed drug and via biliary excretion. Rilpivirine, emtricitabine and tenofovir alafenamide are unlikely to affect clofazimine. However, clofazimine is a moderate inhibitor of CYP3A4 and may increase rilpivirine concentrations but to a modest extent. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses, but equivalent rilpivirine concentrations are unlikely to occur with clofazimine. However, the product labels for rilpivirine/emtricitabine/tenofovir alafenamide indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Clofazimine has a conditional risk of QTc prolongation and/or TdP on the CredibleMeds.org website.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Clofibrate is hydrolyzed to an active metabolite, clofibric acid. Excretion of clofibric acid glucuronide is possibly performed via OAT1. Tenofovir alafenamide is unlikely to compete with the elimination of clofibrate as tenofovir alafenamide results in 90% lower systemic levels of tenofovir compared to tenofovir-DF and emtricitabine is eliminated by other renal transporters. Rilpivirine does not interfere with clofibrate elimination.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. In vitro studies have suggested that transformation of clomifene to its active metabolite is likely to be mediated via CYP2D6. Renal excretion of clomifene is thought to account for approximately 8% of an oral dose therefore there is little potential for an interaction with rilpivirine, emtricitabine and tenofovir derived from tenofovir alafenamide. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Clomipramine is metabolized by CYP3A4, 1A2 and 2C19 to desmethylclomipramine, an active metabolite which has a higher activity than the parent drug. In addition, clomipramine and desmethylclomipramine are metabolized by CYP2D6. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Clonazepam is metabolized by CYP3A4 but rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with clonazepam metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Approximately 70% of administered clonidine is excreted in the urine, mainly in form of the unchanged parent drug (40-60% of the dose). Clonidine is a weak inhibitor of OCT2 but is unlikely to interact with emtricitabine and tenofovir derived from tenofovir alafenamide which are eliminated by different renal transporters. Rilpivirine does not interfere with clonidine elimination.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Clopidogrel is a prodrug and is converted to its active metabolite via CYPs 3A4, 2B6, 2C19 and 1A2. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied but based on the metabolism and clearance a clinically significant interaction is unlikely. Clorazepate is rapidly converted to nordiazepam which is then metabolized to oxazepam by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cloxacillin is metabolised to a limited extent, and the unchanged drug and metabolites are excreted in the urine by glomerular filtration and renal tubular secretion. There is little potential for significant interactions with rilpivirine or emtricitabine and tenofovir (derived from tenofovir alafenamide) via competition for renal transporters. 

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Clozapine is metabolized by CYPs 1A2, 2C19, 3A4, and to a lesser extent by CYPs 2C9 and 2D6. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with clozapine. However, the product labels for rilpivirine/emtricitabine/tenofovir alafenamide indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Clozapine has a possible risk of QTc prolongation and/or TdP on the CredibleMeds.org website.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Cobimetinib is metabolised by CYP3A4 and UGT2B7. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP or UGT enzymes at clinically relevant concentrations. Cobimetinib is unlikely to have a clinically relevant effect on CYP3A4. However, the product labels for rilpivirine indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Cobimetinib has a possible risk of QT prolongation and/or TdP on the CredibleMeds.org website. No interaction is expected with emtricitabine and tenofovir alafenamide

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Cocaine is metabolized by several pathways (CYP and non CYP mediated), with metabolism to norcocaine by CYP3A4 being less than 10% of the overall metabolic clearance. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with cocaine. However, given the known QT prolongation risk associated with cocaine, caution is recommended.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Codeine undergoes predominantly direct glucuronidation with CYP3A4 mediated metabolism accounting for only 10-15% of the overall metabolism. Rilpivirine at a dose of 25 mg once daily does not inhibit or induce CYPs or UGTs. Emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. The major route of elimination for coenzyme Q10 is by biliary and faecal excretion; only a small fraction is eliminated in the urine. Rilpivirine is metabolised by CYP3A4. Coenzyme Q10 is unlikely to have a clinically significant effect on substrates of CYP3A4, UGTs and P-gp. No interaction is expected with emtricitabine or tenofovir alafenamide which are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as colchicine is metabolized by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with colchicine metabolic pathway.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Metabolism of vitamin D to active metabolites occurs in the liver and kidneys, and is thought to involve CYP3A4 and CYP24A1. Significant interactions are not expected with rilpivirine, emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely with vitamin D when given with calcium or in a multivitamin preparation. Metabolism of vitamin D to active metabolites occurs in the liver and kidneys, and is thought to involve CYP3A4 and CYP24A1. Significant interactions are not expected with rilpivirine, emtricitabine or tenofovir alafenamide.

