Hypertension
Usual Dosage Range General Recommendation with NNRTI
CLASS DRUG (TRADE NAME) Unit Cost Units / Day General Recommendation with PI Usage Exceptions Exceptions
(mg/day) Usage
No CP450 interactions. No CP450 interactions.
Beta Blockers atenolol (Tenormin)* 25 - 100 0.20 – 0.24 1 Monitor PR prolongation of all BB's w/ atazanavir
Consider as 1st line Beta 1 Blocking agent Consider as 1st line Beta 1 Blocking agent
Betaxolol is a major 1A2 & 2D6 substrate. delavirdine, a major & minor inhibitor of 2D6 & 1A2, respectively,
Betaxolol is a major 2D6 substrate. Metabolism strongly inhibited by ritonavir (Norvir / Kaletra). Avoid use if sole PI / monitor
can ↓ betaxolol excretion; consider another agent or monitor hypotensive effects closely. nevirapine, a minor
betaxolol (Kerlone) 5 - 20 0.84 – 1.93 1 No drug interactions w/ fosamprenavir. boosted doses closely. Atazanavir & nelfinavir mildly inhibit 1A2; saquinavir, indinavir, & nelfinavir mild substrates and No CP450 interactions with efavirenz.
1A2 & 2D6 inhibitor, can↓ betaxolol excretion; monitor. Betaxolol is a minor 2D6 inhibitor and can ↑ serum
inhibitors of 2D6. Can ↓ betaxolol excretion/ monitor hypotensive effects. Monitor PR prolongation of all BB's w/ atazanavir
levels of delavirdine & nevirapine, minor substrates of 2D6. Clinical significance unknown.
Bisoprolol is a major 3A4 substrate & a minor 2D6 substrate. nevirapine, a major 3A4 inducer & minor 3A4 &
2D6 inhibitor, can ↑ bisoprolol excretion & potentially ↓ bisoprolol excretion. Monitor & adjust dose. efavirenz, a
bisoprolol (Zebeta) 2.5 - 10 1.10 1 Hypotensive effects ↑ by PI's. Avoid use. Bisoprolol is a major 3A4 substrate. Metabolism inhibited by all PI's. Monitor PR prolongation of all BB's w/ atazanavir Monitor
minor 3A4 inhibitor & inducer, can ↑ or ↓ bisoprolol excretion. delavirdine, a major 2D6 substrate, can ↓
bisoprolol excretion. Monitor
Metoprolol is a major 2D6 substrate, minor 2C19 substrate, & minor 2D6 inhibitor. delavirdine, a major
No CP450 interactions w/ Reyataz;
Metoprolol is a major 2D6 substrate, minor 2C19 substrate, & minor 2D6 inhibitor. ritonavir major 2D6 inhibitor. Avoid use. inhibitor of 2C19 & 2D6, will ↓ metoprolol excretion & ↑ hypotensive effects. Avoid use. efavirenz & nevirapine
metoprolol (Lopressor)* metoprolol monitor PR interval. Avoid use w/ Avoid use with delavirdine. Monitor with
50 - 100 0.29 1-2 Minor 2D6 inhibition seen w/ saquinavir, indinavir, & nelfinavir; Minor 2C19 inhibition w/ all PI's excluding atazanavir. Can are minor 2C19 & 2D6 inhibitors, respectively. Can ↓ metoprolol clearance. Monitor. Metoprolol is a minor 2D6
extended release (Toprol XL)* ritonavir. Minor interactions w/ all other all other NNRTI's.
slightly ↓ metoprolol clearance. Monitor hypotensive effects. Monitor PR prolongation of all BB's w/ atazanavir inhibitor and can ↑ serum levels of delavirdine & nevirapine, minor substrates of 2D6. Clinical significance
PI's. Start at low dose & monitor
unknown.
No CP450 Interactions. Consider 1st line No CP450 Interactions. Consider 1st line
nadolol (Corgard)* 40 - 120 0.55 – 1.37 1 Monitor PR prolongation of all BB's w/ atazanavir
nonselective Beta Blocking agent. nonselective Beta Blocking agent.
Propranolol is a major 1A2, 2C19, & 2D6 substrate; minor 3A4 substrate. delavirdine, a major inhibitor of 2C19
Propranolol is a major 1A2, 2C19, & 2D6 substrate; minor 3A4 substrate. All PI's inhibit 3A4 causing a ↓ in propranolol
Avoid use with delavirdine. Monitor with & 2D6, will ↓ propranolol excretion & ↑ hypotensive effects. Avoid use. efavirenz & nevirapine are minor 2C19
metabolism. Major inhibition of 2D6 w/ ritonavir; can ↑ hypotensive effects of propranolol, esp. @ higher doses. Consider other
propranolol (Inderal)* 40 - 160 0.14 - 0.20 2 Monitor all other NNRTI's. Use only if benefit & 2D6 inhibitors, respectively. Can ↓ propranolol clearance. Monitor. delavirdine & nevirapine, minor 1A2
BB's / monitor. All other PI's are minor inhibitors of 1A2 and/or 2C19, which can ↓ propranolol excretion; monitor hypotensive
outweighs risk. inhibitors, can also ↓ propranolol clearance. Propranolol is a minor 2D6 inhibitor; can ↑ serum levels of
effects. Monitor PR prolongation of all BB's w/ atazanavir
delavirdine & nevirapine, minor substrates of 2D6. Clinical significance unknown.
Propranolol is a major 1A2, 2C19, & 2D6 substrate; minor 3A4 substrate. delavirdine, a major inhibitor of 2C19
Propranolol is a major 1A2, 2C19, & 2D6 substrate; minor 3A4 substrate. All PI's inhibit 3A4 causing a ↓ in propranolol
Avoid use with delavirdine. Monitor with & 2D6, will ↓ propranolol excretion & ↑ hypotensive effects. Avoid use. efavirenz & nevirapine are minor 2C19
metabolism. Major inhibition of 2D6 w/ ritonavir; can ↑ hypotensive effects of propranolol, esp. @ higher doses. Consider other
propranolol long acting (Inderal LA) 60 - 180 1.60 - 2.67 1 Monitor all other NNRTI's. Use only if benefit & 2D6 inhibitors, respectively. Can ↓ propranolol clearance. Monitor. delavirdine & nevirapine, minor 1A2
BB's / monitor. All other PI's are minor inhibitors of 1A2 and/or 2C19, which can ↓ propranolol excretion; monitor hypotensive
outweighs risk. inhibitors, can also ↓ propranolol clearance. Propranolol is a minor 2D6 inhibitor; can ↑ serum levels of
effects. Monitor PR prolongation of all BB's w/ atazanavir
delavirdine & nevirapine, minor substrates of 2D6. Clinical significance unknown.
