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Emtricitabine / nelfinavir / tenofovir Disease Interactions

There are 11 disease interactions with emtricitabine / nelfinavir / tenofovir:

Major

Nrtis (Includes Emtricitabine/nelfinavir/tenofovir) ↔ Hepatotoxicity

Severe Potential Hazard, Moderate plausibility

Applies to: Alcoholism, Liver Disease

Hepatotoxicity including lactic acidosis, severe hepatomegaly with steatosis, fulminant hepatitis, and hepatic failure has rarely been associated with the use of nucleoside reverse transcriptase inhibitors (NRTIs) alone or in combination with other antiretroviral agents. Therapy with NRTIs should be administered cautiously in patients with preexisting liver disease, a history of alcohol abuse, or hepatitis. Therapy should be suspended if clinical or laboratory findings suggestive of lactic acidosis or pronouced hepatotoxicity occur.

References

  1. Dolin R, Lambert JS, Morse GD, et al "2',3'-dideoxyinosine in patients with AIDS or AIDS-related complex." Rev Infect Dis 12 (1990): s540-51
  2. Montaner JSG, Rachlis A, Beaulieu R, Gill J, Schlech W, Phillips P, Auclair C, Boulerice F, Schindzielorz A, Smaldone L, Wainber "Safety profile of didanosine among patients with advanced HIV disease who are intolerant to or deteriorate despite zidovudine therapy: results of the canadian open ddi treatment program." J Acquir Immune Defic Syndr 7 (1994): 924-30
  3. Yarchoan R, Mitsuya H, Pluda JM, et al "The National Cancer Institute phase I study of 2',3'-dideoxyinosine administration in adults with AIDS-related complex: analysis of activity and toxicity profiles." Rev Infect Dis 12 (1990): s522-33
View all 22 references
Major

Pis (Includes Emtricitabine/nelfinavir/tenofovir) ↔ Hemophilia

Severe Potential Hazard, Low plausibility

Applies to: Coagulation Defect

There have been postmarketing reports of increased bleeding, including spontaneous skin hematomas and hemarthrosis, in types A and B hemophiliac patients treated with protease inhibitors. However, a causal relationship has not been established. In some patients, additional Factor VIII was given. In more than half of the reported cases, protease inhibitor therapy was continued or reintroduced following an interruption. Hemophiliacs and patients with other coagulation defects should be monitored closely for bleeding during protease inhibitor therapy.

References

  1. "Product Information. Crixivan (indinavir)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Kaletra (lopinavir-ritonavir)" Abbott Pharmaceutical, Abbott Park, IL.
  3. "Product Information. Agenerase (amprenavir)." Glaxo Wellcome, Research Triangle Pk, NC.
View all 10 references
Major

Tenofovir (Includes Emtricitabine/nelfinavir/tenofovir) ↔ Renal Dysfunction

Severe Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Tenofovir is primarily eliminated by the kidney via glomerular filtration and active tubular secretion. Renal impairment, including acute renal failure and Fanconi syndrome, has been reported with tenofovir use. Close monitoring of renal function and lengthening the dosing interval are recommended for patients with creatinine clearance less than 50 mL/min. Creatinine clearance should be calculated in all patients before starting tenofovir treatment and during treatment when clinically appropriate. Routine monitoring of serum creatinine and phosphorus is recommended for patients at risk of or with a history of renal dysfunction. Safety and effectiveness have not been evaluated in patients with renal insufficiency using dose adjustments; therefore, the benefit of tenofovir treatment should be weighed against the risk of renal toxicity. Tenofovir should be avoided in patients who are currently using or have recently used nephrotoxic drugs.

References

  1. "Product Information. Viread (tenofovir)." Gilead Sciences, Foster City, CA.
Moderate

Emtricitabine (Includes Emtricitabine/nelfinavir/tenofovir) ↔ Hemodialysis

Moderate Potential Hazard, High plausibility

Applies to: hemodialysis

Emtricitabine is removed by hemodialysis. Following an emtricitabine dose administered 1.5 hours before the hemodialysis session, approximately 30% of the dose was removed over three hours of hemodialysis (blood flow rate of 400 mL/min and a dialysate flow rate of 600 mL/min). Emtricitabine should be administered after hemodialysis.

References

  1. "Product Information. Emtriva (emtricitabine)." Gilead Sciences, Foster City, CA.
Moderate

Emtricitabine (Includes Emtricitabine/nelfinavir/tenofovir) ↔ Renal Dysfunction

Moderate Potential Hazard, High plausibility

Applies to: Renal Dysfunction

Emtricitabine is primarily eliminated by the kidney. Compared to patients with normal renal function (CrCl above 80 mL/min), peak plasma concentration (Cmax) and systemic exposure (AUC) of emtricitabine increased by 45% and 113%, respectively, in patients with moderate renal dysfunction (CrCl 30 to 49 mL/min), and 27% and 186%, respectively, in patients with severe renal dysfunction (CrCl below 30 mL/min). Systemic exposure was increased even further in patients with end-stage renal disease managed on dialysis. These patients had an approximately 3.5-fold increase in emtricitabine AUC compared to patients with normal renal function. Renal clearance of emtricitabine decreased by 68% and 86%, respectively, in patients with moderate and severe renal dysfunction. Dosage adjustment of emtricitabine is recommended for patients with CrCl below 50 mL/min, including patients on dialysis, in accordance with the manufacturer's product labeling. Clinical response to treatment and renal function should be closely monitored.

