Éfavirenz : interactions médicamenteuses

CYP3A4 Inducers: Avoid concomitant strong CYP3A4 inducers during YONSA treatment. (notice Abiratérone, Interactions médicamenteuses)

• CYP3A Inhibitors: Avoid co-administration with strong CYP3A inhibitors. (notice Acalabrutinib, Interactions médicamenteuses)

Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogs alone or in combination with other antiretrovirals [See Warnings and Precautions (5. (notice Adéfovir, Mise en garde encadrée)

…(Childs-Pugh categories B and C), since alfuzosin blood levels are increased in these patients [see Use in Specific Populations (8.7) and Clinical Pharmacology (12.3) ]. with potent CYP3A4 inhibitors such as ketoconazole, itraconazole, and ritonavir, since alfuzosin blood levels are increased [see Drug Interactions (7.1) and Clinical Pharmacology (12.3) ] . in… (notice Alfuzosine, Contre-indications)

Concomitant use of almotriptan tablets and potent CYP3A4 inhibitors should be avoided in patients with renal or hepatic impairment [see Clinical Pharmacology ( 12.3 )] . (notice Almotriptan, Interactions médicamenteuses)

CYP3A4 Inducers : Avoid coadministration of VIJOICE with a strong CYP3A4 inducer. (notice Alpélisib, Interactions médicamenteuses)

• taking strong cytochrome P450 3A (CYP3A) inhibitors (e.g., ketoconazole, itraconazole), except ritonavir [see Dosage and Administration (2.5) , Warnings and Precautions (5.5) , Drug Interactions (7.1) ] . (notice Alprazolam, Contre-indications)

…Voxilaprevir ↓ velpatasvir ↓ voxilaprevir Coadministration of efavirenz and sofosbuvir/velpatasvir/voxilaprevir is not recommended because it may result in loss of therapeutic effect of sofosbuvir/velpatasvir/voxilaprevir Other agents Anticoagulant:Warfarin ↑ or ↓ warfarin Monitor international normalised ratio (INR) and adjust warfarin dosage if necessary. (notice Éfavirenz, Interactions médicamenteuses)

Drug Interactions : Use with strong cytochrome P450 enzyme inducers (e.g., rifampin, phenobarbital, carbamazepine, phenytoin) is not recommended because loss of efficacy may occur ( 5.5 , 7.1 ) (notice Aprémilast, Mises en garde et précautions)

…Voxilaprevir ↓ velpatasvir ↓ voxilaprevir Coadministration of efavirenz and sofosbuvir/velpatasvir/voxilaprevir is not recommended because it may result in loss of therapeutic effect of sofosbuvir/velpatasvir/voxilaprevir Other agents Anticoagulant:Warfarin ↑ or ↓ warfarin Monitor international normalised ratio (INR) and adjust warfarin dosage if necessary. (notice Éfavirenz, Interactions médicamenteuses)

CYP3A4 Inducers : Avoid concomitant use for greater than 14 days ( 7.1 ) (notice Aripiprazole, Interactions médicamenteuses)

Treatment-experienced patients: Coadministration of efavirenz and atazanavir is not recommended. (notice Éfavirenz, Interactions médicamenteuses)

Do not use avanafil in patients taking strong CYP3A4 inhibitors [see Warnings and Precautions ( 5.2 ) and Dosage and Administration ( 2.3 )]. (notice Avanafil, Interactions médicamenteuses)

Moderate CYP3A4/5 inducers (e.g., bosentan, efavirenz, etravirine, modafinil, and nafcillin) may also reduce the plasma exposure of axitinib and should be avoided if possible. (notice Axitinib, Interactions médicamenteuses)

Not recommended with ATRIPLA, which contains efavirenz, emtricitabine, and tenofovir disoproxil fumarate, unless needed for dose adjustment when coadministered with rifampin. (notice Éfavirenz, Mises en garde et précautions)

…Voxilaprevir ↓ velpatasvir ↓ voxilaprevir Coadministration of efavirenz and sofosbuvir/velpatasvir/voxilaprevir is not recommended because it may result in loss of therapeutic effect of sofosbuvir/velpatasvir/voxilaprevir Other agents Anticoagulant:Warfarin ↑ or ↓ warfarin Monitor international normalised ratio (INR) and adjust warfarin dosage if necessary. (notice Éfavirenz, Interactions médicamenteuses)

Strong CYP3A4 Inducers: Avoid concomitant use. (notice Bortézomib, Interactions médicamenteuses)

Co-administration of such combinations of a CYP2C9 inhibitor plus a strong or moderate CYP3A inhibitor with TRACLEER is not recommended. (notice Bosentan, Interactions médicamenteuses)

• Strong and Moderate CYP3A Inhibitors: Avoid concomitant use with BOSULIF. (notice Bosutinib, Interactions médicamenteuses)

Concomitant use of strong CYP3A4 inhibitors (e.g., azole antimycotics, HIV protease inhibitors) with CYCLOSET should be avoided. (notice Bromocriptine, Interactions médicamenteuses)

Evaluate patients starting CYP3A4 inhibitors or stopping CYP3A4 inducers at frequent intervals for respiratory depression. (notice Buprénorphine, Interactions médicamenteuses)

The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with codeine are complex. (notice Butalbital, aspirine, caféine et codéine, Mise en garde encadrée)

Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with codeine are complex. (notice Butalbital, paracétamol, caféine et codéine, Mise en garde encadrée)

Coadministration with other antiretroviral medications for PrEP is not recommended. (notice Cabotégravir, Interactions médicamenteuses)

Avoid taking a strong CYP3A4 inhibitor (e.g., ketoconazole, itraconazole, clarithromycin, atazanavir, indinavir, nefazodone, nelfinavir, ritonavir, saquinavir, telithromycin, voriconazole) while taking COMETRIQ or reduce the dosage of COMETRIQ if concomitant use with strong CYP3A4 inhibitors cannot be avoided [see Dosage and Administration ( 2.2 ), Clinical Pharmacology… (notice Cabozantinib, Interactions médicamenteuses)

Intervention: Concomitant use of VRAYLAR with a CYP3A4 inducer is not recommended [see Dosage and Administration ( 2.1 , 2.6 ) ] . (notice Cariprazine, Interactions médicamenteuses)

Avoid use of Citalopram Capsules in CYP2C19 poor metabolizers, patients receiving concomitant cimetidine or another CYP2C19 inhibitor, patients with hepatic impairment, and patients who are greater than 60 years of age, because Citalopram Capsules are only available in a 30 mg dose strength and dosage adjustments are not possible [see Drug Interactions ( 7 ),… (notice Citalopram, Mises en garde et précautions)

Antiviral and antiretroviral drugs: Avoid concomitant use. (notice Cladribine, Interactions médicamenteuses)

CYP2C19 inhibitors: Avoid concomitant use of omeprazole or esomeprazole. (notice Clopidogrel, Mises en garde et précautions)

• Concomitant use of Strong CYP3A4 Inducers is not recommended. (notice Clozapine, Interactions médicamenteuses)

Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with codeine are complex. (notice Codéine, Mise en garde encadrée)

Patients with renal or hepatic impairment should not be given colchicine capsules with drugs that inhibit both P-glycoprotein and CYP3A4 inhibitors [see Drug Interactions (7) ] . (notice Colchicine, Contre-indications)

…Voxilaprevir ↓ velpatasvir ↓ voxilaprevir Coadministration of efavirenz and sofosbuvir/velpatasvir/voxilaprevir is not recommended because it may result in loss of therapeutic effect of sofosbuvir/velpatasvir/voxilaprevir Other agents Anticoagulant:Warfarin ↑ or ↓ warfarin Monitor international normalised ratio (INR) and adjust warfarin dosage if necessary. (notice Éfavirenz, Interactions médicamenteuses)

Strong CYP3A4 inhibitors: Avoid concomitant use. (notice Daridorexant, Interactions médicamenteuses)