Coadministration has not been studied. Colesevelam is not absorbed from the gastrointestinal tract, is not metabolised and does not affect CYP enzymes. Rilpivirine is metabolised by CYP3A4. However, given that colesevelam can reduce the gastrointestinal absorption of some drugs, colesevelam should be administered at least four hours before or after rilpivirine, emtricitabine, tenofovir alafenamide to minimize the risk of reduced absorption.

Coadministration has not been studied. Colestyramine may delay or reduce the absorption of drugs. Administration of other drugs should be at least 1 hour before or 4-6 hours after colestyramine. [Note: this interaction is not specific for rilpivirine, emtricitabine and tenofovir alafenamide, but for any medication taken with colestyramine.]

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Collagen hydrolysate is digested and absorbed as essential amino acids for use in essential physiological processes. Rilpivirine is metabolized by CYP3A4. Collagen hydrolysate is unlikely to affect CYP3A4. No interaction is expected with emtricitabine and tenofovir alafenamide which are eliminated renally.

Coadministration with conjugated estrogens as hormone replacement therapy (HRT) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Conjugated estrogens are metabolized by CYP3A4, CYP1A2 and are glucuronidated. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. No interaction is expected with emtricitabine and tenofovir alafenamide. In addition, no interaction is expected with progestogens administered as part of HRT. Note, use of conjugated estrogens as part of gender affirming treatment should be avoided as they are associated with high thromboembolic risk.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Copanlisib is metabolised by CYP3A (~90%) and CYP1A1 (~10%). Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. Rilpivirine at 25 mg once daily is unlikely to inhibit or induce CYPs. Copanlisib does not inhibit or induce CYP3A4. No interaction is expected with emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Creatine monohydrate is not degraded during normal digestion and nearly 99% of orally ingested creatine monohydrate is either taken up by muscle or excreted in urine. Rilpivirine is metabolized by CYP3A4. Creatine is unlikely to affect CYP3A4. No interaction is expected with emtricitabine and tenofovir alafenamide which are eliminated renally.

Coadministration has not been studied. Crizotinib is mainly metabolized by CYP3A4 and is a moderate inhibitor of CYP3A4. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP enzymes at clinically relevant concentrations. Crizotinib may increase rilpivirine exposure, however, no dose adjustment is needed. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses, but these are unlikely to occur with crizotinib. The product labels for rilpivirine indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Crizotinib has a possible risk of QT prolongation and/or TdP on the CredibleMeds.org website. No interaction is expected with emtricitabine and tenofovir alafenamide

Coadministration has not been studied. Several constituents of Piper cubeba were shown to inhibit CYP3A4 in vitro, and could potentially increase the exposure of rilpivirine, but to a limited extent and no dose adjustment is required for rilpivirine. Piperine, a component of Piper cubeba, inhibits intestinal P-gp. Tenofovir alafenamide is a substrate of P-gp and absorption of tenofovir alafenamide could potentially increase. No effect on emtricitabine exposure is expected.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cyanocobalamin undergoes enterohepatic recycling and is excreted almost entirely in the urine.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely with cyanocobalamin when given alone or in multivitamins. Cyanocobalamin undergoes enterohepatic recycling and is excreted almost entirely in the urine.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. The metabolism of cyclizine has not been fully described but may involve CYP2D6. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP enzymes at clinically relevant concentrations. Emtricitabine and tenofovir (derived from tenofovir alafenamide) are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cyclophosphamide is metabolized by two pathways. Activation (major pathway) to 4-hydroxycyclophosphamide is catalyzed by CYPs 2B6 (major), 2C9 and 3A4. Inactivation (minor, 10%) to the neurotoxic chloroacetaldehyde metabolite is performed mainly by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interfere with cyclophosphamide metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cycloserine is predominantly excreted renally via glomerular filtration. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cyproterone acetate is metabolized by CYP3A4 and does not inhibit CYPs when used at doses lower than 100 mg three times per day. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cytarabine is metabolized by cytidine deaminase. Rilpivirine, emtricitabine and tenofovir alafenamide do not interfere with this metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cytisine is primarily excreted renally as unchanged drug. There are no reports of CYP or transporter involvement and significant pharmacokinetic interactions are unlikely. Rilpivirine is metabolised by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally.