No CP450 interactions w/ fosamprenavir
Timolol is a major 2D6 substrate, minor 2D6 inhibitor. ritonavir is a major 2D6 metabolite; ritonavir serum levels can ↑.
or Reyataz; monitor PR interval w/ Timolol is a major 2D6 substrate, minor 2D6 inhibitor. delavirdine, a strong inhibitor of 2D6, will ↑ timolol
Metabolism strongly inhibited by ritonavir (Norvir / Kaletra). Avoid use if sole PI / monitor boosted doses closely. saquinavir, Avoid use with delavirdine. Monitor with
timolol (Blocadren)* 20 - 40 0.82 1-2 Reyataz. Avoid use w/ ritonavir. Minor serum levels. Avoid use. nevirapine, a minor 2D6 inhibitor, can ↓ timolol excretion. Monitor. Serum levels of
indinavir, & nelfinavir mild substrates and inhibitors of 2D6. Can ↓timolol excretion/ monitor hypotensive effects. Monitor PR all other NNRTI's.
interactions w/ all other PI's. Start at low delavirdine & nevirapine, minor 2D6 substrates, can ↑. Clinical significance unknown.
prolongation of all BB's w/ atazanavir
dose & monitor
No change in hypotensive effects w/ use of
Beta Blockers with intrinsic Acebutolol is a mild inhibitor of 2D6. ritonavir is a major 2D6 metabolite; ritonavir serum levels can ↑. saquinavir, indinavir & No change in hypotensive effects w/ use of Acebutolol is a mild inhibitor of 2D6. delavirdine & nevirapine are mild substrates of 2D6; Serum levels can ↑.
acebutolol (Sectral)* 200 - 800 0.70 - 0.90 2 PI's. PI clearance can be ↓. Clinical
sympathomimmetic activity nelfinavir mild substrates of 2D6; Serum levels can increase. Monitor PR prolongation of all BB's w/ atazanavir NNRTI's. Clinical significance unknown.
significance unknown.
No CP450 interactions w/ fosamprenavir
Pindolol is a major 2D6 substrate, minor 2D6 inhibitor. ritonavir is a major 2D6 metabolite; ritonavir serum levels can ↑.
or Reyataz; monitor PR interval w/ Pindolol is a major 2D6 substrate, minor 2D6 inhibitor. delavirdine, a strong inhibitor of 2D6, will ↑ pindolol
Metabolism strongly inhibited by ritonavir (Norvir / Kaletra). Avoid use if sole PI / monitor boosted doses closely. saquinavir, Avoid use with delavirdine. Monitor with
pindolol (generic)* 10 - 40 0.34 2 Reyataz. Avoid use w/ ritonavir. Minor serum levels. Avoid use. nevirapine, a minor 2D6 inhibitor, can ↓ pindolol excretion. Monitor. Serum levels of
indinavir, & nelfinavir mild substrates and inhibitors of 2D6. Can ↓timolol excretion/ monitor hypotensive effects. Monitor PR all other NNRTI's.
interactions w/ all other PI's. Start at low delavirdine & nevirapine, minor 2D6 substrates, can ↑. Clinical significance unknown.
prolongation of all BB's w/ atazanavir
dose & monitor
Carvedilol is a major substrate of 2C8/9 & 2D6; minor substrate of 1A2, 2E1, & 3A4. Metabolism strongly inhibited by ritonavir
Carvedilol is a major 2C8/9 & 2D6 substrate; clearance ↓ with use of delavirdine, a major inhibitor of 2C8/9 &
Combined alpha- and Beta (Norvir / Kaletra). Avoid use if sole PI / monitor boosted doses closely. saquinavir, nelfinavir, & nelfinavir mild substrates and Avoid use with delavirdine. Monitor with
carvedilol (Coreg)* 12.5 - 50 1.97 - 2.10 1-2 Monitor. 2D6. Avoid use. Carvedilol is also a minor 1A2 & 3A4 substrate. Serum levels of carvedilol can ↑ or ↑ with use of
Blockers inhibitors of 2D6. Can ↓timolol excretion/ monitor hypotensive effects. All PI's cause minor inhibition of 2C8/9, 2D6, and/or 1A2; all other NNRTI's.
efavirenz & nevirapine; monitor.
can ↓ metabolism & ↑ hypotensive effects. Monitor.
No CP450 interactions w/ fosamprenavir
or Reyataz; monitor PR interval w/ Labetalol is a major 2D6 substrate, minor 2D6 inhibitor. ritonavir is a major 2D6 metabolite; ritonavir serum levels can ↑. Labetalol is a major 2D6 substrate, minor 2D6 inhibitor. delavirdine, a strong inhibitor of 2D6, will ↑ labetalol
Avoid use with delavirdine. Monitor with
labetalol (Normodyne, Trandate)* 200 - 800 0.28 - 0.53 2 Reyataz. Avoid use w/ ritonavir. Minor Metabolism strongly inhibited by ritonavir (Norvir / Kaletra). Avoid use if sole PI / monitor boosted doses closely. saquinavir, serum levels. Avoid use. nevirapine, a minor 2D6 inhibitor, can ↓ labetalol excretion. Monitor. Serum levels of
all other NNRTI's.
interactions w/ all other PI's. Start at low indinavir, & nelfinavir mild substrates and inhibitors of 2D6. Can ↓labetalol excretion/ monitor hypotensive effects. delavirdine & nevirapine, minor 2D6 substrates, can ↑. Clinical significance unknown. Preferred over carvedilol
dose & monitor
ACE Inhibitors benzapril (Lotensin)* 10 - 40 0.47 1 No CP450 Interactions. No CP450 Interactions.
No CP450 interactions w/ fosamprenavir
Captopril is a major 2D6 substrate. Metabolism strongly inhibited by ritonavir (Norvir / Kaletra). Avoid use if sole PI / monitor No CP450 drug interactions with
or Reyataz; Avoid use w/ ritonavir. Minor Captopril is a major 2D6 substrate. delavirdine, a strong inhibitor of 2D6, will ↑ labetalol serum levels. Avoid
captopril (Capoten)* 25 - 100 0.19 - 0.22 2 boosted doses closely. saquinavir, indinavir, & nelfinavir mild inhibitors of 2D6. Can ↓captopril excretion/ monitor hypotensive efavirenz. Avoid use with delavirdine.
interactions w/ all other PI's. Start at low use. nevirapine, a minor 2D6 inhibitor, can ↓ captopril excretion. Monitor.
effects. Monitor use with nevirapine.
dose & monitor
Enalapril is a major 3A4 substrate. All NNRTI's are minor 3A4 inhibitors; excretion can be ↓. nevirapine &
Monitor closely. Use only if benefits Enalapril is a major 3A4 substrate. All PI's are major inhibitors of 3A4 (excluding saquinavir w/ moderate 3A4 inhibition. ↓ in
enalapril (Vasotec)* 5 - 40 0.45 - 0.84 1-2 Monitor efavirenz are major & minor inducers, respectively, of 3A4. Excretion can ↑, primarily with nevirapine. Adjust
outweigh risks enalapril clearance can ↑ hypotensive effects. Start at low dose & monitor closely
dose & monitor.