Protease inhibitor: Lopinavir/ritonavir ↓ lopinavir * Lopinavir/ritonavir once daily dosing is not recommended when coadministered with efavirenz. (notice Éfavirenz, Interactions médicamenteuses)

Protease inhibitor: Lopinavir/ritonavir ↓ lopinavir * Lopinavir/ritonavir once daily dosing is not recommended when coadministered with efavirenz. (notice Éfavirenz, Interactions médicamenteuses)

Avoid concomitant use of strong CYP3A4 inhibitors. (notice Dasatinib, Interactions médicamenteuses)

Avoid use of moderate or strong CYP3A4 inducers with EMFLAZA, as they may reduce efficacy ( 7.1 ) (notice Déflazacort, Interactions médicamenteuses)

• Avoid concomitant use of strong CYP3A4 inhibitors or inducers. (notice Dexaméthasone, Interactions médicamenteuses)

QT Prolongation: Monitor ECG if concomitant use of drugs that prolong QT interval cannot be avoided or if concomitant CYP3A4 inhibitors used. (notice Dextrométhorphane et quinidine, Mises en garde et précautions)

WARNING: PERIPHERAL ISCHEMIA FOLLOWING COADMINISTRATION WITH POTENT CYP3A4 INHIBITORS Serious and/or life-threatening peripheral ischemia has been associated with the coadministration of dihydroergotamine with potent CYP3A4 inhibitors including protease inhibitors and macrolide antibiotics. (notice Dihydroergotamine, Mise en garde encadrée)

Concomitant use of Docetaxel Injection and drugs that inhibit CYP3A4 may increase exposure to docetaxel and should be avoided. (notice Docétaxel, Interactions médicamenteuses)

HIV Antiviral Agents efavirenz etravirine nevirapine ↓ doravirine Use with efavirenz, etravirine, or nevirapine is not recommended. (notice Doravirine, Interactions médicamenteuses)

• Avoid concomitant use of doxorubicin hydrochloride with inhibitors and inducers of CYP3A4, CYP2D6, and/or P-gp ( 7.1 ) (notice Doxorubicine, Interactions médicamenteuses)

• CYP3A inducers: Avoid concomitant use. (notice Dronédarone, Interactions médicamenteuses)

Drug-Drug Interactions Strong Inhibitors of Cytochrome P450 (CYP) 3A4 Tamsulosin-containing products, including JALYN, should not be coadministered with strong CYP3A4 inhibitors (e.g., ketoconazole) as this can significantly increase tamsulosin exposure [see Drug Interactions (7.1) , Clinical Pharmacology (12.3) ]. (notice Dutastéride et tamsulosine, Mises en garde et précautions)

…Voxilaprevir ↓ velpatasvir ↓ voxilaprevir Coadministration of efavirenz and sofosbuvir/velpatasvir/voxilaprevir is not recommended because it may result in loss of therapeutic effect of sofosbuvir/velpatasvir/voxilaprevir Other agents Anticoagulant:Warfarin ↑ or ↓ warfarin Monitor international normalised ratio (INR) and adjust warfarin dosage if necessary. (notice Éfavirenz, Interactions médicamenteuses)

Lactic Acidosis and Severe Hepatomegaly with Steatosis Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogs and other antiretrovirals. (notice Éfavirenz, lamivudine et ténofovir, Mises en garde et précautions)

• Recent use (i.e., within at least 72 hours) of the following potent CYP3A4 inhibitors: ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, or nelfinavir [see Drug Interactions (7.2) and Clinical Pharmacology (12.3) ]. (notice Élétriptan, Contre-indications)

Therefore, concomitant use with strong CYP3A inducers is not recommended [see Drug Interactions (7.1) and Clinical Pharmacology (12.3) ] . (notice Élexacaftor, tézacaftor et ivacaftor, Mises en garde et précautions)

Not recommended with ATRIPLA, which contains efavirenz, emtricitabine, and tenofovir disoproxil fumarate, unless needed for dose adjustment when coadministered with rifampin. (notice Éfavirenz, Mises en garde et précautions)

Not recommended with ATRIPLA, which contains efavirenz, emtricitabine, and tenofovir disoproxil fumarate, unless needed for dose adjustment when coadministered with rifampin. (notice Éfavirenz, Mises en garde et précautions)

Not recommended with ATRIPLA, which contains efavirenz, emtricitabine, and tenofovir disoproxil fumarate, unless needed for dose adjustment when coadministered with rifampin. (notice Éfavirenz, Mises en garde et précautions)

Not recommended with ATRIPLA, which contains efavirenz, emtricitabine, and tenofovir disoproxil fumarate, unless needed for dose adjustment when coadministered with rifampin. (notice Éfavirenz, Mises en garde et précautions)

…Voxilaprevir ↓ velpatasvir ↓ voxilaprevir Coadministration of efavirenz and sofosbuvir/velpatasvir/voxilaprevir is not recommended because it may result in loss of therapeutic effect of sofosbuvir/velpatasvir/voxilaprevir Other agents Anticoagulant:Warfarin ↑ or ↓ warfarin Monitor international normalised ratio (INR) and adjust warfarin dosage if necessary. (notice Éfavirenz, Interactions médicamenteuses)

Therapy with BARACLUDE is not recommended for HIV/HBV co-infected patients who are not also receiving highly active antiretroviral therapy (HAART) [see Warnings and Precautions (5.2) ] . (notice Entécavir, Mise en garde encadrée)

…Patients Eplerenone is contraindicated in all patients with: • serum potassium > 5.5 mEq/L at initiation, • creatinine clearance ≤ 30 mL/min, or • concomitant administration of strong CYP3A inhibitors (e.g., ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, and nelfinavir) [see Drug Interactions (7.1) , Clinical Pharmacology (12.3)… (notice Éplérénone, Contre-indications)

WARNING Serious and/or life-threatening peripheral ischemia has been associated with the coadministration of ergotamine tartrate and caffeine tablets with potent CYP 3A4 inhibitors including protease inhibitors and macrolide antibiotics. (notice Ergotamine et caféine, Mise en garde encadrée)

Avoid co-administering erlotinib with strong CYP3A4 inhibitors (e.g., boceprevir, clarithromycin, conivaptan, indinavir, itraconazole, ketoconazole, lopinavir/ritonavir, nefazodone, nelfinavir, posaconazole, ritonavir, saquinavir, telithromycin, voriconazole, grapefruit or grapefruit juice) or a combined CYP3A4 and CYP1A2 inhibitor (e.g., ciprofloxacin). (notice Erlotinib, Interactions médicamenteuses)

Consequently, estazolam should be avoided in patients receiving ketoconazole and itraconazole, which are very potent inhibitors of CYP3A (see CONTRAINDICATIONS ). (notice Estazolam, Mises en garde)

VYTORIN is contraindicated in the following conditions: Concomitant use of strong CYP3A4 inhibitors (select azole anti-fungals, macrolide antibiotics, anti-viral medications, and nefazodone) [see Drug Interactions (7.1) ] . (notice Ézétimibe et simvastatine, Contre-indications)

• Concomitant use with CYP3A4 inhibitors (or discontinuation of CYP3A4 inducers) can result in a fatal overdose of fentanyl. (notice Fentanyl, Mise en garde encadrée)

CYP3A4 Inhibitors Doses of Toviaz greater than 4 mg are not recommended in adult patients taking strong CYP3A4 inhibitors, such as ketoconazole, itraconazole, and clarithromycin [see Dosage and Administration (2.5) ]. (notice Fésotérodine, Interactions médicamenteuses)

Contraindicated with Strong or Moderate CYP3A4 Inhibitors The concomitant use of ADDYI and moderate or strong CYP3A4 inhibitors increases flibanserin concentrations, which can cause severe hypotension and syncope [see Warnings and Precautions (5.2) ] . (notice Flibansérine, Mise en garde encadrée)

Strong cytochrome P450 3A4 inhibitors (e.g., ritonavir, ketoconazole): Use not recommended. (notice Fluticasone, Interactions médicamenteuses)