Coadministration has not been studied. The prodrug of dabigatran is a very sensitive substrate of P-gp. Inhibition of P-gp by rilpivirine is unlikely to be clinically significant at clinically relevant concentrations, however, the European product label for Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) advises that increases in dabigatran plasma concentrations due to inhibition of intestinal P-gp cannot be excluded.

Coadministration has not been studied but is not recommended. Dabrafenib is metabolized by CYP3A4 and CYP2C8 and the active metabolites are metabolized by CYP3A4. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP enzymes at clinically relevant concentrations. Dabrafenib is a strong inducer of CYP3A4 and decreased midazolam exposure by 74%. A similar decrease in rilpivirine exposure may occur and therefore coadministration is not recommended. Furthermore, rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses. The product labels for rilpivirine indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Dabrafenib has a possible risk of QT prolongation and/or TdP on the CredibleMeds.org website. No interaction is expected with emtricitabine and tenofovir alafenamide

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dacarbazine undergoes activation to MTIC primarily via CYP1A2 and to a lesser extent by CYP2E1, with CYP1A1 having a role in extrahepatic metabolism. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. In vitro data indicate that dacarbazine is a substrate of the renal transporter OAT1. However, emtricitabine and tenofovir are unlikely to compete for active renal transport as emtricitabine is eliminated by different renal transporters and tenofovir alafenamide results in 90% lower systemic levels of tenofovir compared to tenofovir-DF. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. No dose adjustment of daclatasvir is required. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dacomitinib is metabolised by CYP2D6 (~26%) to O-desmethyl dacomitinib, an active metabolite with similar activity to dacomitinib, whilst CYP3A4 (~6%) contributes to the formation of other minor metabolites. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP enzymes at clinically relevant concentrations. Dacomitinib does not inhibit or induce CYP3A4. No interaction is expected with emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dactinomycin is minimally metabolized. 

Coadministration has not been studied but based on metabolism and clearance, a clinically significant interaction is unlikely. Dalteparin is excreted largely unchanged via the kidneys. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dapagliflozin is primarily metabolised by UGT1A9 which is not affected by rilpivirine, emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Rilpivirine is mainly metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. Dapivirine is metabolized mainly by CYP3A4 and to a lesser extent by glucuronidation. However, the risk of drug-drug interactions is low with the dapivirine vaginal ring due to its low systemic exposure. Furthermore, dapivirine concentrations in vaginal fluid exceed the in vitro HIV IC99 by 1000-fold.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Metabolism of dapsone is mainly by N-acetylation with a component of N-hydroxylation, and is via multiple CYP P450 enzymes. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Daptomycin is eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Daratumumab, is an IgG1 monoclonal antibody and is likely to be eliminated via intracellular catabolism, similarly to endogenous IgG. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Daridorexant is mainly metabolised by CYP3A4. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. Daridorexant is a weak inhibitor of CYP3A4 but is unlikely to have a clinically significant effect on rilpivirine. Rilpivirine at 25 mg daily is unlikely to inhibit or induce CYP3A4 to a clinically relevant extent. No interaction is expected with emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Darifenacin is metabolized by CYP3A4 and CYP2D6 but rilpivirine at a dose of 25 mg once daily is not likely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir do not interfere with darifenacin metabolism.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Darolutamide is primarily metabolised by CYP3A4, and to a lesser extent by UGT1A9 and UGT1A1, and is a substrate of P-gp. Rilpivirine is metabolized by CYP3A4 but has no inducing effects on CYPs. Emtricitabine and tenofovir alafenamide are eliminated renally. Darolutamide is a weak inducer of CYP3A4 but is unlikely to have a clinically significant effect on rilpivirine. No interaction is expected with emtricitabine or tenofovir alafenamide. Note, androgen deprivation treatment may prolong the QT interval. Caution should be taken when using with antiretroviral drugs that can potentially prolong the QT interval such as rilpivirine (although at supra-therapeutic concentrations).

Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) is indicated for use as a complete regimen for the treatment of HIV-1 infection. However, in specific clinical situations where an intensification of HIV treatment is needed, the coadministration with darunavir/ritonavir would be possible from a pharmacokinetic standpoint. No dose adjustment is required when rilpivirine is co-administered with darunavir/ritonavir. Coadministration of rilpivirine (150 mg once daily) and darunavir/ritonavir (800/100 mg once daily) increased rilpivirine Cmax by 79% and AUC and Cmin increased by 2.3- and 2.78-fold, respectively. Darunavir Cmax, AUC and Cmin decreased by 10%, 11% and 11%, respectively. Coadministration of darunavir/ritonavir (800/100 mg once daily) with emtricitabine/tenofovir alafenamide (200/10 mg, once daily) increased tenofovir AUC and Cmax by 105% and 142% (n-10). No significant effects were observed on darunavir pharmacokinetics relative to historical controls. Tenofovir alafenamide is dosed 25 mg in Odefsey whereas the recommended dose of tenofovir alafenamide is 10 mg with P-gp inhibitors such as darunavir/ritonavir, but it should be noted that tenofovir alafenamide has been associated with a large clinical safety profile.