fosinopril (Monopril) 10 - 40 1.44 1 No CP450 Interactions No CP450 Interactions
lisinopril (Prinivil, Zestril)* 10 - 40 0.47 - 0.81 1 No CP450 Interactions No CP450 Interactions
moexipril (Univasc)* 7.5 - 30 1.57 1 No CP450 Interactions No CP450 Interactions
quinapril (Accupril) 10 - 80 1.09 1 No CP450 Interactions No CP450 Interactions
ramipril (Altace)* 2.5 - 20 1.62 - 2.04 1 No CP450 Interactions No CP450 Interactions
trandolapril (Mavik)* 1-4 1.27 1 No CP450 Interactions No CP450 Interactions
* FL Medicaid approved based on the generic/brand availability
Hypertension
Usual Dosage Range General Recommendation with NNRTI
CLASS DRUG (TRADE NAME) Unit Cost Units / Day General Recommendation with PI Usage Exceptions Exceptions
(mg/day) Usage
Candesartan is a minor substrate & inhibitor of 2C8/9. Metabolism can be ↓ by all PI's excluding fosamprenavir. ritonavir is a No CP450 interactions with nevirapine.
Candesartan is a minor substrate & inhibitor of 2C8/9. delavirdine, a major 2C8/9 inhibitor can ↓ clearance.
Angiotensin II antagonists candesartan (Atacand) 8 - 32 1.94 - 2.50 1 Monitor minor inducer / inhibitor of 2C8/9; can ↑ or ↓ clearance of candesartan. Interactions with PI on hypotensive effects may not be of Monitor with use of delavirdine &
Monitor. efavirenz, a minor 2C8/9 inhibitor, can ↓ clearance. May not be of clinical significance.
clinical significance. fosamprenavir & Nelfinavir minor substrates of 2C8/9; serum levels can ↑. efavirenz.
No change in hypotensive effects w/ use of
Eprosartan is a minor inhibitor of 2C8/9. fosamprenavir & nelfinavir minor substrates of 2C8/9; serum levels can ↑ Clinical No CP450 Interactions. Consider first line
eprosartan (Teveten) 400 - 800 2.20 - 2.77 1-2 PI's. No CP450 drug interactions w/ all
significance unknown. choice of ARB's.
PI's excluding fosamprenavir & nelfinavir.
Irbesartan weakly inhibits 3A4 & 2D6. All NNRTI's are major 3A4 substrates and, excluding efavirenz, minor
Irbesartan moderately inhibits 2C8/9 and weakly inhibits 3A4 & 2D6. fosamprenavir & Nelfinavir minor substrates of 2C8/9;
Monitor adverse reactions of NNRTI's. 2D6 substrates. Can ↑ serum levels of NNRTI's, thus ↑ risk of adverse reactions. Monitor. Irbesartan is a minor
irbesartan (Avapro)* 150 - 300 2.00 - 2.44 1 Monitor can ↑ serum levels. All PI's are 3A4 and/or 2D6 substrates. Can ↑ PI serum levels; clinical significance unknown. Irbesartan is a
Use if risk outweigh benefits. 2C8/9 substrate. delavirdine, a major 2C8/9 inhibitor can ↓ clearance. Monitor. efavirenz, a minor 2C8/9
minor 2C8/9 substrate. Clearance can be ↓ by all PI's excluding fosamprenavir. Clearance can ↑ or ↓ w/ ritonavir use. Monitor
inhibitor, can ↓ clearance. May not be of clinical significance.
Losartan is a major 2C8/9 & 3A4 substrate. All NNRTI's are minor inhibitors of 3A4 & can ↓ clearance.
Losartan is a major 2C8/9 & 3A4 substrate. All PI's are major inhibitors of 3A4 (excluding saquinavir w/ moderate 3A4 nevirapine & efavirenz are major & minor inducers of 3A4, respectively; can ↑ clearance. Due to conflicting
inhibition) & minor inhibitors of 2C8/9 (excluding fosamprenavir). ↓ in losartan clearance can ↑ hypotensive effects. Avoid use if Monitor adverse reactions of NNRTI's. effects on 3A4, monitor & adjust dose. delavirdine, a major 2C8/9 inhibitor, can ↓ clearance & ↑ hypotensive
losartan (Cozaar)* 25 - 100 1.84 - 2.67 1-2 Avoid use
possible. Losartan is a moderate inhibitor of 2C8/9 and a mild inhibitor of 1A2, 2C19, 3A4. Can ↑ serum levels of all PI's. May Use if risk outweigh benefits. effects. Monitor. efavirenz, a minor 2C8/9 inhibitor, can ↓ clearance. May not be of clinical significance.
not be clinically significant. Losartan weakly inhibits 3A4. All NNRTI's are major 3A4 substrates. Can ↑ serum levels of NNRTI's, thus ↑
risk of adverse reactions. Monitor.
No CP450 Interactions. No CP450 Interactions. Consider first line
olmesartan (Benicar)* 20 - 40 1.94 1
Angiotensin II antagonist drug of choice. choice of ARB's.
No change in hypotensive effects w/ use of
No CP450 Interactions. Consider first line
telmisartan (Micardis) 20 - 80 1.97 - 2.33 1 PI's. No CP450 drug interactions w/ all Nelfinavir is a major substrate of 2C19. Telmisartan, a minor inhibitor of 2C19, can ↓ nelfinavir clearance.
choice of ARB's.
PI's excluding nelfinavir.
No change in hypotensive effects w/ use of
Valsartan is a minor 2C8/9 inhibitor. fosamprenavir & nelfinavir minor substrates of 2C8/9; serum levels can ↑ Clinical No CP450 Interactions. Consider first line
valsartan (Diovan)* 80 - 320 1.87 - 2.97 1-2 PI's. No CP450 drug interactions w/ all
significance unknown. choice of ARB's.
PI's excluding fosamprenavir & nelfinavir.
Diltiazem is a major 3A4 substrate & minor 2C8/9 & 2D6. All NNRTI's are minor inhibitors of 3A4; possible ↓
Diltiazem is a major 3A4 substrate & minor 2C8/9 & 2D6. All PI's are major inhibitors of 3A4 (excluding saquinavir w/
in diltiazem clearance. nevirapine & efavirenz are major & minor inducers of 3A4, respectively; can ↑
Calcium Channel Blockers - diltiazem extended release Avoid use if possible. Use only if benefits moderate 3A4 inhibition). ↓ in diltiazem clearance can ↑ hypotensive effects. Avoid use if possible. Diltiazem is a moderate Avoid use if possible. Use only if benefits
180 - 420 1.00 - 4.48 1 clearance. Due to conflicting effects on 3A4, monitor & adjust dose. Diltiazem is a moderate inhibitor of 3A4 &
non-Dihydropyridines (Cardizem CD, Dilacor XR, Tiazac) outweigh risks. inhibitor of 3A4 & mild inhibitor of 2C8/9 & 2D6. Potential to ↑ serum levels of all PI's. Monitor PR prolongation of diltiazem w/ outweigh risks.