Avoid strong cytochrome P450 3A4 inhibitors (e.g., ritonavir, ketoconazole): May increase risk of systemic corticosteroid and cardiovascular effects. (notice Fluticasone et salmétérol, Interactions médicamenteuses)

…Voxilaprevir ↓ velpatasvir ↓ voxilaprevir Coadministration of efavirenz and sofosbuvir/velpatasvir/voxilaprevir is not recommended because it may result in loss of therapeutic effect of sofosbuvir/velpatasvir/voxilaprevir Other agents Anticoagulant:Warfarin ↑ or ↓ warfarin Monitor international normalised ratio (INR) and adjust warfarin dosage if necessary. (notice Éfavirenz, Interactions médicamenteuses)

Protease inhibitor: Lopinavir/ritonavir ↓ lopinavir * Lopinavir/ritonavir once daily dosing is not recommended when coadministered with efavirenz. (notice Éfavirenz, Interactions médicamenteuses)

…Voxilaprevir ↓ velpatasvir ↓ voxilaprevir Coadministration of efavirenz and sofosbuvir/velpatasvir/voxilaprevir is not recommended because it may result in loss of therapeutic effect of sofosbuvir/velpatasvir/voxilaprevir Other agents Anticoagulant:Warfarin ↑ or ↓ warfarin Monitor international normalised ratio (INR) and adjust warfarin dosage if necessary. (notice Éfavirenz, Interactions médicamenteuses)

Cytochrome P450 3A4 Interaction The concomitant use of HYSINGLA ER with all cytochrome P450 3A4 inhibitors may result in an increase in hydrocodone plasma concentrations, which could increase or prolong adverse reactions and may cause potentially fatal respiratory depression. (notice Hydrocodone, Mise en garde encadrée)

Cytochrome P450 3A4 Interaction The concomitant use of Hydrocodone Polistirex and Chlorpheniramine Polistirex with all cytochrome P450 3A4 inhibitors may result in an increase in hydrocodone plasma concentrations, which could increase or prolong adverse drug effects and may cause potentially fatal respiratory depression. (notice Hydrocodone et chlorphénamine, Mise en garde encadrée)

Cytochrome P450 3A4 Interaction The concomitant use of hydrocodone bitartrate and homatropine methylbromide with all cytochrome P450 3A4 inhibitors may result in an increase in hydrocodone plasma concentrations, which could increase or prolong adverse drug effects and may cause potentially fatal respiratory depression. (notice Hydrocodone et homatropine, Mise en garde encadrée)

Cytochrome P450 3A4 Interaction The concomitant use of Hydrocodone Bitartrate and Ibuprofen Tablets with all cytochrome P450 3A4 inhibitors may result in an increase in hydrocodone plasma concentrations, which may cause potentially fatal respiratory depression. (notice Hydrocodone et ibuprofène, Mise en garde encadrée)

Cytochrome P450 3A4 Interaction The concomitant use of hydrocodone bitartrate and acetaminophen tablets with all Cytochrome P450 3A4 inhibitors may result in an increase in hydrocodone plasma concentrations, which could increase or prolong adverse reactions and may cause potentially fatal respiratory depression. (notice Hydrocodone et paracétamol, Mise en garde encadrée)

Increased Toxicity with Concomitant Use of Antiretroviral Drugs Pancreatitis Pancreatitis (including fatal cases) have occurred in patients with HIV infection during therapy with hydroxyurea and didanosine, with or without stavudine. (notice Hydroxycarbamide, Interactions médicamenteuses)

• Strong CYP3A4 Inducers: Do not administer strong CYP3A4 inducers with CAMPTOSAR. (notice Irinotécan, Interactions médicamenteuses)

Antifungals: Voriconazole Itraconazole Ketoconazole Posaconazole ↓ voriconazole * ↑ efavirenz * ↓ itraconazole * ↓ hydroxyitraconazole * ↓ ketoconazole ↓ posaconazole * Efavirenz and voriconazole should not be coadministered at standard doses. (notice Éfavirenz, Interactions médicamenteuses)

…bradycardia [see Warnings and Precautions ( 5.3 )] • Severe hepatic impairment [see Use in Specific Populations ( 8.6 )] • Pacemaker dependence (heart rate maintained exclusively by the pacemaker) [see Drug Interactions ( 7.3 )] • Concomitant use of strong cytochrome P450 3A4 (CYP3A4) inhibitors [see Drug Interactions ( 7.1 )] Acute decompensated heart failure ( 4 ) (notice Ivabradine, Contre-indications)

Antifungals: Voriconazole Itraconazole Ketoconazole Posaconazole ↓ voriconazole * ↑ efavirenz * ↓ itraconazole * ↓ hydroxyitraconazole * ↓ ketoconazole ↓ posaconazole * Efavirenz and voriconazole should not be coadministered at standard doses. (notice Éfavirenz, Interactions médicamenteuses)

Avoid strong CYP3A4 inhibitors. (notice Lapatinib, Interactions médicamenteuses)

Strong CYP3A4 Inhibitors: Avoid coadministration of strong CYP3A4 inhibitors with VITRAKVI. (notice Larotrectinib, Interactions médicamenteuses)

Velpatasvir/ Sofosbuvir ↓ velpatasvir Coadministration of efavirenz and sofosbuvir/velpatasvir is not recommended because it may result in loss of therapeutic effect of sofosbuvir/velpatasvir. (notice Éfavirenz, Interactions médicamenteuses)

Strong or moderate CYP3A inhibitors: Avoid concomitant use. (notice Lemborexant, Interactions médicamenteuses)

…Agents: atazanavir/cobicistat Drug-drug interaction study was conducted. atazanavir/ritonavir ↑ lenacapavir (atazanavir/cobicistat, atazanavir/ritonavir) Concomitant administration of efavirenz, nevirapine, or tipranavir/ritonavir may result in loss of therapeutic effect and development of resistance. efavirenz nevirapine tipranavir/ritonavir ↓ lenacapavir (efavirenz,… (notice Lénacapavir, Interactions médicamenteuses)

Concomitant administration of JUXTAPID with moderate or strong CYP3A4 inhibitors, as this can increase JUXTAPID exposure [see Warnings and Precautions (5.6) , Drug Interactions (7.1) , and Clinical Pharmacology (12.3) ]. (notice Lomitapide, Contre-indications)

Protease inhibitor: Lopinavir/ritonavir ↓ lopinavir * Lopinavir/ritonavir once daily dosing is not recommended when coadministered with efavirenz. (notice Éfavirenz, Interactions médicamenteuses)

• Strong CYP3A Inhibitors : Avoid concomitant use; reduce LORBRENA dose if concomitant use cannot be avoided. (notice Lorlatinib, Interactions médicamenteuses)

Concomitant administration with strong CYP3A4 inhibitors (e.g., itraconazole, ketoconazole, posaconazole, voriconazole, HIV protease inhibitors, boceprevir, telaprevir, erythromycin, clarithromycin, telithromycin, nefazodone and cobicistat-containing products) (see WARNINGS , Myopathy/Rhabdomyolysis ). (notice Lovastatine, Contre-indications)

CYP3A4 inducers: Avoid concomitant use with CAPLYTA. (notice Lumatépérone, Interactions médicamenteuses)

Strong CYP3A4 inhibitors (e.g., ketoconazole, clarithromycin, ritonavir, voriconazole, mibefradil, etc.) [see Drug Interactions ( 7.1 )]. (notice Lurasidone, Contre-indications)

Strong CYP3A4 inducers (rifampin) reduce exposure to macitentan: avoid co-administration with OPSUMIT ( 7.1 , 12.3 ). (notice Macitentan, Interactions médicamenteuses)

SELZENTRY is contraindicated in patients with severe renal impairment or ESRD (creatinine clearance [CrCl] less than 30 mL per minute) who are concomitantly taking potent CYP3A inhibitors or inducers [see Warnings and Precautions ( 5.3 )]. (notice Maraviroc, Contre-indications)