Symtuza (darunavir, cobicistat, emtricitabine, tenofovir alafenamide) and Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) are indicated for use as complete regimens for the treatment of HIV-1 infection and should not be administered with other antiretroviral products. Furthermore, both products contain emtricitabine and tenofovir alafenamide and must not be administered with other products containing emtricitabine and tenofovir alafenamide.

Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) is indicated for use as a complete regimen for the treatment of HIV-1 infection. However, in specific clinical situations where an intensification of HIV treatment is needed, coadministration with darunavir/cobicistat would be possible from a pharmacokinetic standpoint. Darunavir/cobicistat is expected to increase rilpivirine concentrations, but the expected increase in rilpivirine concentrations is not considered clinically relevant and no dose adjustment is required. Coadministration with emtricitabine/tenofovir alafenamide has not been studied, but no interaction with emtricitabine is expected. Coadministration with darunavir/cobicistat (800/150 mg once daily) and tenofovir alafenamide alone (25 mg once daily) increased tenofovir AUC and Cmax by 224% and 216%, respectively. Tenofovir alafenamide is dosed 25 mg in Odefsey whereas the recommended dose of tenofovir alafenamide is 10 mg with P-gp inhibitors such as darunavir/cobicistat, but it should be noted that tenofovir alafenamide has been associated with a large clinical safety profile.

Coadministration has not been studied. Dasatinib is metabolized by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Dasatinib is a weak inhibitor of CYP3A4 and therefore could potentially increase rilpivirine exposure although to a moderate extent. Emtricitabine and tenofovir alafenamide do not interact with dasatinib metabolic pathway. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses, but equivalent rilpivirine concentrations are unlikely to occur with dasatinib. However, the product labels for rilpivirine/emtricitabine/tenofovir alafenamide indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Dasatinib has a possible risk of QT prolongation and/or TdP on the CredibleMeds.org website.

Coadministration has not been studied. An in vitro study has shown that daunorubicin was able to inhibit metabolism mediated by CYP3A4, but was unlikely to cause clinically significant drug interactions via this mechanism. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with daunorubicin metabolic pathway. However, damage to the myocardium is one of the major risks of daunorubicin treatment and may include: dose-independent supraventricular arrhythmias (sinus tachycardia, premature ventricular contractions, AV-block) and/or non-specific ECG abnormalities. 

Coadministration has not been studied. The primary route of decitabine metabolism is likely by cytidine deaminase. Decitabine is a prodrug and is activated intracellularly through sequential phosphorylation via phosphokinases activities to the active triphosphate. Phosphorylation of emtricitabine occurs via the same enzymes and competition may occur for this activation path. However, the clinical relevance of this interaction is unknown. Rilpivirine is metabolised by CYP3A4. Decitabine does not inhibit or induce CYP enzymes. No interaction is expected with tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Deferasirox is mainly glucuronidated by UGT1A1 and to a lesser extent by UGT1A3; CYP-mediated metabolism appears to be minor (~8%). Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. Deferasirox is a weak inducer of CYP3A4 and was shown to reduce midazolam exposure by 17%, although it is unlikely to significantly decrease rilpivirine concentrations. Rilpivirine is unlikely to affect UGT1A1 or UGT1A3. Significant interactions are not expected with emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Deflazacort is immediately metabolised by plasma esterases to the active metabolite (21-desdeflazacort) which is then metabolised mainly by CYP3A4 to several inactive metabolites which are excreted in the urine (~70%) and faeces (~30%). Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. Deflazacort and 21-desdeflazacort do not inhibit or induce CYP3A4. Rilpivirine at 25 mg once daily is unlikely to inhibit or induce CYPs to a clinically relevant extent. No interaction is expected with emtricitabine or tenofovir alafenamide.