2D6. NNRTI's are major 3A4 substrates and, excluding efavirenz, minor 2D6 substrates. Strong possibility of ↑
atazanavir.
serum levels of all NNRTI's, thus ↑ risk of adverse reactions, i.e. rash & hepatotoxicity. Avoid Use.
Diltiazem is a major 3A4 substrate & minor 2C8/9 & 2D6. All NNRTI's are minor inhibitors of 3A4; possible ↓
Diltiazem is a major 3A4 substrate & minor 2C8/9 & 2D6. All PI's are major inhibitors of 3A4 (excluding saquinavir w/
Avoid use if possible. Use only if benefits in diltiazem clearance. nevirapine & efavirenz are major & minor inducers of 3A4, respectively; can ↑
diltiazem extended release moderate 3A4 inhibition). ↓ in diltiazem clearance can ↑ hypotensive effects. Avoid use if possible. Diltiazem is a moderate Avoid use if possible. Use only if benefits
120 - 540 0.60 - 0.74 1 outweigh risks. Start at low dose & titrate clearance. Due to conflicting effects on 3A4, monitor & adjust dose. Diltiazem is a moderate inhibitor of 3A4 &
(Cardizem LA)* inhibitor of 3A4 & mild inhibitor of 2C8/9 & 2D6. Potential to ↑ serum levels of all PI's. Monitor PR prolongation of diltiazem w/ outweigh risks.
slowly 2D6. NNRTI's are major 3A4 substrates and, excluding efavirenz, minor 2D6 substrates. Strong possibility of ↑
atazanavir.
serum levels of all NNRTI's, thus ↑ risk of adverse reactions, i.e. rash & hepatotoxicity. Avoid Use.
Verapamil is a major 3A4 substrate & minor substrate of 1A2 & 2C8/9. All NNRTI's are minor inhibitors of
3A4; can ↓ verapamil clearance. nevirapine & efavirenz are major & minor inducers of 3A4, respectively; can ↑
Verapamil is a major 3A4 substrate & minor substrate of 1A2, 2B6, 2C8/9 & 2E1. All PI's are major inhibitors of 3A4 (excluding clearance. Due to conflicting effects on 3A4, monitor & adjust dose. delavirdine & nevirapine are minor
Avoid use if possible. Use only if benefits
verapamil immediate release saquinavir w/ moderate 3A4 inhibition). ↓ in verapamil clearance can ↑ hypotensive effects. Avoid use if possible. Verapamil is a Avoid use if possible. Use only if benefits inhibitors of 1A2 & can further ↓ excretion. delavirdine is also a major 2C8/9 inhibitor; monitor hypotensive
80 - 320 0.15 - 1.89 3 outweigh risks. Start at low dose & titrate
(Calan, Isoptin)* moderate inhibitor of 3A4 & mild inhibitor of 1A2, 2C8/9, & 2D6. Potential to ↑ serum levels of all PI's. Monitor PR outweigh risks. effects due to various CP450 interactions. efavirenz, a minor 2C8/9 inhibitor, can ↓ clearance. May not be of
slowly
prolongation of verapamil w/ atazanavir. clinical significance. Verapamil is a moderate inhibitor of 3A4 & mild inhibitor of 2D6. NNRTI's are major 3A4
substrates and, excluding efavirenz, minor 2D6 substrates. Moderate possibility of ↑ serum levels of all
NNRTI's, thus ↑ risk of adverse reactions, i.e. rash & hepatotoxicity. Avoid Use.
Verapamil is a major 3A4 substrate & minor substrate of 1A2 & 2C8/9. All NNRTI's are minor inhibitors of
3A4; can ↓ verapamil clearance. nevirapine & efavirenz are major & minor inducers of 3A4, respectively; can ↑
Verapamil is a major 3A4 substrate & minor substrate of 1A2, 2B6, 2C8/9 & 2E1. All PI's are major inhibitors of 3A4 (excluding clearance. Due to conflicting effects on 3A4, monitor & adjust dose. delavirdine & nevirapine are minor
verapamil long acting (Calan SR, Avoid use if possible. Use only if benefits saquinavir w/ moderate 3A4 inhibition). ↓ in verapamil clearance can ↑ hypotensive effects. Avoid use if possible. Verapamil is a Avoid use if possible. Use only if benefits inhibitors of 1A2 & can further ↓ excretion. delavirdine is also a major 2C8/9 inhibitor; monitor hypotensive
120 - 480 0.55 - 0.77 1-2
Isoptin SR) outweigh risks. moderate inhibitor of 3A4 & mild inhibitor of 1A2, 2C8/9, & 2D6. Potential to ↑ serum levels of all PI's. Monitor PR outweigh risks. effects due to various CP450 interactions. efavirenz, a minor 2C8/9 inhibitor, can ↓ clearance. May not be of
prolongation of verapamil w/ atazanavir. clinical significance. Verapamil is a moderate inhibitor of 3A4 & mild inhibitor of 2D6. NNRTI's are major 3A4
substrates and, excluding efavirenz, minor 2D6 substrates. Moderate possibility of ↑ serum levels of all
NNRTI's, thus ↑ risk of adverse reactions, i.e. rash & hepatotoxicity. Avoid Use.
Verapamil is a major 3A4 substrate & minor substrate of 1A2 & 2C8/9. All NNRTI's are minor inhibitors of
3A4; can ↓ verapamil clearance. nevirapine & efavirenz are major & minor inducers of 3A4, respectively; can ↑
Verapamil is a major 3A4 substrate & minor substrate of 1A2, 2B6, 2C8/9 & 2E1. All PI's are major inhibitors of 3A4 (excluding clearance. Due to conflicting effects on 3A4, monitor & adjust dose. delavirdine & nevirapine are minor
Avoid use if possible. Use only if benefits
verapamil - Coer, Covera HS, saquinavir w/ moderate 3A4 inhibition). ↓ in verapamil clearance can ↑ hypotensive effects. Avoid use if possible. Verapamil is a Avoid use if possible. Use only if benefits inhibitors of 1A2 & can further ↓ excretion. delavirdine is also a major 2C8/9 inhibitor; monitor hypotensive
120 - 360 1.79 - 2.34 1 outweigh risks. Start at low dose & titrate
Verelan PM)* moderate inhibitor of 3A4 & mild inhibitor of 1A2, 2C8/9, & 2D6. Potential to ↑ serum levels of all PI's. Monitor PR outweigh risks. effects due to various CP450 interactions. efavirenz, a minor 2C8/9 inhibitor, can ↓ clearance. May not be of
slowly
prolongation of verapamil w/ atazanavir. clinical significance. Verapamil is a moderate inhibitor of 3A4 & mild inhibitor of 2D6. NNRTI's are major 3A4
substrates and, excluding efavirenz, minor 2D6 substrates. Moderate possibility of ↑ serum levels of all
NNRTI's, thus ↑ risk of adverse reactions, i.e. rash & hepatotoxicity. Avoid Use.