Although there have been no reports of such interactions with methylergonovine alone, strong and moderate CYP 3A4 inhibitors should not be co-administered with methylergonovine. (notice Méthylergométrine, Interactions médicamenteuses)

CYP3A inducers: Do not use mifepristone with CYP3A inducers ( 7.3 ). (notice Mifépristone, Interactions médicamenteuses)

Le millepertuis peut abaisser les taux sanguins de certains médicaments contre le VIH au point de provoquer un échec du traitement. (NCCIH, St. John's Wort)

Strong CYP3A Inhibitors and Inducers: Avoid concomitant use. (notice Mitapivat, Interactions médicamenteuses)

John's Wort) Clinical Impact Significant decrease in plasma naldemedine concentrations, which may reduce efficacy [see Clinical Pharmacology (12.3) ] Intervention Avoid use of SYMPROIC with strong CYP3A inducers. (notice Naldémédine, Interactions médicamenteuses)

Patients concomitantly using strong CYP3A4 inhibitors (e.g., clarithromycin, ketoconazole) because these medications can significantly increase exposure to naloxegol which may precipitate opioid withdrawal symptoms such as hyperhidrosis, chills, diarrhea, abdominal pain, anxiety, irritability, and yawning [see Drug Interactions (7.1) and Clinical Pharmacology… (notice Naloxégol, Contre-indications)

CYP2B6 Inducers (e.g., ritonavir, lopinavir, efavirenz, carbamazepine, phenobarbital, and phenytoin) may reduce efficacy by reducing bupropion exposure, avoid concomitant use. (notice Naltrexone et bupropion, Interactions médicamenteuses)

Co-administration of nevirapine and efavirenz is not recommended as this combination has been associated with an increase in adverse reactions and no improvement in efficacy. (notice Névirapine, Mises en garde et précautions)

John’s Wort reduce the bioavailability and efficacy of nifedipine; therefore nifedipine should not be used in combination with strong CYP3A inducers such as rifampin (See CONTRAINDICATIONS ). (notice Nifédipine, Interactions médicamenteuses)

Avoid use of concomitant drugs known to prolong the QT interval and strong CYP3A4 inhibitors [see Drug Interactions ( 7.1 , 7.2 )] . (notice Nilotinib, Mise en garde encadrée)

Therefore, the concomitant administration of NYMALIZE and strong CYP3A4 inhibitors should generally be avoided [ see Warnings and Precautions (5.3) ]. (notice Nimodipine, Interactions médicamenteuses)

Protease inhibitor: Lopinavir/ritonavir ↓ lopinavir * Lopinavir/ritonavir once daily dosing is not recommended when coadministered with efavirenz. (notice Éfavirenz, Interactions médicamenteuses)

CYP3A4 inhibitors and inducers : SULAR is substrate of CYP3A4 and coadministration of SULAR with any known inducer or inhibitor of CYP3A4 should be avoided in general. (notice Nisoldipine, Interactions médicamenteuses)

Counsel patients to use a back-up method or alternative method of contraception when enzyme inducers are used with COCs ( 7.1 ) -- - ---------- ------ USE IN SPECIFIC POPULATIONS---- -- -- --------- ---- Lactation: Not recommended; Lo Loestrin Fe can decrease milk production ( 8.2 ) (notice Noréthistérone et éthinylestradiol, Interactions médicamenteuses)

If a CYP3A4 inducer is discontinued, consider OLINVYK dosage reduction and monitor for signs of respiratory depression. (notice Olicéridine, Interactions médicamenteuses)

Cytochrome P450 3A4 Interaction The concomitant use of Oxycodone Hydrochloride Oral Solution with all cytochrome P450 3A4 inhibitors may result in an increase in oxycodone plasma concentrations, which could increase or prolong adverse reactions and may cause potentially fatal respiratory depression. (notice Oxycodone, Mise en garde encadrée)

Cytochrome P450 3A4 Interaction The concomitant use of oxycodone hydrochloride tablets with all cytochrome P450 3A4 inhibitors may result in an increase in oxycodone plasma concentrations, which could increase or prolong adverse reactions and may cause potentially fatal respiratory depression. (notice Oxycodone et paracétamol, Mise en garde encadrée)

• CYP3A Inducers: Avoid concurrent use of IBRANCE with strong CYP3A inducers. (notice Palbociclib, Interactions médicamenteuses)

Strong CYP3A4 and P-glycoprotein (P-gp) inducers : Avoid using a strong inducer of CYP3A4 and/or P-gp during a dosing interval for ERZOFRI. (notice Palipéridone, Interactions médicamenteuses)

Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with codeine are complex. (notice Paracétamol et codéine, Mise en garde encadrée)

Strong CYP3A4 Inhibitors : Avoid coadministration of VOTRIENT with strong CYP3A4 inhibitors. (notice Pazopanib, Interactions médicamenteuses)

Cytochrome P450 3A4 Interaction The concomitant use of DEMEROL Injection with all cytochrome P450 3A4 inhibitors may result in an increase in meperidine plasma concentrations, which could increase or prolong adverse reactions and may cause potentially fatal respiratory depression. (notice Péthidine, Mise en garde encadrée)

Strong or Moderate CYP3A4 Inducers: Avoid concomitant use of NUPLAZID. (notice Pimavansérine, Interactions médicamenteuses)

Antifungals: Voriconazole Itraconazole Ketoconazole Posaconazole ↓ voriconazole * ↑ efavirenz * ↓ itraconazole * ↓ hydroxyitraconazole * ↓ ketoconazole ↓ posaconazole * Efavirenz and voriconazole should not be coadministered at standard doses. (notice Éfavirenz, Interactions médicamenteuses)

Anthelmintic: Praziquantel ↓ praziquantel Coadministration with efavirenz is not recommended due to significant decrease in plasma concentrations of praziquantel, with risk of treatment failure due to increased hepatic metabolism by efavirenz. (notice Éfavirenz, Interactions médicamenteuses)

Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with codeine are complex, requiring careful consideration of the effects on the parent drug, codeine, and the active metabolite, morphine. (notice Prométhazine et codéine, Mise en garde encadrée)

• Avoid simultaneous use of propafenone with both a cytochrome P450 2D6 (CYP2D6) inhibitor and a 3A4 inhibitor (CYP3A4). (notice Propafénone, Mises en garde et précautions)

ASPRUZYO Sprinkle is contraindicated in patients: Taking strong inhibitors of CYP3A [see Drug Interactions (7.1)] Taking inducers of CYP3A [see Drug Interactions (7.1)] With liver cirrhosis [see Use in Specific Populations (8.6)] Strong CYP3A inhibitors (e.g., ketoconazole, clarithromycin, nelfinavir) (4, 7.1) (notice Ranolazine, Contre-indications)

Therefore, co-administration with antiretroviral and anti-HCV drugs metabolized by CYP3A is not recommended or there may be a need to increase the dose of antiretroviral or anti-HCV drugs (see PRECAUTIONS-Drug Interactions ). (notice Rifabutine, Mises en garde)

Not recommended with ATRIPLA, which contains efavirenz, emtricitabine, and tenofovir disoproxil fumarate, unless needed for dose adjustment when coadministered with rifampin. (notice Éfavirenz, Mises en garde et précautions)

• Strong CYP3A4 Inhibitors: Avoid concomitant administration. (notice Rimégépant, Interactions médicamenteuses)

• Certain CYP3A inducers: Coadministration with strong inducers of CYP3A is not recommended. (notice Ritlécitinib, Interactions médicamenteuses)

Protease inhibitor: Lopinavir/ritonavir ↓ lopinavir * Lopinavir/ritonavir once daily dosing is not recommended when coadministered with efavirenz. (notice Éfavirenz, Interactions médicamenteuses)

…Voxilaprevir ↓ velpatasvir ↓ voxilaprevir Coadministration of efavirenz and sofosbuvir/velpatasvir/voxilaprevir is not recommended because it may result in loss of therapeutic effect of sofosbuvir/velpatasvir/voxilaprevir Other agents Anticoagulant:Warfarin ↑ or ↓ warfarin Monitor international normalised ratio (INR) and adjust warfarin dosage if necessary. (notice Éfavirenz, Interactions médicamenteuses)

