Which medicines should not be taken with Biktarvy?
Medically reviewed by Leigh Ann Anderson, PharmD. Last updated on May 13, 2020.
- Biktarvy (bictegravir, emtricitabine and tenofovir alafenamide) is an oral, 3-drug combination tablet used to treat immunodeficiency virus type 1 (HIV-1). Biktarvy is a complete regimen and its use with other antiretroviral medications for the treatment of HIV-1 infection is not recommended.
- Biktarvy is associated with multiple drug-drug and drug-food interactions as it contains three different medicines, increasing your risk for interactions. You should not take Biktarvy with dofetilide (Tikosyn), a drug used for heart rhythm disorders or rifampin (Rifadin), a medicine for tuberculosis (TB). These drugs are contraindicated with the use of Biktary. (see Table 1).
- It is important to have your doctor or pharmacist review your medications for possible drug interactions each time you start or even stop a new prescription, over-the-counter or herbal medicine or dietary supplement.
- Biktarvy can also cause problems if you have certain medical conditions. For example, liver disease such as hepatitis, kidney disease, and certain bone diseases like osteoporosis may be affected by Biktarvy.
What are drug interactions?
Anytime you take a medication and mix it with other medications, or certain foods, beverages, over-the-counter (OTC) medications, or herbal supplements you are at risk of a drug interaction.
Most drug interactions are not serious; however, a few are so it’s important to understand the possible outcome before you combine medications with other drugs, alcohol, certain foods or other substances.
The more medications you take, the greater the chance for your drug interacting with another medicine or substance. Drug-drug interactions can decrease how well your medications work, may increase minor or serious unexpected side effects, or even increase the blood level and toxicity of a certain drug.
Many drug interactions, including those with Biktarvy, occur if one drug affects another drug’s absorption through the stomach or intestine, distribution throughout the body, metabolism (break down) in the liver, or excretion through the kidneys.
Drug interactions can be complicated, especially if you take several medications, so always consult with your health care professional.
Drug Interactions with Biktary
Drug interactions with Biktarvy can lead to several outcomes, including:
- Loss of the intended therapeutic effect
- Increased risk of serious side effects from elevated blood levels of drugs
- Need to adjust the dose or dosing interval of Biktarvy or use alternative medications
Note: There are many other possible drug interactions with Biktary. Have your doctor or pharmacist screen for drug interactions each time you start - or even stop - a medication. Discuss these selected drug interactions with your health care providers.
|Drug of Concern||Outcome||Action|
*Table is not inclusive of all possible drug interactions.
|Anticonvulsants: carbamazepine, oxcarbazepine, phenobarbital phenytoin||Decreased bictegravir and tenofovir alafenamide blood levels||Biktarvy should be used with alternative anticonvulsants.|
|dofetilide (Tikosyn) - a drug used for irregular heart beats||Increased dofetilide blood levels with serious, life-threatening side effects.||Do not use with Biktarvy (contraindicated)|
|Rifampin - used for TB treatment||Decreased blood levels of bictegravir and tenofovir alafenamide, which may lower effectiveness for HIV and cause viral resistance.||Do not use with Biktarvy (contraindicated due to bictegravir component).|
|Rifabutin, rifapentine||Decreased blood levels of bictegravir, which may lower effectiveness for HIV and cause viral resistance.||Use with rifabutin or rifapentine is not recommended.|
|St. John’s wort - herbal supplement often used for depression||Decreased blood levels of bictegravir and tenofovir alafenamide, which may lower effectiveness for HIV and cause viral resistance.||Coadministration with St. John’s wort is not recommended.|
|Supplements or medicines that contain magnesium (Mg), Aluminum (Al), Calcium (Ca) and Iron (Fe) (including certain antacids, laxatives, sucralfate, and buffered medications).||Decreased absorption and blood levels of bictegravir, which may lower effectiveness for HIV and cause viral resistance.||
Antacids containing Al/Mg:
If you take antacids that contain aluminum or magnesium, take Biktavry at least 2 hours before or 6 hours after you take these antacids.
Routine administration of Biktarvy together with, or 2 hours after you take antacids containing Al / Mg is not recommended.
Supplements or antacids containing calcium or iron:
If you take supplements or antacids that contain iron or calcium, take Biktarvy with food at the same time that you take these supplements or antacids.
It is not recommended you routinely take Biktarvy with calcium or iron supplements on an empty stomach. Taking Biktarvy on an empty stomach with Ca or Fe products, or up to 2 hours after you have taken these products, is not recommended.
|metformin||Increased metformin and tenofovir alafenamide blood levels.||Talk to your doctor. You may need a dose adjustment if you have been receiving metformin.|
Certain enzymes and transporters found in your body, often in your kidney or liver, can affect your drug therapy. Your pharmacist or doctor can check to see if you take any drugs that affect these compounds that may alter your response to Biktarvy or other medicines. These include:
- organic cation transporter 2 (OCT2)
- multidrug and toxin extrusion transporter 1 (MATE1)
- Cytochrome P450 3A (CYP3A)
- UDP-glucuronosyltransferase 1A1 (UGT1A1)
- P-glycoprotein (P-gp)
- Breast cancer resistance protein (BCRP)
Because emtricitabine and tenofovir, two components of Biktarvy, are primarily excreted by your kidneys, use of Biktarvy with drugs that affect kidney function may increase concentrations of emtricitabine, tenofovir, and other drugs that go through the kidney. This may increase the risk of side effects.