* FL Medicaid approved based on the generic/brand availability
Hypertension
Usual Dosage Range General Recommendation with NNRTI
CLASS DRUG (TRADE NAME) Unit Cost Units / Day General Recommendation with PI Usage Exceptions Exceptions
(mg/day) Usage
Amlodipine is a major 3A4 substrate. All NNRTI's are minor inhibitors of 3A4. Can ↓ amlodipine clearance.
nevirapine & efavirenz are major & minor inducers of 3A4, respectively; can ↑ clearance. Due to conflicting
Amlodipine is a major 3A4 substrate. All PI's are major inhibitors of 3A4 (excluding saquinavir w/ moderate 3A4 inhibition). ↓
Calcium Channel Blockers - Monitor closely. Use only if benefits Monitor hypotensive effects. Monitor effects on 3A4, monitor & adjust dose. Amlodipine is a weak inhibitor of 2B6 , 2D6, & 3A4. NNRTI's are major
amlodipine (Norvasc)* 2.5 - 10 1.74 - 2.37 1 in amlodipine clearance can ↑ hypotensive effects. Avoid use if possible. Amlodipine is a moderate inhibitor of 1A2 & minor
Dihydropyridines outweigh risks adverse reactions of NNRTI's. 3A4 substrates and, excluding efavirenz, minor 2D6 substrates. Can ↑ serum levels of all NNRTI's, thus ↑
inhibitor of 2A6, 2B6, 2C8/9, 2D6, & 3A4. Potential to ↑ serum levels of all PI's.
adverse reactions. Can ↓ clearance of efavirenz, a major 2B6 substrate, and nevirapine, a minor 2D6 substrate.
Can ↑ risk of adverse reactions. Monitor.
Felodipine is a major 3A4 substrate. All NNRTI's are minor inhibitors of 3A4. Can ↓ felodipine clearance.
Felodipine is a major 3A4 substrate. All PI's are major inhibitors of 3A4 (excluding saquinavir w/ moderate 3A4 inhibition. ↓ in nevirapine & efavirenz are major & minor inducers of 3A4, respectively; can ↑ clearance. Due to conflicting
Monitor closely. Use only if benefits Monitor hypotensive effects. Monitor
felodipine (Plendil) 2.5 - 20 1.17 - 1.90 1 fosinopril clearance can ↑ hypotensive effects. Avoid if possible. Felodipine is a minor inhibitor of 2C8/9, 2D6, & 3A4. Potential effects on 3A4, monitor & adjust dose. Felodipine is a minor inhibitor of 2D6 & 3A4. NNRTI's are major 3A4
outweigh risks adverse reactions of NNRTI's.
to ↑ serum levels of all PI's. substrates and, excluding efavirenz, minor 2D6 substrates. Can ↑ serum levels of all NNRTI's, thus ↑ risk of
adverse reactions. Monitor.
Monitor closely. Calcium channel blocker Isradipine is a major 3A4 substrate. All NNRTI's are minor inhibitors of 3A4. Can ↓ isradipine clearance.
of choice due to least amount of drug Isradipine is a major 3A4 substrate. All PI's are major inhibitors of 3A4 (excluding saquinavir w/ moderate 3A4 inhibition). ↓ in Monitor hypotensive effects. Monitor nevirapine & efavirenz are major & minor inducers of 3A4, respectively; can ↑ clearance. Due to conflicting
isradipine (Dynacirc CR)* 2.5 - 10 1.94 - 3.64 2
interactions. Use only if benefits outweigh isradipine clearance can ↑ hypotensive effects. Isradipine is a minor inhibitor of 3A4. Potential to ↑ serum levels of all PI's. adverse reactions of NNRTI's. effects on 3A4, monitor & adjust dose. Isradipine is a minor inhibitor of 3A4. NNRTI's are major 3A4
risks substrates; can ↑ serum levels of all NNRTI's, thus ↑ risk of adverse reactions. Monitor
Nicardipine is a major 3A4 substrate & minor 1A2, 2C8/9 & 2D6 substrate. All NNRTI's are minor inhibitors of
3A4, causing an ↓ of nicardipine clearance. nevirapine & efavirenz are major & minor inducers of 3A4,
Nicardipine is a major 3A4 substrate & minor 1A2, 2C8/9, 2D6, & 2E1 substrate. All PI's are major inhibitors of 3A4 (excluding
respectively; can ↑ clearance. Due to conflicting effects on 3A4, monitor & adjust dose. delavirdine is a major
nicardipine sustained release saquinavir w/ moderate 3A4 inhibition) & minor inhibitors of 1A2, 2C8/9, 2D6, and/or 2E1. ↓ in nicardipine clearance can ↑
60 - 120 0.36 - 0.52 2 Avoid use if possible. Avoid Use. inhibitor of 2C8/9 & 2D6. Can ↑ nicardipine levels. delavirdine & nevirapine are minor 1A2 inhibitors &
(Cardene SR)* hypotensive effects. Nicardipine is a major & moderate inhibitor of 2C8/9, 3A4 & 2C19, 2D6, respectively. Can ↑ serum levels
efavirenz is a minor 2C8/9 inhibitor. Can ↓ in nicardipine clearance. Nicardipine is a major inhibitor of 3A4 as
of all PI's.
well as a moderate inhibitor of 2D6. All NNRTI's are major substrates of 3A4 and, excluding efavirenz, minor
substrates of 2D6. Can ↑ serum levels & risk of adverse reactions of all NNRTI's. Avoid Use
Nifedipine is a major substrate of 3A4 & minor substrate of 2D6. All NNRTI's are minor inhibitors of 3A4,
Nifedipine is a major substrate of 3A4 & minor substrate of 2D6. All PI's are major inhibitors of 3A4 (excluding saquinavir w/ causing an ↓ of nifedipine clearance. nevirapine & efavirenz are major & minor inducers of 3A4, respectively;
nifedipine long acting (Adalat CC, Monitor closely. Use only if benefits moderate 3A4 inhibition). ↓ in nifedipine clearance can ↑ hypotensive effects. ritonavir is a major inhibitor of 2D6; saquinavir, Monitor hypotensive effects. Monitor can ↑ clearance. Due to conflicting effects on 3A4, monitor & adjust dose. delavirdine & efavirenz are major &
30 - 60 1.17 - 2.57 1
Procardia XL)* outweigh risks nelfinavir, & nelfinavir mild inhibitors of 2D6. Can ↓nifedipine excretion; monitor hypotensive effects. Nifedipine is a moderate adverse reactions of NNRTI's. minor inhibitors of 2D6, respectively. Can ↓ nifedipine clearance. Monitor. Nifedipine is mild inhibitor of 2D6, &
inhibitor of 1A2 & mild inhibitor of 2C8/9, 2D6, & 3A4. Can ↑ serum levels of PI's. 3A4. NNRTI's are major 3A4 substrates and, excluding efavirenz, minor 2D6 substrates. Can ↑ serum levels of
all NNRTI's, thus ↑ risk of adverse reactions. Monitor.