• Drug Interactions: Use with strong cytochrome P450 enzyme inducers (e.g., rifampicin, phenobarbital, carbamazepine, phenytoin) is not recommended. (notice Roflumilast, Mises en garde et précautions)

Intervention: Avoid the use of VARUBI in patients who require chronic administration of strong CYP3A4 inducers. (notice Rolapitant, Interactions médicamenteuses)

• Avoid use with rifampin and strong CYP3A4 inducers ( 7.3 ). (notice Romidepsine, Interactions médicamenteuses)

• Strong cytochrome P450 3A4 inhibitors (e.g., ritonavir, ketoconazole): Use not recommended. (notice Salmétérol, Interactions médicamenteuses)

Severe renal impairment (CCr < 30 mL/min) Severe hepatic impairment (Child-Pugh score ≥ 10) Concomitant administration with strong Cytochrome P450 3A4 (CYP3A4) inhibitors (e.g., ketoconazole, clarithromycin, itraconazole, ritonavir) [see DRUG INTERACTIONS (7.1) ] Patients with a history of hypersensitivity to silodosin or any of the ingredients in silodosin capsules… (notice Silodosine, Contre-indications)

ZOCOR is contraindicated in the following conditions: Concomitant use of strong CYP3A4 inhibitors (select azole anti-fungals, macrolide antibiotics, anti-viral medications, and nefazodone) [see Drug Interactions (7.1) ] . (notice Simvastatine, Contre-indications)

Interaction with Strong Inhibitors and Inducers of CYP3A4 and/or P-gp Avoid concomitant use of sirolimus with strong inhibitors of CYP3A4 and/or P-gp (such as ketoconazole, voriconazole, itraconazole, erythromycin, telithromycin, or clarithromycin) or strong inducers of CYP3A4 and/or P-gp (such as rifampin or rifabutin) [ see Drug Interactions (7.2) ]. (notice Sirolimus, Mises en garde et précautions)

Velpatasvir/ Sofosbuvir ↓ velpatasvir Coadministration of efavirenz and sofosbuvir/velpatasvir is not recommended because it may result in loss of therapeutic effect of sofosbuvir/velpatasvir. (notice Éfavirenz, Interactions médicamenteuses)

The dosage of Solifenacin succinate tablets greater than 5 mg once daily is not recommended when concomitantly used with strong CYP3A4 inhibitors [see Dosage and Administration ( 2.4 )] . (notice Solifénacine, Interactions médicamenteuses)

• Strong CYP3A Inducers: Avoid strong CYP3A4 inducers. (notice Sorafénib, Interactions médicamenteuses)

Concomitant use of JOURNAVX with strong CYP3A inhibitors is contraindicated [see Warnings and Precautions (5.1) , Drug Interactions (7.1) ] . (notice Suzétrigine, Contre-indications)

Inducers of CYP3A4 Strong CYP3A4 inducers should not be used with tamoxifen. (notice Tamoxifène, Interactions médicamenteuses)

• Should not be used in combination with strong inhibitors of CYP3A4. (notice Tamsulosine, Mises en garde et précautions)

Strong CYP3A4 inducers (e.g., rifampin): Avoid use of HETLIOZ in combination with rifampin or other CYP3A4 inducers, because of decreased exposure ( 7.2 , 12.3 ) (notice Tasimeltéon, Interactions médicamenteuses)

Not recommended with ATRIPLA, which contains efavirenz, emtricitabine, and tenofovir disoproxil fumarate, unless needed for dose adjustment when coadministered with rifampin. (notice Éfavirenz, Mises en garde et précautions)

Avoid co-administration of strong CYP3A4 inhibitors (e.g., itraconazole, clarithromycin, ritonavir) and strong CYP3A4 inducers (e.g., rifampin, phenytoin) with TEPADINA due to the potential effects on efficacy and toxicity [see Clinical Pharmacology ( 12.3 ) ] . (notice Thiotépa, Interactions médicamenteuses)

• Avoid use with strong CYP3A inhibitors or CYP3A inducers. (notice Ticagrélor, Interactions médicamenteuses)

…dominant polycystic kidney disease (ADPKD) outside of FDA-approved REMS [see Warnings and Precautions (5.2) ] Unable to sense or respond to thirst Hypovolemic hyponatremia Taking strong CYP3A inhibitors [see Warnings and Precautions (5.5) ] Anuria Hypersensitivity (e.g., anaphylactic shock, rash generalized) to tolvaptan or any components of the product [see Adverse… (notice Tolvaptan, Contre-indications)

Drugs known to prolong the QT interval and strong CYP3A4 inhibitors should be avoided [see Warnings and Precautions (5.1) ] . (notice Torémifène, Mise en garde encadrée)

CYP3A inhibitors: Avoid concomitant strong CYP3A inhibitors ( 7.1 ) (notice Trabectédine, Interactions médicamenteuses)

The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (notice Tramadol, Mise en garde encadrée)

Interactions with Drugs Affecting Cytochrome P450 Isoenzymes The effects of concomitant use or discontinuation of cytochrome P450 3A4 inducers, 3A4 inhibitors, or 2D6 inhibitors with tramadol are complex. (notice Tramadol et paracétamol, Mise en garde encadrée)

The use of RALDESY Should be avoided in patients with known QT prolongation or in combination with other drugs that are inhibitors of CYP3A4 (e.g., itraconazole, clarithromycin, voriconazole), or known to prolong QT interval including Class 1A antiarrhythmics (e.g., quinidine, procainamide) or Class 3 antiarrhythmics (e.g., amiodarone, sotalol), certain antipsychotic… (notice Trazodone, Mises en garde et précautions)

• Strong CYP3A Inhibitors and Inducers: Avoid coadministration with strong CYP3A inhibitors and inducers. (notice Trétinoïne, Interactions médicamenteuses)

Strong CYP 3A Inhibitors Triazolam is contraindicated in patients receiving strong inhibitors of CYP 3A such as ketoconazole, itraconazole, nefazodone, ritonavir, indinavir, nelfinavir, saquinavir, and lopinavir [see Contraindications (4) , Drug Interactions (7.1) ] . (notice Triazolam, Mises en garde et précautions)

UBRELVY is contraindicated: With concomitant use of strong CYP3A4 inhibitors [see Drug Interactions ( 7.1 )] In patients with a history of serious hypersensitivity to ubrogepant or any component of UBRELVY. (notice Ubrogépant, Contre-indications)

Ella should not be administered with CYP3A4 inducers [see Drug interactions (7.1) and Clinical Pharmacology (12.3) ] . (notice Ulipristal, Mises en garde et précautions)

Strong CYP3A4 Inducers : Coadministration of RINVOQ/RINVOQ LQ with strong CYP3A4 inducers is not recommended. (notice Upadacitinib, Interactions médicamenteuses)

Use of strong CYP3A4 inducers with INGREZZA or INGREZZA SPRINKLE Concomitant use is not recommended. (notice Valbénazine, Interactions médicamenteuses)

Avoid concomitant use of VEPPANU with strong CYP3A inhibitors or drugs known to prolong the QTc interval. (notice Vepdégestrant, Mises en garde et précautions)

Therefore, the concomitant use of strong CYP3A inhibitors with vincristine sulfate should be avoided. (notice Vincristine, Interactions médicamenteuses)

Antifungals: Voriconazole Itraconazole Ketoconazole Posaconazole ↓ voriconazole * ↑ efavirenz * ↓ itraconazole * ↓ hydroxyitraconazole * ↓ ketoconazole ↓ posaconazole * Efavirenz and voriconazole should not be coadministered at standard doses. (notice Éfavirenz, Interactions médicamenteuses)

