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Drug Interactions between AccessPak for HIV PEP Basic and ribavirin

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

ribavirin tenofovir

Applies to: ribavirin and AccessPak for HIV PEP Basic (emtricitabine / tenofovir disoproxil)

MONITOR: Concomitant use of oral ribavirin and nucleoside reverse transcriptase inhibitors (NRTIs) may increase the risk of symptomatic hyperlactatemia and lactic acidosis. Ribavirin itself is a nucleoside analogue, and these agents alone and in combination have been associated with the syndrome of lactic acidosis and severe hepatomegaly with steatosis. Other mitochondrial toxicities associated with the use of nucleoside analogues include lipodystrophy, peripheral neuropathy, and pancreatitis.

MANAGEMENT: Coadministration of ribavirin and NRTIs should be undertaken with caution and only if the benefit is anticipated to outweigh the potential risks. Patients should be advised to promptly seek medical attention if they experience symptoms of toxicity such as nausea, vomiting, abdominal pain/distention, fatigue, unexplained weight loss, tachypnea, dyspnea, motor weakness, numbness, tingling, and pain in hands and feet.

References (4)
  1. "Product Information. Rebetron (interferon alfa-2b-ribavirin)." Scherer Laboratories Inc
  2. Lafeuillade A, Hittinger G, Chadapaud S (2001) "Increased mitochondrial toxicity with ribavirin in HIV/HCV coinfection." Lancet, 357, p. 280-1
  3. Guyader D, Poinsignon Y, Cano Y, Saout L (2002) "Fatal lactic acidosis in a HIV-positive patient treated with interferon and ribavirin for chronic hepatitis C." J Hepatol, 37, p. 289-91
  4. (2003) "Product Information. Copegus (ribavirin)." Roche Laboratories
Moderate

ribavirin emtricitabine

Applies to: ribavirin and AccessPak for HIV PEP Basic (emtricitabine / tenofovir disoproxil)

MONITOR: Concomitant use of oral ribavirin and nucleoside reverse transcriptase inhibitors (NRTIs) may increase the risk of symptomatic hyperlactatemia and lactic acidosis. Ribavirin itself is a nucleoside analogue, and these agents alone and in combination have been associated with the syndrome of lactic acidosis and severe hepatomegaly with steatosis. Other mitochondrial toxicities associated with the use of nucleoside analogues include lipodystrophy, peripheral neuropathy, and pancreatitis.

MANAGEMENT: Coadministration of ribavirin and NRTIs should be undertaken with caution and only if the benefit is anticipated to outweigh the potential risks. Patients should be advised to promptly seek medical attention if they experience symptoms of toxicity such as nausea, vomiting, abdominal pain/distention, fatigue, unexplained weight loss, tachypnea, dyspnea, motor weakness, numbness, tingling, and pain in hands and feet.

References (4)
  1. "Product Information. Rebetron (interferon alfa-2b-ribavirin)." Scherer Laboratories Inc
  2. Lafeuillade A, Hittinger G, Chadapaud S (2001) "Increased mitochondrial toxicity with ribavirin in HIV/HCV coinfection." Lancet, 357, p. 280-1
  3. Guyader D, Poinsignon Y, Cano Y, Saout L (2002) "Fatal lactic acidosis in a HIV-positive patient treated with interferon and ribavirin for chronic hepatitis C." J Hepatol, 37, p. 289-91
  4. (2003) "Product Information. Copegus (ribavirin)." Roche Laboratories

Drug and food interactions

Moderate

ribavirin food

Applies to: ribavirin

ADJUST DOSING INTERVAL: Food enhances the oral absorption and bioavailability of ribavirin. Administration of a single oral dose of ribavirin following a high-fat meal delayed absorption (Tmax was doubled) but increased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) by up to 70% compared to administration in the fasting state.

MANAGEMENT: To ensure maximal oral absorption, ribavirin should be administered with or immediately after a meal.

References (2)
  1. (2003) "Product Information. Copegus (ribavirin)." Roche Laboratories
  2. (2004) "Product Information. Rebetol (ribavirin)." Schering-Plough Corporation
Minor

tenofovir food

Applies to: AccessPak for HIV PEP Basic (emtricitabine / tenofovir disoproxil)

Food enhances the oral absorption and bioavailability of tenofovir, the active entity of tenofovir disoproxil fumarate. According to the product labeling, administration of the drug following a high-fat meal increased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of tenofovir by approximately 14% and 40%, respectively, compared to administration in the fasting state. However, administration with a light meal did not significantly affect the pharmacokinetics of tenofovir compared to administration in the fasting state. Food delays the time to reach tenofovir Cmax by approximately 1 hour. Tenofovir disoproxil fumarate may be administered without regard to meals.

References (1)
  1. (2001) "Product Information. Viread (tenofovir)." Gilead Sciences

Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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