Nisoldipine is a major 3A4 substrate. All NNRTI's are minor inhibitors of 3A4, causing an ↓ of nisoldipine
Monitor closely. Consider calcium channel
Nisoldipine is a major 3A4 substrate. All PI's are major inhibitors of 3A4 (excluding saquinavir w/ moderate 3A4 inhibition). ↓ Monitor hypotensive effects. Monitor clearance. nevirapine & efavirenz are major & minor inducers of 3A4, respectively; can ↑ clearance. Due to
nisoldipine (Sular)* 10 - 40 2.74 - 3.80 1 blocker 2nd drug of choice. Use only if
in nisoldipine clearance can ↑ hypotensive effects. Nisoldipine is a mild inhibitor of 1A2 & 3A4. Can ↑ serum levels of PI's. adverse reactions of NNRTI's. conflicting effects on 3A4, monitor & adjust dose. Nisoldipine is a mild inhibitor of 3A4. All NNRTI's are major
benefits outweigh risks
3A4 substrates; can ↑ serum levels of NNRTI's, thus ↑ risk of adverse reactions. Monitor.
Alpha -1 blockers doxazosin (Cardura)* 1 - 16 0.77 - 0.87 1-2 No CP450 Interactions No CP450 Interactions
prazosin (Minipress)* 2 - 20 0.18 - 0.30 2-3 No CP450 Interactions No CP450 Interactions
terazosin (Hytrin)* 1 - 20 0.86 1-2 No CP450 Interactions No CP450 Interactions
No change in hypotensive effects w/ use of No change in hypotensive effects. Monitor All NNRTI's are major substrates of 3A4. Hydralazine, a minor 3A4 inhibitor, can ↑ NNRTI serum levels. Can ↑
Direct vasodilators hydralazine (Apresoline)* 25 - 100 0.24 - 0.38 2 All PI's are major substrates of 3A4. Hydralazine, a minor 3A4 inhibitor, can ↑ PI serum levels. Clinical significance unknown.
PI's. adverse reactions of NNRTI's. risk of adverse reactions. Monitor.
minoxidil (Loniten) 2.5 - 80 0.35 - 0.58 1-2 No CP450 drug interactions No CP450 drug interactions
Amlodipine is a major 3A4 substrate. All NNRTI's are minor inhibitors of 3A4. Can ↓ amlodipine clearance.
nevirapine & efavirenz are major & minor inducers of 3A4, respectively; can ↑ clearance. Due to conflicting
Avoid use if possible. Use only if benefits No CpP450 interactions w/ benzapril. Amlodipine is a major 3A4 substrate. All PI's are major inhibitors of 3A4 (excluding
ACE Inhibitors and Calcium Monitor hypotensive effects. Monitor effects on 3A4, monitor & adjust dose. Amlodipine is a weak inhibitor of 2B6 , 2D6, & 3A4. NNRTI's are major
Amlodipine-benzapril HCL (Lotrel)* 2.5/10 to 10/20 2.74 - 3.54 1 outweigh risks. Start at low dose & titrate saquinavir w/ moderate 3A4 inhibition). ↓ in amlodipine clearance can ↑ hypotensive effects. Avoid use if possible. Amlodipine is
Channel Blockers adverse reactions of NNRTI's. 3A4 substrates and, excluding efavirenz, minor 2D6 substrates. Can ↑ serum levels of all NNRTI's, thus ↑
slowly a moderate inhibitor of 1A2 & minor inhibitor of 2A6, 2B6, 2C8/9, 2D6, & 3A4. Potential to ↑ serum levels of all PI's.
adverse reactions. Can ↓ clearance of efavirenz, a major 2B6 substrate, and nevirapine, a minor 2D6 substrate.
Can ↑ risk of adverse reactions. Monitor.
Enalapril & felodipine are major 3A4 substrates. All NNRTI's are minor inhibitors of 3A4. Can ↓ enalapril &
Enalapril & felodipine are major 3A4 substrates. All PI's are major inhibitors of 3A4 (excluding saquinavir w/ moderate 3A4 felodipine clearance. nevirapine & efavirenz are major & minor inducers of 3A4, respectively; can ↑ enalapril &
Monitor closely. Use only if benefits Monitor hypotensive effects. Monitor
Enalapril-felodipine (Lexxel)* 5/5 2.16 1-2 inhibition. ↓ in enalapril & fosinopril clearance can ↑ hypotensive effects. Felodipine is a minor inhibitor of 2C8/9, 2D6, & 3A4. felodipine clearance. Due to conflicting effects on 3A4, monitor & adjust dose. Felodipine is a minor inhibitor of
outweigh risks adverse reactions of NNRTI's.
Potential to ↑ serum levels of all PI's. Avoid if possible. 2D6 & 3A4. NNRTI's are major 3A4 substrates and, excluding efavirenz, minor 2D6 substrates. Can ↑ serum
levels of all NNRTI's, thus ↑ risk of adverse reactions. Monitor.
No CP450 drug interactions w/ trandolapril. Verapamil is a major 3A4 substrate & minor substrate of 1A2 &
2C8/9. All NNRTI's are minor inhibitors of 3A4; can ↓ verapamil clearance. nevirapine & efavirenz are major &
minor inducers of 3A4, respectively; can ↑ clearance. Due to conflicting effects on 3A4, monitor & adjust dose.
No CP450 drug interactions w/ trandolapril. Verapamil is a major 3A4 substrate & minor substrate of 1A2, 2B6, 2C8/9 & 2E1.
Avoid use if possible. Use only if benefits Avoid use if possible. Use only if benefits delavirdine & nevirapine are minor inhibitors of 1A2 & can further ↓ excretion. delavirdine is also a major
All PI's are major inhibitors of 3A4 (excluding saquinavir w/ moderate 3A4 inhibition). ↓ in amlodipine clearance can ↑
Trandolapril-verapamil (Tarka)* 2/180 or 1/240 to 4/240 2.54 1 outweigh risks. Start at low dose & titrate outweigh risks. Start at low dose & titrate 2C8/9 inhibitor; monitor hypotensive effects due to various CP450 interactions. efavirenz, a minor 2C8/9
hypotensive effects. Avoid use if possible. Verapamil is a moderate inhibitor of 3A4 & mild inhibitor of 1A2, 2C8/9, & 2D6.
slowly slowly inhibitor, can ↓ clearance. May not be of clinical significance. Verapamil is a moderate inhibitor of 3A4 & mild
Potential to ↑ serum levels of all PI's.
inhibitor of 2D6. NNRTI's are major 3A4 substrates and, excluding efavirenz, minor 2D6 substrates. Moderate
possibility of ↑ serum levels of all NNRTI's, thus ↑ risk of adverse reactions, i.e. rash & hepatotoxicity. Avoid
Use.