…Voxilaprevir ↓ velpatasvir ↓ voxilaprevir Coadministration of efavirenz and sofosbuvir/velpatasvir/voxilaprevir is not recommended because it may result in loss of therapeutic effect of sofosbuvir/velpatasvir/voxilaprevir Other agents Anticoagulant:Warfarin ↑ or ↓ warfarin Monitor international normalised ratio (INR) and adjust warfarin dosage if necessary. (notice Éfavirenz, Interactions médicamenteuses)

Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogues alone or in combination, including zidovudine and other antiretrovirals. (notice Zidovudine, Mise en garde encadrée)

John's wort, a CYP3A4 inducer, in combination with zolpidem may decrease blood levels of zolpidem and is not recommended. (notice Zolpidem, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

Patients receiving efavirenz should be alerted to the potential for additive central nervous system effects when efavirenz is used concomitantly with alcohol or psychoactive drugs. (notice Éfavirenz, Mises en garde et précautions)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

CYP3A4 inhibitors: Use with caution in combination due to increased exposure of alosetron. (notice Alosétron, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Calcium channel blockers: Diltiazem Others (e.g., felodipine, nicardipine, nifedipine, verapamil) ↓ diltiazem * ↓ desacetyl diltiazem * ↓ N-monodesmethyl diltiazem * ↓ calcium channel blocker Diltiazem dose adjustments should be guided by clinical response (refer to the full prescribing information for diltiazem). (notice Éfavirenz, Interactions médicamenteuses)

Calcium channel blockers: Diltiazem Others (e.g., felodipine, nicardipine, nifedipine, verapamil) ↓ diltiazem * ↓ desacetyl diltiazem * ↓ N-monodesmethyl diltiazem * ↓ calcium channel blocker Diltiazem dose adjustments should be guided by clinical response (refer to the full prescribing information for diltiazem). (notice Éfavirenz, Interactions médicamenteuses)

Calcium channel blockers: Diltiazem Others (e.g., felodipine, nicardipine, nifedipine, verapamil) ↓ diltiazem * ↓ desacetyl diltiazem * ↓ N-monodesmethyl diltiazem * ↓ calcium channel blocker Diltiazem dose adjustments should be guided by clinical response (refer to the full prescribing information for diltiazem). (notice Éfavirenz, Interactions médicamenteuses)

Calcium channel blockers: Diltiazem Others (e.g., felodipine, nicardipine, nifedipine, verapamil) ↓ diltiazem * ↓ desacetyl diltiazem * ↓ N-monodesmethyl diltiazem * ↓ calcium channel blocker Diltiazem dose adjustments should be guided by clinical response (refer to the full prescribing information for diltiazem). (notice Éfavirenz, Interactions médicamenteuses)

Calcium channel blockers: Diltiazem Others (e.g., felodipine, nicardipine, nifedipine, verapamil) ↓ diltiazem * ↓ desacetyl diltiazem * ↓ N-monodesmethyl diltiazem * ↓ calcium channel blocker Diltiazem dose adjustments should be guided by clinical response (refer to the full prescribing information for diltiazem). (notice Éfavirenz, Interactions médicamenteuses)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

HMG-CoA reductase inhibitors: Atorvastatin PravastatinSimvastatin ↓ atorvastatin * ↓ pravastatin * ↓ simvastatin * Plasma concentrations of atorvastatin, pravastatin and simvastatin decreased. (notice Éfavirenz, Interactions médicamenteuses)

Antimalarials: Artemether/lumefantrine Atovaquone/ proguanil ↓ artemether * ↓ dihydroartemisinin * ↓ lumefantrine * ↓ atovaquone ↓ proguanil Consider alternatives to artemether/ lumefantrine because of the risk of QT interval prolongation. (notice Éfavirenz, Interactions médicamenteuses)

Antimalarials: Artemether/lumefantrine Atovaquone/ proguanil ↓ artemether * ↓ dihydroartemisinin * ↓ lumefantrine * ↓ atovaquone ↓ proguanil Consider alternatives to artemether/ lumefantrine because of the risk of QT interval prolongation. (notice Éfavirenz, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

Narcotic analgesic: Methadone ↓ methadone * Monitor for signs of methadone withdrawal and increase methadone dose if required to alleviate withdrawal symptoms. * The interaction between efavirenz and the drug was evaluated in a clinical study. (notice Éfavirenz, Interactions médicamenteuses)

Clinically Significant Interactions with Bexagliflozin Tablets UGT Enzyme Inducers Clinical Impact UGT Enzyme Inducers may significantly reduce exposure to bexagliflozin and lead to a decreased efficacy [ see Clinical Pharmacology ( 12.3 )]. (notice Bexagliflozine, Interactions médicamenteuses)

Strong CYP2D6 REXULTI may be administered without dosage adjustment in patients with MDD when administered with strong CYP2D6 inhibitors (e.g., paroxetine, fluoxetine). or CYP3A4 inhibitors Administer half of recommended dosage. (notice Brexpiprazole, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

Interactions with Strong Cytochrome P450 3A4 Inhibitors Caution should be exercised when considering the co-administration of PULMICORT FLEXHALER with ketoconazole, and other known strong CYP3A4 inhibitors (e.g., ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir, telithromycin) because adverse effects related to… (notice Budésonide, Mises en garde et précautions)

Strong cytochrome P450 3A4 inhibitors (e.g., ritonavir): Risk of increased systemic corticosteroid effects. (notice Budésonide et formotérol, Mises en garde et précautions)

Narcotic analgesic: Methadone ↓ methadone * Monitor for signs of methadone withdrawal and increase methadone dose if required to alleviate withdrawal symptoms. * The interaction between efavirenz and the drug was evaluated in a clinical study. (notice Éfavirenz, Interactions médicamenteuses)

Bupropion dose should not exceed the maximum recommended dose. (notice Éfavirenz, Interactions médicamenteuses)

Other inhibitors and inducers of CYP3A4: Substances that inhibit CYP3A4, such as ketoconazole or ritonavir, may inhibit buspirone metabolism and increase plasma concentrations of buspirone while substances that induce CYP3A4, such as dexamethasone or certain anticonvulsants (phenytoin, phenobarbital, carbamazepine), may increase the rate of buspirone metabolism. (notice Buspirone, Interactions médicamenteuses)

Narcotic analgesic: Methadone ↓ methadone * Monitor for signs of methadone withdrawal and increase methadone dose if required to alleviate withdrawal symptoms. * The interaction between efavirenz and the drug was evaluated in a clinical study. (notice Éfavirenz, Interactions médicamenteuses)

Table 7: Clinically Significant Drug Interactions with INVOKANA UGT Enzyme Inducers Clinical Impact: UGT enzyme inducers decrease canagliflozin exposure which may reduce the effectiveness of INVOKANA. (notice Canagliflozine, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

Co-administration of CYP2C19 inhibitors, such as omeprazole or fluvoxamine, with carisoprodol could result in increased exposure of carisoprodol and decreased exposure of meprobamate. (notice Carisoprodol, Interactions médicamenteuses)

Amiodarone Amiodarone and its metabolite desethyl amiodarone, inhibitors of CYP2C9, and P- glycoprotein increased concentrations of the S(-)-enantiomer of carvedilol by at least 2 fold [see Clinical Pharmacology (12.5) ]. (notice Carvédilol, Interactions médicamenteuses)

Other Inducers of Hepatic CYP Enzymes Adults : When Caspofungin acetate for Injection is co-administered to adult patients with other inducers of hepatic CYP enzymes, such as efavirenz, nevirapine, phenytoin, dexamethasone, or carbamazepine, administration of a daily dose of 70 mg of Caspofungin acetate for Injection should be considered [see Dosage and Administration… (notice Caspofungine, Interactions médicamenteuses)

Co-administration of celecoxib with drugs that are known to inhibit CYP2C9 (e.g., fluconazole) may enhance the exposure and toxicity of celecoxib whereas co-administration with CYP2C9 inducers (e.g., rifampin) may lead to compromised efficacy of celecoxib. (notice Célécoxib, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