Coadministration has not been studied. Delamanid is primarily metabolised by albumin to DM-6705; metabolism of DM-6705 to other metabolites is thought to involve pathways mediated by CYP enzymes, including CYP3A4. No pharmacokinetic interaction is expected as rilpivirine, emtricitabine and tenofovir alafenamide do not affect CYP enzymes. However, QTc prolongation has been reported with delamanid (and is very closely correlated with the metabolite DM-6705). Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with delamanid. However, the product labels for rilpivirine/emtricitabine/tenofovir alafenamide indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Delamanid has a possible risk of QT prolongation and/or TdP on the CredibleMeds.org website.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Denosumab is not eliminated via hepatic metabolism but follows the immunoglobulin clearance pathway.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Desflurane is almost exclusively eliminated unchanged by the lungs. 

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely as desipramine is metabolized by CYP2D6. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with desipramine. However, the product labels for rilpivirine indicate that rilpivirine/emtricitabine/tenofovir alafenamide should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Desipramine has a possible risk of QT prolongation and/or TdP on the CredibleMeds.org website. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Desloratadine is metabolized to the active metabolite 3-hydroxydesloratadine, which is subsequently glucuronidated. The enzyme(s) responsible for the formation of the active metabolite have not been identified, but no clinically relevant interactions have been observed with inhibitors of CYP enzymes. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. Desloratadine does not inhibit CYP3A4.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Desmopressin undergoes no significant hepatic metabolism and is not a substrate for CYP enzymes. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. Desmopressin does not inhibit CYP enzymes and no metabolic drug interactions are expected.

Coadministration with a desogestrel-containing combined oral contraceptive (COC) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Desogestrel is a prodrug which is activated to etonogestrel by CYP2C9 (and possible CYP2C19); the metabolism of etonogestrel is mediated by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Compared to historical controls, coadministration of rilpivirine (25 mg once daily) and a COC containing ethinylestradiol/norethindrone had no significant effect on rilpivirine or ethinylestradiol pharmacokinetics. Emtricitabine and tenofovir alafenamide do not interact with the desogestrel or ethinylestradiol metabolic pathways.

Coadministration with a desogestrel-containing progestogen-only pill (POP) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Desogestrel is a prodrug which is activated to etonogestrel by CYP2C9 (and possible CYP2C19); the metabolism of etonogestrel is mediated by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with desogestrel metabolic pathway. 

Coadministration with Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) is contraindicated with systemic dexamethasone (except as a single dose) as significant decreases in rilpivirine plasma concentrations may occur. Dexamethasone is metabolized by CYP3A4. Rilpivirine is primarily metabolized by CYP3A4 and has no inhibitory or inducing effects on drug metabolizing enzymes. Dexamethasone is a dose-dependent inducer of CYP3A4 and is a moderate CYP3A4 inducer at doses above 16 mg. Coadministration may decrease rilpivirine concentrations due to induction of CYP3A4. No interaction is expected with emtricitabine, however, dexamethasone induces intestinal P-glycoprotein and could reduce the absorption of tenofovir alafenamide, although to a moderate extent. No a priori dose adjustment of tenofovir alafenamide is needed as coadministration with rifampicin (a stronger inducer) led to lower intracellular tenofovir diphosphate concentrations but which were still higher than those achieved with tenofovir-DF. In the specific case of patients being treated with short term dexamethasone for COVID-19 please refer to www.covid19-druginteractions.org for additional advice.

Coadministration has not been studied. Dexamethasone is metabolized by CYP3A4. Rilpivirine is primarily metabolized by CYP3A4 and has no inhibitory or inducing effects on drug metabolizing enzymes. No interaction is expected with emtricitabine. Although dexamethasone induces intestinal P-glycoprotein, low dose dexamethasone is not expected to significantly reduce absorption of tenofovir alafenamide. Dexamethasone is a weak CYP3A4 inducer at a low dose and may decrease rilpivirine concentrations. Although the level of induction is likely to be relatively modest, it should be noted that real-life data have shown a large inter-individual variability in rilpivirine concentrations with some individuals having rilpivirine trough concentrations below the minimal target concentration (i.e., 50 ng/mL) even in the absence of inducers. Consider doubling the dose of rilpivirine to 50 mg once daily during treatment with low dose dexamethasone In the specific case of patients being treated with short term dexamethasone for COVID-19 please refer to www.covid19-druginteractions.org for additional advice.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dexketoprofen is mainly excreted as glucuronide conjugates; CYP2C8/9 plays a minor role in metabolism. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. Rilpivirine at 25 mg once daily is unlikely to inhibit or induce CYPs/UGTs to a clinically relevant extent. Dexketoprofen is unlikely to affect CYP3A4. No interaction is expected with emtricitabine. Coadministration is unlikely to be of concern for nephrotoxicity as tenofovir alafenamide results in 90% lower systemic levels of tenofovir compared to tenofovir-DF.