* FL Medicaid approved based on the generic/brand availability
Hypertension
Usual Dosage Range General Recommendation with NNRTI
CLASS DRUG (TRADE NAME) Unit Cost Units / Day General Recommendation with PI Usage Exceptions Exceptions
(mg/day) Usage
Benzapril-Hydrochlorothiazide
ACE Inhibitors and Diuretics 5/6.25 to 20/25 0.47 1 No CP450 Interactions No CP450 Interactions
(Lotensin HCT)*
No CP450 interactions w/ fosamprenavir
Captopril is a major 2D6 substrate. Metabolism strongly inhibited by ritonavir (Norvir / Kaletra). Avoid use if sole PI / monitor No CP450 drug interactions with
Captopril-Hydrochlorothiazide or Reyataz; Avoid use w/ ritonavir. Minor Captopril is a major 2D6 substrate. delavirdine, a strong inhibitor of 2D6, will ↑ labetalol serum levels. Avoid
25/15 to 50/25 0.65 - 0.92 2 boosted doses closely. saquinavir, nelfinavir, & nelfinavir mild inhibitors of 2D6. Can ↓captopril excretion/ monitor hypotensive efavirenz. Avoid use with delavirdine.
(Capozide)* interactions w/ all other PI's. Start at low use. nevirapine, a minor 2D6 inhibitor, can ↓ captopril excretion. Monitor.
effects. Monitor use with nevirapine.
dose & monitor
Enalapril is a major 3A4 substrate. All NNRTI's are minor 3A4 inhibitors; excretion can be ↓. nevirapine &
Enalapril-Hydrochlorothiazide Monitor closely. Use only if benefits Enalapril is a major 3A4 substrate. All PI's are major inhibitors of 3A4 (excluding saquinavir w/ moderate 3A4 inhibition. ↓ in
5/12.5 to 10/25 1.04 - 1.07 1-2 Monitor efavirenz are major & minor inducers, respectively, of 3A4. Excretion can ↑, primarily with nevirapine. Adjust
(Vaseretic)* outweigh risks enalapril clearance can ↑ hypotensive effects. Start at low dose & monitor closely
dose & monitor.
Fosinopril-Hydrochlorothiazide
10/12.5 to 20/12.5 1.18 1 No CP450 Interactions No CP450 Interactions
(Monopril/HCT)
Lisinopril-Hydrochlorothiazide
10/12.5 to 20/25 0.74 - 0.90 1 No CP450 Interactions No CP450 Interactions
(Prinzide / Zestoretic)*
Moexipril-Hydrochlorothiazide
7.5/12.5 to 15/25 1.52 1 No CP450 Interactions No CP450 Interactions
(Uniretic)*
Quinapril-Hydrochlorothiazide
10/12.5 to 20/25 1.20 1 No CP450 Interactions No CP450 Interactions
(Accuretic)
Candesartan is a minor substrate & inhibitor of 2C8/9. Metabolism can be ↓ by all PI's excluding fosamprenavir. ritonavir is a No CP450 interactions with nevirapine.
Angiotensin II Receptor Candesartan-Hydrochlorothiazide Retail prices may Candesartan is a minor substrate & inhibitor of 2C8/9. delavirdine, a major 2C8/9 inhibitor can ↓ clearance.
16/12.5 to 32/12.5 1 Monitor minor inducer / inhibitor of 2C8/9; can ↑ or ↓ clearance of candesartan. fosamprenavir & Nelfinavir minor substrates of 2C8/9; Monitor with use of delavirdine &
Antagonists and Diuretics (Atacand HCT) vary Monitor. efavirenz, a minor 2C8/9 inhibitor, can ↓ clearance. May not be of clinical significance.
serum levels can ↑. efavirenz.
No change in hypotensive effects w/ use of
Eprosartan-Hydrochlorothiazide Retail prices may Eprosartan is a minor inhibitor of 2C8/9. fosamprenavir & nelfinavir minor substrates of 2C8/9; serum levels can ↑ Clinical No CP450 Interactions. Consider first line
600/12.5 to 600/25 1 PI's. No CP450 drug interactions w/ all
(Teveten HCT) vary significance unknown. choice of ARB / Diuretic
PI's excluding fosamprenavir & nelfinavir.
Irbesartan weakly inhibits 3A4 & 2D6. All NNRTI's are major 3A4 substrates and, excluding efavirenz, minor
Irbesartan moderately inhibits 2C8/9 and weakly inhibits 3A4 & 2D6. fosamprenavir & Nelfinavir minor substrates of 2C8/9;
Irbesartan - Hydrochlorothiazide Monitor adverse reactions of NNRTI's. 2D6 substrates. Can ↑ serum levels of NNRTI's, thus ↑ risk of adverse reactions. Monitor. Irbesartan is a minor
150/12.5 to 300/12.5 2.60 1 Monitor can ↑ serum levels. All PI's are 3A4 and/or 2D6 substrates. Can ↑ PI serum levels; clinical significance unknown. Irbesartan is a
(Avalide)* Use if risk outweigh benefits. 2C8/9 substrate. delavirdine, a major 2C8/9 inhibitor can ↓ clearance. Monitor. efavirenz, a minor 2C8/9
minor 2C8/9 substrate. Clearance can be ↓ by all PI's excluding fosamprenavir. Clearance can ↑ or ↓ w/ ritonavir use. Monitor
inhibitor, can ↓ clearance. May not be of clinical significance.
Losartan is a major 2C8/9 & 3A4 substrate. All NNRTI's are minor inhibitors of 3A4 & can ↓ clearance.
Losartan is a major 2C8/9 & 3A4 substrate. All PI's are major inhibitors of 3A4 (excluding saquinavir w/ moderate 3A4 nevirapine & efavirenz are major & minor inducers of 3A4, respectively; can ↑ clearance. Due to conflicting
Losartan - Hydrochlorothiazide inhibition) & minor inhibitors of 2C8/9 (excluding fosamprenavir). ↓ in losartan clearance can ↑ hypotensive effects. Avoid use if Monitor adverse reactions of NNRTI's. effects on 3A4, monitor & adjust dose. delavirdine, a major 2C8/9 inhibitor, can ↓ clearance & ↑ hypotensive
50/12.5 to 100/25 2.04 - 2.60 1-2 Avoid use
(Hyzaar)* possible. Losartan is a moderate inhibitor of 2C8/9 and a mild inhibitor of 1A2, 2C19, 3A4. Can ↑ serum levels of all PI's. May Use if risk outweigh benefits. effects. Monitor. efavirenz, a minor 2C8/9 inhibitor, can ↓ clearance. May not be of clinical significance.
not be clinically significant. Losartan weakly inhibits 3A4. All NNRTI's are major 3A4 substrates. Can ↑ serum levels of NNRTI's, thus ↑
risk of adverse reactions. Monitor.