In a drug interaction study, co-administration of orally inhaled ciclesonide and oral ketoconazole, a potent inhibitor of cytochrome P450 3A4, increased the exposure (AUC) of des-ciclesonide by approximately 3.6-fold at steady state, while levels of ciclesonide remained unchanged. (notice Ciclésonide, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

Strong and moderate CYP3A4 and CYP2C19 inhibitors: Increase exposure to cilostazol. (notice Cilostazol, Interactions médicamenteuses)

Co-administration with a strong CYP3A4 inhibitor may increase serum levels of cinacalcet. (notice Cinacalcet, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

Inhibitors of CYP3A4 and CYP3A5 Inhibitors of CYP3A4 and/or CYP3A5 may increase plasma concentrations of clindamycin [ see Clinical Pharmacology (12.3) ]. (notice Clindamycine, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Antifungals: Voriconazole Itraconazole Ketoconazole Posaconazole ↓ voriconazole * ↑ efavirenz * ↓ itraconazole * ↓ hydroxyitraconazole * ↓ ketoconazole ↓ posaconazole * Efavirenz and voriconazole should not be coadministered at standard doses. (notice Éfavirenz, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

CYP3A4 Inhibitors The systemic exposure of darifenacin from darifenacin extended-release tablets is increased in the presence of CYP3A4 inhibitors. (notice Darifénacine, Interactions médicamenteuses)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

CYP3A4 inhibitors such as itraconazole, voriconazole, fluconazole, grapefruit juice, or ketoconazole may increase plasma hormone concentrations. (notice Désogestrel et éthinylestradiol, Interactions médicamenteuses)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

Decreased exposure of some antiretroviral drugs (e.g., rilpivirine, atazanavir, and nelfinavir) when used concomitantly with dexlansoprazole may reduce antiviral effect and promote the development of drug resistance . (notice Dexlansoprazole, Interactions médicamenteuses)

Co-administration of diclofenac with CYP2C9 inhibitors (e.g. voriconazole) may enhance the exposure and toxicity of diclofenac whereas co- administration with CYP2C9 inducers (e.g. rifampin) may lead to compromised efficacy of diclofenac. (notice Diclofénac, Interactions médicamenteuses)

Co-administration of diclofenac with CYP2C9 inhibitors (e.g., voriconazole) may enhance the exposure and toxicity of diclofenac [see Clinical Pharmacology (12.3) ] whereas co-administration with CYP2C9 inducers (e.g., rifampin) may lead to compromised efficacy of diclofenac. (notice Diclofénac et misoprostol, Interactions médicamenteuses)

Calcium channel blockers: Diltiazem Others (e.g., felodipine, nicardipine, nifedipine, verapamil) ↓ diltiazem * ↓ desacetyl diltiazem * ↓ N-monodesmethyl diltiazem * ↓ calcium channel blocker Diltiazem dose adjustments should be guided by clinical response (refer to the full prescribing information for diltiazem). (notice Éfavirenz, Interactions médicamenteuses)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Non-nucleoside reverse transcriptase inhibitor: Efavirenz a ↓Dolutegravir Adjust dose of TIVICAY to twice daily for treatment-naïve and treatment-experienced, INSTI-naïve adult patients. (notice Dolutégravir, Interactions médicamenteuses)

Strong cytochrome P450 (CYP) 3A inhibitors may increase exposure to doxazosin and increased risk of hypotension. (notice Doxazosine, Interactions médicamenteuses)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

Examples Glutethimide and phenobarbital Intervention If a patient initiates or discontinues therapy with an enzyme inducer, dose adjustment of doxercalciferol may be necessary. (notice Doxercalciférol, Interactions médicamenteuses)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

Monitor for increased dronabinol-related adverse reactions when dronabinol oral solution is co-administered with inhibitors of CYP2C9 (e.g., amiodarone, fluconazole) and inhibitors of CYP3A4 enzymes (e.g., ketoconazole, itraconazole, clarithromycin, ritonavir, erythromycin, grapefruit juice). (notice Dronabinol, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Consider monitoring serum potassium concentration in high-risk patients who take a strong CYP3A4 inhibitor long-term and concomitantly. (notice Drospirénone et éthinylestradiol, Mises en garde et précautions)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

Antifungals: Voriconazole Itraconazole Ketoconazole Posaconazole ↓ voriconazole * ↑ efavirenz * ↓ itraconazole * ↓ hydroxyitraconazole * ↓ ketoconazole ↓ posaconazole * Efavirenz and voriconazole should not be coadministered at standard doses. (notice Éfavirenz, Interactions médicamenteuses)

Narcotic analgesic: Methadone ↓ methadone * Monitor for signs of methadone withdrawal and increase methadone dose if required to alleviate withdrawal symptoms. * The interaction between efavirenz and the drug was evaluated in a clinical study. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

• Decreased exposure of some antiretroviral drugs (e.g., rilpivirine atazanavir, and nelfinavir) when used concomitantly with esomeprazole may reduce antiviral effect and promote the development of drug resistance [see Clinical Pharmacology (12.3) ] . (notice Ésoméprazole, Interactions médicamenteuses)

Inhibitors of CYP3A4 such as erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir and grapefruit juice may increase plasma concentrations of estrogens and may result in side effects. (notice Estradiol, Interactions médicamenteuses)

Women who take medications that are strong CYP3A4 inducers should not choose Natazia as their oral contraceptive while using these inducers and for at least 28 days after discontinuation of these inducers due to the possibility of increased breakthrough bleeding and/or decreased contraceptive efficacy. (notice Estradiol et diénogest, Interactions médicamenteuses)

Inducers and/or inhibitors of CYP3A4 may affect estrogen drug metabolism and decrease or increase the estrogen plasma concentration. (notice Estradiol et noréthistérone, Interactions médicamenteuses)

Concomitant administration of itraconazole, a strong CYP3A4 inhibitor, with DUAVEE, resulted in increases in bazedoxifene exposure (40%) and, to a lesser extent, conjugated estrogens exposure (9% for baseline-adjusted total estrone, 5% for total equilin), compared to DUAVEE alone [see Pharmacokinetics (12.3) ] . (notice Estrogènes conjugués et bazédoxifène, Interactions médicamenteuses)

The dose of LUNESTA should be reduced in patients who are administered potent inhibitors of CYP3A4, such as ketoconazole, while taking LUNESTA. (notice Eszopiclone, Mises en garde et précautions)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Decreased exposure of etonogestrel may be expected. (notice Éfavirenz, Interactions médicamenteuses)

Concomitant use of Etravirine with efavirenz or nevirapine may cause a significant decrease in the plasma concentrations of etravirine and loss of therapeutic effect of Etravirine. (notice Étravirine, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

Strong CYP 3A4 inducers: Concomitant use of strong CYP 3A4 inducers decreases exemestane exposure. (notice Exémestane, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Calcium channel blockers: Diltiazem Others (e.g., felodipine, nicardipine, nifedipine, verapamil) ↓ diltiazem * ↓ desacetyl diltiazem * ↓ N-monodesmethyl diltiazem * ↓ calcium channel blocker Diltiazem dose adjustments should be guided by clinical response (refer to the full prescribing information for diltiazem). (notice Éfavirenz, Interactions médicamenteuses)

Phenobarbital Clinical Impact: Chronic administration of phenobarbital, a known enzyme inducer, may be associated with a decrease in the plasma half-life of fenoprofen. (notice Fénoprofène, Interactions médicamenteuses)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

Anti-infective: Clarithromycin ↓ clarithromycin * ↑ 14-OH metabolite * Consider alternatives to macrolide antibiotics because of the risk of QT interval prolongation. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

HMG-CoA reductase inhibitors: Atorvastatin PravastatinSimvastatin ↓ atorvastatin * ↓ pravastatin * ↓ simvastatin * Plasma concentrations of atorvastatin, pravastatin and simvastatin decreased. (notice Éfavirenz, Interactions médicamenteuses)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