Coadministration has not been studied and is contraindicated as significant decreases in rilpivirine plasma concentrations may occur. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dexmedetomidine undergoes extensive hepatic metabolism through direct glucuronidation (mainly via UGT1A4, 2B10) and cytochrome P450 (mainly CYP2A6). Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dextromethorphan is metabolized by CYP2D6. Rilpivirine is metabolized by CYP3A4. Emtricitabine and tenofovir alafenamide are eliminated renally. Rilpivirine at 25 mg once daily is unlikely to inhibit or induce CYP2D6 to a clinically relevant extent. Dextromethorphan does not inhibit or induce CYP3A4. No interaction is expected with emtricitabine or tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dextropropoxyphene is mainly metabolized by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Diamorphine is rapidly metabolized by sequential deacetylation to morphine which is then mainly glucuronidated to morphine-3-glucuronide (UGT2B7>UGT1A1) and, to a lesser extent, to the pharmacologically active morphine-6-glucuronide (UGT2B7>UGT1A1). Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied but based on the metabolism and clearance a clinically significant interaction is unlikely. Diazepam is metabolized to nordiazepam (by CYP3A4 and 2C19) and to temazepam (mainly by CYP3A4). Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Diclofenac is partly glucuronidated by UGT2B7 and partly oxidized by CYP2C9. In addition, coadministration with an NSAID is unlikely to be of concern for nephrotoxicity as tenofovir alafenamide results in 90% lower systemic levels of tenofovir compared to tenofovir-DF. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Diethylcarbamazine is mainly excreted unchanged in the urine. A clinically significant interaction is not expected with tenofovir alafenamide which results in 90% lower systemic levels of tenofovir compared to tenofovir-DF. Also, there is little potential for interaction with emtricitabine or rilpivirine. 

Coadministration with rilpivirine/emtricitabine/tenofovir alafenamide has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Coadministration of digoxin and rilpivirine had no significant effect on digoxin pharmacokinetics. No effect is expected on emtricitabine or tenofovir alafenamide as digoxin is eliminated renally via the renal transporters OATP4C1 and P-glycoprotein, whereas emtricitabine and tenofovir alafenamide are excreted by different renal transporters.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dihydrocodeine undergoes predominantly direct glucuronidation, with CYP3A4 mediated metabolism accounting for only 5-10% of the overall metabolism. Rilpivirine at a dose of 25 mg once daily does not inhibit or induce CYPs or UGTs. Emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied. Dihydroergotamine is a substrate and inhibitor of CYP3A4 and could potentially increase rilpivirine concentrations, but to a limited extent and no dose adjustment is required for rilpivirine. Emtricitabine and tenofovir alafenamide do not interact with dihydroergotamine elimination.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Diloxanide furoate is largely hydrolysed under the combined action of bacterial and gut esterases and subsequently glucuronidated. No clinically-significant drug interactions are known, and significant interactions with antiretrovirals are unlikely. 

Coadministration has not been studied. Diltiazem is metabolized by CYP3A4 and CYP2D6. Diltiazem is an inhibitor of CYP3A4 and could potentially increase rilpivirine exposure, but to a limited extent and no dose adjustment is required for rilpivirine. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with diltiazem. However, the product labels for rilpivirine indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Diltiazem has a conditional risk of QT prolongation and/or TdP on the CredibleMeds.org website. No interaction is expected with emtricitabine and tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dimethyl fumarate is metabolized by esterases before entering the blood stream. Further metabolism occurs though the TCA cycle. Rilpivirine is metabolised by CYP3A4. Dimethyl fumarate is unlikely to have a clinically significant effect on substrates of CYPs, UGTs and P-gp. No interaction is expected with emtricitabine or tenofovir alafenamide which are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Diphenhydramine is mainly metabolized by CYP2D6. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dipyridamole is glucuronidated by many UGTs, specifically those of the UGT1A subfamily. Rilpivirine, emtricitabine and tenofovir alafenamide are unlikely to interfere with this pathway.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Disopyramide is metabolized by CYP3A4 (25%) and 50% of the drug is eliminated unchanged in the urine. In vitro data suggest that disopyramide weakly inhibits the renal transporter OCT2 in rats. Rilpivirine, emtricitabine and tenofovir derived from tenofovir alafenamide are not transported by OCT2 and therefore are unlikely to be affected by disopyramide. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with disopyramide. However, given the known QT prolongation risk associated with disopyramide, caution is recommended.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Disulfiram is reduced to diethyldithiocarbamic acid, is conjugated with glucuronic acid, oxidised to sulphate, methylated and decomposed to diethylamine and carbon disulphide. 