Olmesartan medoxomil -
Retail prices may No CP450 Interactions. No CP450 Interactions. Consider first line
Hydrochlorothiazide (Benicar 20/12.5 to 40/25 1
vary Angiotensin II antagonist drug of choice. choice of ARB / Diuretic
HCT)*
No change in hypotensive effects w/ use of
Telmisartan-Hydrochlorothiazide No CP450 Interactions. Consider first line
40/12.5 to 80/12.5 2.20 - 2.80 1 PI's. No CP450 drug interactions w/ all Nelfinavir is a major substrate of 2C19. Telmisartan, a minor inhibitor of 2C19, can ↓ nelfinavir clearance.
(Micardis HCT) choice of ARB / Diuretic
PI's excluding nelfinavir.
No change in hypotensive effects w/ use of
Valsartan-Hydrochlorothiazide Valsartan is a minor 2C8/9 inhibitor. fosamprenavir & nelfinavir minor substrates of 2C8/9; serum levels can ↑ Clinical No CP450 Interactions. Consider first line
80/12.5 to 160/25 2.20 - 2.84 1-2 PI's. No CP450 drug interactions w/ all
(Diovan HCT)* significance unknown. choice of ARB / Diuretic
PI's excluding fosamprenavir & nelfinavir.
No CP450 interactions. No CP450 interactions.
Beta Blockers and Diuretics Atenolol-chlorthalidone (Tenoretic)* 50/25 to 100/25 0.50 - 0.62 1 Consider as 1st line Beta 1 Blocking / Consider as 1st line Beta 1 Blocking /
Diuretic agent Diuretic agent
Bisoprolol is a major 3A4 substrate & a minor 2D6 substrate. nevirapine, a major 3A4 inducer & minor 3A4 &
Bisoprolol-Hydrochlorothiazide 2D6 inhibitor, can ↑ bisoprolol excretion & potentially ↓ bisoprolol excretion. Monitor & adjust dose. efavirenz, a
2.5/6.25 to 10/6.25 0.97 1 Hypotensive effects ↑ by PI's. Avoid use. Bisoprolol is a major 3A4 substrate. Metabolism inhibited by all PI's. Monitor
(Ziac) minor 3A4 inhibitor & inducer, can ↑ or ↓ bisoprolol excretion. delavirdine, a major 2D6 substrate, can ↓
bisoprolol excretion. Monitor
Metoprolol is a major 2D6 substrate, minor 2C19 substrate, & minor 2D6 inhibitor. delavirdine, a major
No CP450 interactions w/ Reyataz;
Metoprolol is a major 2D6 substrate, minor 2C19 substrate, minor 2D6 inhibition. ritonavir major 2D6 inhibitor. Avoid use. inhibitor of 2C19 & 2D6, will ↓ metoprolol excretion & ↑ hypotensive effects. Avoid use. efavirenz & nevirapine
Metoprolol-Hydrochlorothiazide monitor PR interval. Avoid use w/ Avoid use with delavirdine. Monitor with
50/25 to 100/25 1.02 - 1.45 1-2 Minor 2D6 inhibition seen w/ saquinavir, indinavir, & nelfinavir; Minor 2C19 inhibition w/ all PI's excluding atazanavir. Can are minor 2C19 & 2D6 inhibitors, respectively. Can ↓ metoprolol clearance. Monitor. Metoprolol is a minor 2D6
(Lopressor HCT)* ritonavir. Minor interactions w/ all other all other NNRTI's.
slightly ↓ metoprolol clearance. Monitor hypotensive effects. inhibitor and can ↑ serum levels of delavirdine & nevirapine, minor substrates of 2D6. Clinical significance
PI's. Start at low dose & monitor
unknown.
No CP450 Interactions. Consider 1st line
Nadolol - bendroflumethiazide No CP450 Interactions. Consider 1st line
40/5 to 80/5 2.17 - 2.74 1 nonselective Beta Blocking / Diuretic
(Corzide)* nonselective Beta Blocking agent.
agent.
Propranolol is a major 1A2, 2C19, & 2D6 substrate; minor 3A4 substrate. delavirdine, a major inhibitor of 2C19
Propranolol is a major 1A2, 2C19, & 2D6 substrate; minor 3A4 substrate. All PI's inhibit 3A4 causing a ↓ in propranolol
Avoid use with delavirdine. Monitor with & 2D6, will ↓ propranolol excretion & ↑ hypotensive effects. Avoid use. efavirenz & nevirapine are minor 2C19
Propranolol LA-Hydrochlorothiazide metabolism. Major inhibition of 2D6 w/ ritonavir; can ↑ hypotensive effects of propranolol, esp. @ higher doses. Consider other
40/25 to 80/25 0.20 - 0.22 1 Monitor all other NNRTI's. Use only if benefit & 2D6 inhibitors, respectively. Can ↓ propranolol clearance. Monitor. delavirdine & nevirapine, minor 1A2
(Inderide LA)* BB's / monitor. All other PI's are minor inhibitors of 1A2 and/or 2C19, which can ↓ propranolol excretion; monitor hypotensive
outweighs risk. inhibitors, can also ↓ propranolol clearance. Propranolol is a minor 2D6 inhibitor; can ↑ serum levels of
effects.
delavirdine & nevirapine, minor substrates of 2D6. Clinical significance unknown.
No CP450 interactions w/ fosamprenavir
or Reyataz; monitor PR interval w/ Timolol is a major 2D6 substrate, minor 2D6 inhibitor. ritonavir is a major 2D6 metabolite; ritonavir serum levels can ↑. Timolol is a major 2D6 substrate, minor 2D6 inhibitor. delavirdine, a strong inhibitor of 2D6, will ↑ timolol
Timolol-Hydrochlorothiazide Avoid use with delavirdine. Monitor with
10/25 0.79 2 Reyataz. Avoid use w/ ritonavir. Minor Metabolism strongly inhibited by ritonavir (Norvir / Kaletra). Avoid use if sole PI / monitor boosted doses closely. saquinavir, serum levels. Avoid use. nevirapine, a minor 2D6 inhibitor, can ↓ timolol excretion. Monitor. Serum levels of
(Timolide) all other NNRTI's.
interactions w/ all other PI's. Start at low nelfinavir, & nelfinavir mild substrates and inhibitors of 2D6. Can ↓timolol excretion/ monitor hypotensive effects. delavirdine & nevirapine, minor 2D6 substrates, can ↑. Clinical significance unknown.
dose & monitor
* FL Medicaid approved based on the generic/brand availability