References

  1. "Product Information. Emtriva (emtricitabine)." Gilead Sciences, Foster City, CA.
Moderate

Nelfinavir (Includes Emtricitabine/nelfinavir/tenofovir) ↔ Liver Disease

Moderate Potential Hazard, High plausibility

Applies to: Liver Disease

Nelfinavir is primarily metabolized by the liver. Patients with liver disease may be at greater risk for adverse effects from nelfinavir due to decreased drug clearance. Therapy with nelfinavir should be administered cautiously in patients with liver disease.

References

  1. "Product Information. Viracept (nelfinavir)." Agouron Pharma Inc, La Jolla, CA.
  2. Sommadossi JP "HIV protease inhibitors: pharmacologic and metabolic distinctions." AIDS 13 (1999): s29-40
Moderate

Nelfinavir (Includes Emtricitabine/nelfinavir/tenofovir) ↔ Pku

Moderate Potential Hazard, High plausibility

Applies to: Phenylketonuria

Viracept (brand of nelfinavir) oral powder contains 11.2 mg of phenylalanine per each gram of powder. The phenylalanine content should be considered when this product is used in patients who must restrict their intake of phenylalanine (i.e. phenylketonurics).

References

  1. "Product Information. Viracept (nelfinavir)." Agouron Pharma Inc, La Jolla, CA.
Moderate

Pis (Includes Emtricitabine/nelfinavir/tenofovir) ↔ Hyperglycemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Abnormal Glucose Tolerance, Diabetes Mellitus

New onset or exacerbation of preexisting diabetes mellitus, glucose intolerance, and hyperglycemia have been reported during postmarketing surveillance in HIV patients treated with protease inhibitors (PIs). Frequently, insulin resistance may accompany fat redistribution and serum lipid elevations in what is collectively termed the HIV-associated lipodystrophy syndrome. Although a causal relationship has not been established, these metabolic disturbances have most often occurred in HIV patients during treatment with potent antiretroviral regimens containing PIs. Patients with or predisposed to glucose disorders should be monitored during PI therapy. Dosage adjustments in insulin or oral hypoglycemic medications may be necessary in patients with diabetes. In some cases, glucose abnormalities persisted despite discontinuation of PI therapy.

References

  1. Hardy H, Esch LD, Morse GD "Glucose disorders associated with HIV and its drug therapy." Ann Pharmacother 35 (2001): 343-51
  2. "Product Information. Viracept (nelfinavir)." Agouron Pharma Inc, La Jolla, CA.
  3. "Product Information. Invirase (saquinavir)." Roche Laboratories, Nutley, NJ.
View all 22 references
Moderate

Pis (Includes Emtricitabine/nelfinavir/tenofovir) ↔ Hyperlipidemia

Moderate Potential Hazard, High plausibility

Applies to: History - Myocardial Infarction, Hyperlipidemia, Ischemic Heart Disease

Hyperlipidemia have been observed in 10% of patients receiving ritonavir during clinical trials. Increases of 30% to 40% from baseline have been reported for total cholesterol and 200% to 300% or more for triglycerides. These effects have also been reported during postmarketing experience with other protease inhibitors (PIs) but may be the most dramatic with ritonavir. The clinical significance of these elevations is unclear. Severe hyperlipidemia is known to sometimes cause pancreatitis. In addition, some patients have reportedly developed symptomatic atherosclerosis and coronary artery disease after initiating PI treatment. Patients with preexisting hyperlipidemia may require closer monitoring during PI therapy, and adjustments made accordingly in their lipid-lowering regimen. PI therapy should be administered cautiously in patients with coronary artery disease or a history of ischemic heart disease.

References

  1. "Product Information. Lexiva (fosamprenavir)." GlaxoSmithKline, Research Triangle Park, NC.
  2. "Product Information. Agenerase (amprenavir)." Glaxo Wellcome, Research Triangle Pk, NC.
  3. "Product Information. Invirase (saquinavir)." Roche Laboratories, Nutley, NJ.
View all 19 references
Moderate

Tenofovir (Includes Emtricitabine/nelfinavir/tenofovir) ↔ Bone Toxicity

Moderate Potential Hazard, Moderate plausibility

Applies to: Osteoporosis, Vitamin D Deficiency

Osteomalacia and reduced bone mineral density have been reported in animal toxicology studies involving tenofovir exposures 6- to 12-fold those observed in humans. The mechanism of bone toxicity has not been established, and it is not known if long-term use of tenofovir disoproxil fumarate will cause bone abnormalities in humans.

References

  1. "Product Information. Viread (tenofovir)." Gilead Sciences, Foster City, CA.
Moderate

Tenofovir (Includes Emtricitabine/nelfinavir/tenofovir) ↔ Liver Disease

Minor Potential Hazard, Low plausibility

Applies to: Liver Disease

There are no data concerning the use of tenofovir disoproxil fumarate in patients with hepatic impairment. Tenofovir and tenofovir disoproxil are not metabolized by liver enzymes. However, since tenofovir is not entirely eliminated by the kidney (70% to 80%), tenofovir pharmacokinetics may be altered in patients with impaired hepatic function.

References

  1. "Product Information. Viread (tenofovir)." Gilead Sciences, Foster City, CA.

emtricitabine / nelfinavir / tenofovir drug Interactions

There are 718 drug interactions with emtricitabine / nelfinavir / tenofovir

emtricitabine / nelfinavir / tenofovir alcohol/food Interactions

There are 2 alcohol/food interactions with emtricitabine / nelfinavir / tenofovir

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

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