Coadministration has not been studied. Some European product labels for docetaxel warn in vitro studies have shown that the metabolism of docetaxel may be modified by the concomitant administration of compounds which are metabolised by cytochrome P450 3A (and thus may inhibit the enzyme competitively). As a result, caution should be exercised when treating patients with these medicinal products as concomitant therapy since there is a potential for a significant interaction. Emtricitabine and tenofovir alafenamide are not expected to interfere with docetaxel metabolism. 

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely as dofetilide is mainly excreted unchanged in urine. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with dofetilide. However, given the known QT prolongation risk associated with dofetilide, caution is recommended.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Dolasetron is converted by carbonyl reductase to its active metabolite, hydrodolasetron, which is mainly glucuronidated (60%) and metabolized by CYP2D6 (10-20%) and CYP3A4 (<1%). Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with dolasetron metabolic pathway. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses, but these are unlikely to occur with dolasetron. However, the product labels for rilpivirine/emtricitabine/tenofovir alafenamide indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Dolasetron has a possible risk of QT prolongation and/or TdP on the CredibleMeds.org website.

Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) is indicated for use as a complete regimen for the treatment of HIV-1 infection. However, in specific clinical situations where an intensification of HIV treatment is needed, coadministration with dolutegravir would be possible from a pharmacokinetic standpoint. No clinically relevant drug-drug interaction is expected between dolutegravir and rilpivirine, emtricitabine or tenofovir alafenamide. Coadministration of dolutegravir (50 mg once daily) and rilpivirine (25 mg once daily) increased dolutegravir Cmax, AUC and Ctrough by 13%, 12% and 22%, respectively. Rilpivirine Cmax, AUC and Ctrough increased by 10%, 6% and 21%, respectively. Coadministration of dolutegravir (50 mg once daily) with emtricitabine/tenofovir alafenamide (200/10 mg, once daily) increased tenofovir AUC and Cmax by 25% and 10% (n=10). No significant effects were observed on dolutegravir pharmacokinetics relative to historical controls.

Dolutegravir/lamivudine/tenofovir-DF and Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) are indicated for use as complete regimens for the treatment of HIV-1 infection and should not be administered with other antiretroviral products. In addition, products containing emtricitabine should not be administered with products containing lamivudine due to the risk for intracellular interactions between cytidine analogues such as emtricitabine and lamivudine. Furthermore, products containing tenofovir-DF should not be coadministered with products containing tenofovir alafenamide.

Triumeq (dolutegravir, abacavir, lamivudine) and Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) are both indicated for use as complete regimens for the treatment of HIV-1 infection and should not be co-administered with other antiretroviral medicinal products. Furthermore, products containing emtricitabine should not be administered with products containing lamivudine due to the risk for intracellular interactions between cytidine analogues such as emtricitabine and lamivudine.

Dovato (dolutegravir/lamivudine) and Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) are indicated for use as complete regimens for the treatment of HIV-1 infection and should not be administered with other antiretroviral products. In addition, products containing emtricitabine should not be administered with products containing lamivudine due to the risk for intracellular interactions between cytidine analogues such as emtricitabine and lamivudine.

Juluca (dolutegravir/rilpivirine) and Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) are indicated for use as complete regimens for the treatment of HIV-1 infection and should not be administered with other antiretroviral products. Furthermore, both products contain rilpivirine and should not be administered with additional rilpivirine.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Domperidone is mainly metabolized by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with domperidone metabolic pathway. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with domperidone. However, given the known QT prolongation risk associated with domperidone, caution is recommended.

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Donepezil is metabolized by CYP3A4 and CYP2D6 (minor). Rilpivirine is metabolized by CYP3A4 but has no inhibitory or inducing effects on CYPs. However, rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with donepezil. Given the known QT prolongation risk associated with donepezil, caution is recommended. Emtricitabine and tenofovir alafenamide do not interfere with donepezil’s elimination pathway.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dopamine is metabolised in the liver, kidneys, and plasma by monoamine oxidase (MAO) and catechol-O-methyltransferase to inactive compounds. About 25% of a dose of dopamine is metabolised to norepinephrine within the adrenergic nerve terminals. There is little potential for dopamine to affect disposition of antiretrovirals, or to be affected if co-administered with antiretrovirals.

Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) is indicated for use as a complete regimen for the treatment of HIV 1 infection and must not be administered with another NNRTI.

Delstrigo (doravirine, lamivudine, tenofovir-DF) and Odefsey (rilpivirine, emtricitabine, tenofovir alafenamide) are indicated for use as complete regimens for the treatment of HIV-1 infection and should not be administered with other antiretroviral products. In addition, products containing emtricitabine should not be administered with products containing lamivudine due to the risk for intracellular interactions between cytidine analogues such as emtricitabine and lamivudine. Furthermore, products containing tenofovir-DF should not be coadministered with products containing tenofovir alafenamide.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Doxazosin is metabolized mainly by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Doxepin is metabolized to nordoxepin (a metabolite with comparable pharmacological activity as the parent compound) mainly by CYP2C19. In addition, doxepin and nordoxepin are metabolized by CYP2D6. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a pharmacokinetic interaction is unlikely. Doxorubicin is mainly eliminated in the bile by P-gp and BCRP and does not undergo CYP-mediated metabolism. (Some product labels suggest doxorubicin is a substrate of CYP3A4, however, there are no strong data supporting the role of CYP3A4 in doxorubicin metabolism.) However, rilpivirine should be used with caution when coadministered with a drug that has a potential risk to prolong the QT interval. In healthy subjects, supratherapeutic doses of rilpivirine (75 mg once daily and 300 mg once daily) have been shown to prolong the QT interval. Possible cardiac toxicities (ECG abnormalities and sometimes arrhythmias) have been reported with doxorubicin. Use with caution. ECG monitoring is recommended.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Doxycycline is excreted in the urine and faeces as unchanged active substance. Between 40%-60% of an administered dose can be accounted for in the urine. There is therefore little potential for a clinically significant interaction with rilpivirine or with emtricitabine and tenofovir (derived from tenofovir alafenamide) via competition for renal elimination transport mechanisms. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Doxylamine is metabolised primarily by CYP2D6, CYP1A2 and CYP2C9. Rilpivirine is metabolized by CYP3A4 and does not inhibit or induce CYP enzymes at clinically relevant concentrations. Doxylamine is unlikely to have a clinically significant effect on rilpivirine. No interaction is expected with emtricitabine or tenofovir alafenamide which are eliminated renally.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Droloxifene is mainly glucuronidated. Rilpivirine, emtricitabine and tenofovir alafenamide do not interact with droloxifene metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Dronabinol is mainly metabolized by CYP2C9 and to a lesser extent by CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with dronabinol metabolic pathway. 

Coadministration has not been studied. Dronedarone is metabolized by CYP3A4 and is a moderate inhibitor of CYP3A4. Rilpivirine is primarily metabolized by CYP3A4 and dronedarone could potentially increase rilpivirine concentrations although to an extent that would not warrant a dose adjustment. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but these are unlikely to occur during coadministration with methadone. However, given the known QT prolongation risk associated with dronedarone, caution is recommended. No interaction is expected with emtricitabine and tenofovir alafenamide.

Coadministration with a drospirenone-containing combined oral contraceptive (COC) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Drospirenone is metabolized to a minor extent via CYP3A4. Ethinylestradiol is mainly metabolized by hydroxylation. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Compared to historical controls, coadministration of rilpivirine (25 mg once daily) and a COC containing ethinylestradiol/norethindrone had no significant effect on rilpivirine or ethinylestradiol pharmacokinetics. Emtricitabine and tenofovir alafenamide do not interact with the drospirenone or ethinylestradiol metabolic pathways.

Coadministration with drospirenone as hormone replacement therapy (HRT) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Drospirenone is metabolized to a minor extent via CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway. In addition, no interaction is expected with estradiol or estrogens administered as part of HRT.

Coadministration with a drospirenone progestogen-only pill (POP) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Drospirenone is metabolized to a minor extent via CYP3A4. Rilpivirine at a dose of 25 mg once daily is unlikely to have a clinically relevant effect on the exposure of medicinal products metabolised by CYP enzymes. Emtricitabine and tenofovir alafenamide do not interact with this metabolic pathway.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Drotaverine is metabolised in the liver by O-deethylation. Clinically relevant pharmacokinetic interactions have not been reported. Rilpivirine is metabolised by CYP3A4. No interaction is expected with emtricitabine or tenofovir alafenamide which are eliminated renally.