Examples of drugs that may be affected include, acyclovir, cidofovir, ganciclovir, valacyclovir, valganciclovir, aminoglycosides (e.g., gentamicin), and high-dose or multiple nonsteroidal antiinflammatory drugs (NSAIDs) such as ibuprofen or naproxen.
The manufacturer of Biktarvy notes that NO clinically significant drug interactions have been observed when Biktarvy is combined with:
- ethinyl estradiol
Review these, and other potential Biktarvy drug interactions in the Drugs.com Drug Interaction Checker.
What health conditions are a concern if I take Biktarvy?
Drug interactions don’t always occur with just other drugs or foods. Your existing medical conditions can impact Biktavry, too.
For example, if you have ongoing liver, kidney or bone disease you may be at greater risk of worsening these conditions when you take Biktarvy. Tell your doctor if any of these conditions affect you.
There are several disease interactions with Biktarvy which include:
- liver (hepatic) diseases, including hepatitis B virus (HBV)
- kidney (renal) impairment
- bone toxicity such as osteoporosis
Other serious side effects for Biktarvy, which might affect these conditions, include:
- immune system changes
- kidney problems, including kidney failure
- liver problems, which may rarely lead to death (rare)
- too much lactic acid in your blood known as lactic acidosis (rare)
Biktarvy is not recommended in patients with severe renal impairment (estimated CrCl <30 mL/min) or severe hepatic impairment (Child-Pugh Class C). Your doctor can determine if you have kidney impairment with lab tests.
Tell your doctor immediately if any new or worsening side effects occur. Tell your doctor right away if you get any of these symptoms, which may be a signal of lactic acidosis:
- weakness or being more tired than usual
- unexpected muscle pain
- shortness of breath, fast breathing
- stomach pain with nausea and vomiting
- cold or blue hands and feet
- feeling dizzy or lightheaded
- fast or abnormal heartbeat
Hepatitis B (HBV) infection and liver toxicity
Biktarvy may worsen hepatitis B (HBV) infection. If you have both HIV-1 and HBV and stop taking Biktarvy, your HBV may suddenly become worse. Do not stop taking Biktarvy without first talking to your health care provider, as they will need to monitor your health.
Tell your doctor right away if you get any of these symptoms, which may be a signal of liver toxicity:
- skin or the white part of your eyes turns yellow
- dark “tea-colored” urine
- light-colored stools
- loss of appetite for several days or longer, nausea
- pain in your stomach area
How is Biktary used?
Biktarvy, from Gilead, is an oral, 3-drug combination tablet used to treat immunodeficiency virus type 1 (HIV-1). It contains the integrase strand transfer inhibitor (INSTI) bictegravir, along with the nucleoside analog reverse transcriptase inhibitors (NRTIs) emtricitabine (FTC) and tenofovir alafenamide (TAF).
Biktarvy was FDA-approved in Feb. 2018 as a complete regimen for the treatment of HIV-1 infection in adults and children weighing at least 25 kg (55 lbs):
- who have no antiretroviral treatment history or,
- to replace the current antiretroviral regimen in certain patients.
Biktarvy is taken once a day, every day, with or without food. Biktarvy is taken by itself (not with other HIV-1 medicines) to treat HIV-1 infection. It is considered a complete regime in one pill. Do not miss any doses.
The most common side effects you might experience with Biktary include:
- diarrhea (occurring in 6%, or 6 out of every 100 patients)
- nausea (occurring in 6%, or 6 out of every 100 patients)
- headache (occurring in 5%, or 5 out of every 100 patients)
Biktarvy contains three different medications used to treat HIV-1, so this can greatly increase your risk for a drug interaction. (see Table 1)
Not all drug interactions are serious, but some may be, so it is important to have a review of drug interactions each time you start or stop a medication. There are hundreds of possible drug interactions with Biktarvy, and not all Biktarvy drug interactions are listed in this review.
Always have your doctor or pharmacist review for possible drug interactions each time you start or stop a medication. Discuss these selected drug interactions with your health care providers. Never stop a medication without talking to your doctor first.
- Biktarvy [package insert]. Foster City, CA. Gilead. June 2019 Accessed May 8 2020 at https://www.gilead.com/~/media/files/pdfs/medicines/hiv/biktarvy/biktarvy_pi.pdf
- Biktary. Important Facts. Gilead.com. Accessed May 8, 2020 at https://services.gileadhiv.com/content/pdf/BIKTARVY/Important_Facts.pdf
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