CYP3A4 Interactions: Fosaprepitant is a weak inhibitor of CYP3A4, and aprepitant, the active moiety, is a substrate, inhibitor, and inducer of CYP3A4; see Full Prescribing Information for recommendations regarding contraindications, risk of adverse reactions, and dosage adjustment of FOCINVEZ and concomitant drugs. (notice Fosaprépitant, Mises en garde et précautions)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

• CYP3A4 Inducer: Increase IRESSA to 500 mg daily in patients receiving a strong CYP3A4 inducer. (notice Géfitinib, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

…Interactions: Effect of other Drugs on INTUNIV Concomitant Drug Name or Drug Class Clinical Rationale and Magnitude of Drug Interaction Clinical Recommendation Strong and moderate CYP3A4 inhibitors, e.g., ketoconazole, fluconazole Guanfacine is primarily metabolized by CYP3A4 and its plasma concentrations can be significantly affected resulting in an increase… (notice Guanfacine, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Concomitant administration of inhibitors of CYP3A4 may lead to increases in serum concentrations of ALKINDI SPRINKLE and increase the risk of adverse reactions associated with the use of excessive doses. (notice Hydrocortisone, Interactions médicamenteuses)

Narcotic analgesic: Methadone ↓ methadone * Monitor for signs of methadone withdrawal and increase methadone dose if required to alleviate withdrawal symptoms. * The interaction between efavirenz and the drug was evaluated in a clinical study. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

• CYP3A4 Inducers: Monitor for increased toxicity when used in combination with CYP3A4 inducers. (notice Ifosfamide, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

CYP3A4 inducers may decrease Gleevec C max and area under curve (AUC). (notice Imatinib, Interactions médicamenteuses)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

Calcium channel blockers: Diltiazem Others (e.g., felodipine, nicardipine, nifedipine, verapamil) ↓ diltiazem * ↓ desacetyl diltiazem * ↓ N-monodesmethyl diltiazem * ↓ calcium channel blocker Diltiazem dose adjustments should be guided by clinical response (refer to the full prescribing information for diltiazem). (notice Éfavirenz, Interactions médicamenteuses)

Concomitant Use with CYP3A Inducers Use of KALYDECO with strong CYP3A inducers, such as rifampin, substantially decreases the exposure of ivacaftor, which may reduce the therapeutic effectiveness of KALYDECO. (notice Ivacaftor, Mises en garde et précautions)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Decreased exposure of some antiretroviral drugs (e.g., rilpivirine, atazanavir, and nelfinavir) when used concomitantly with lansoprazole may reduce antiviral effect and promote the development of drug resistance. (notice Lansoprazole, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

Enzyme inducers (e.g., CYP3A4) : May decrease the effectiveness of TYBLUME or increase breakthrough bleeding. (notice Lévonorgestrel et éthinylestradiol, Interactions médicamenteuses)

Narcotic analgesic: Methadone ↓ methadone * Monitor for signs of methadone withdrawal and increase methadone dose if required to alleviate withdrawal symptoms. * The interaction between efavirenz and the drug was evaluated in a clinical study. (notice Éfavirenz, Interactions médicamenteuses)

Strong P-glycoprotein/CYP3A4 inducer: The efficacy of TRADJENTA may be reduced when administered in combination (e.g., with rifampin). (notice Linagliptine, Interactions médicamenteuses)

Inducers of P-glycoprotein or CYP3A4 Enzymes Clinical Impact Rifampin decreased linagliptin exposure, suggesting that the efficacy of linagliptin may be reduced when administered in combination with a strong P-gp or CYP3A4 inducer. (notice Linagliptine et metformine, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

Antimalarials: Artemether/lumefantrine Atovaquone/ proguanil ↓ artemether * ↓ dihydroartemisinin * ↓ lumefantrine * ↓ atovaquone ↓ proguanil Consider alternatives to artemether/ lumefantrine because of the risk of QT interval prolongation. (notice Éfavirenz, Interactions médicamenteuses)

Thus concomitant usage of CYP2C9 inhibitors (such as amiodarone, fluconazole, and sulphaphenazole) may lead to abnormally high plasma levels of meloxicam due to reduced metabolic clearance [ see Use in Specific Populations ( 8.8 ); and Clinical Pharmacology ( 12.3 , 12.5 ) ]. (notice Méloxicam, Interactions médicamenteuses)

Inducers of CYP3A4 (e.g., phenytoin, carbamazepine, dexamethasone, rifampin, and phenobarbital) could increase the rate of elimination of donepezil. (notice Mémantine et donépézil, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Narcotic analgesic: Methadone ↓ methadone * Monitor for signs of methadone withdrawal and increase methadone dose if required to alleviate withdrawal symptoms. * The interaction between efavirenz and the drug was evaluated in a clinical study. (notice Éfavirenz, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

Hepatic Enzyme Inducers (e.g., barbiturates, phenytoin, carbamazepine, rifampin) : Drugs which induce cytochrome P450 3A4 enzyme activity may enhance the metabolism of corticosteroids and require that the dosage of the corticosteroid be increased. (notice Méthylprednisolone, Interactions médicamenteuses)

Antifungals: Voriconazole Itraconazole Ketoconazole Posaconazole ↓ voriconazole * ↑ efavirenz * ↓ itraconazole * ↓ hydroxyitraconazole * ↓ ketoconazole ↓ posaconazole * Efavirenz and voriconazole should not be coadministered at standard doses. (notice Éfavirenz, Interactions médicamenteuses)

Cytochrome P450-3A4 Inhibitors: May result in prolonged sedation due to decreased plasma clearance of midazolam. (notice Midazolam, Interactions médicamenteuses)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

Strong cytochrome P450 3A4 inhibitors (e.g., ritonavir): Risk of increased systemic corticosteroid effects. (notice Mométasone, Mises en garde et précautions)

Narcotic analgesic: Methadone ↓ methadone * Monitor for signs of methadone withdrawal and increase methadone dose if required to alleviate withdrawal symptoms. * The interaction between efavirenz and the drug was evaluated in a clinical study. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

Narcotic analgesic: Methadone ↓ methadone * Monitor for signs of methadone withdrawal and increase methadone dose if required to alleviate withdrawal symptoms. * The interaction between efavirenz and the drug was evaluated in a clinical study. (notice Éfavirenz, Interactions médicamenteuses)

• Decreased exposure of some antiretroviral drugs (e.g., rilpivirine, atazanavir, and nelfinavir) when used concomitantly with esomeprazole magnesium may reduce antiviral effect and promote the development of drug resistance [see Clinical Pharmacology (12.3) ]. (notice Naproxène et ésoméprazole, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

…salicylates, monoamine oxidase inhibitors, non-selective beta-adrenergic-blocking agents, anabolic hormones (e.g., methandrostenolone), guanethidine, gymnema sylvestre, glucomannan, thioctic acid, and inhibitors of CYP2C9 (e.g., amiodarone, fluconazole, voriconazole, sulfinpyrazone) or in patients known to be poor metabolizers of CYP2C9 substrates, alcohol. (notice Natéglinide, Interactions médicamenteuses)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

Calcium channel blockers: Diltiazem Others (e.g., felodipine, nicardipine, nifedipine, verapamil) ↓ diltiazem * ↓ desacetyl diltiazem * ↓ N-monodesmethyl diltiazem * ↓ calcium channel blocker Diltiazem dose adjustments should be guided by clinical response (refer to the full prescribing information for diltiazem). (notice Éfavirenz, Interactions médicamenteuses)

Coadministration of P-gp and CYP3A4 inhibitors may increase nintedanib exposure. (notice Nintédanib, Interactions médicamenteuses)

CYP3A4 inhibitors such as itraconazole, voriconazole, fluconazole, grapefruit juice, or ketoconazole may increase plasma hormone concentrations. (notice Norelgestromine et éthinylestradiol, Interactions médicamenteuses)

Some drugs or herbal products that may decrease the effectiveness of HCs include efavirenz, phenytoin, barbiturates, carbamazepine, bosentan, felbamate, griseofulvin, oxcarbazepine, rifampicin, rifabutin, rufinamide, aprepitant, and products containing St. (notice Noréthistérone, Interactions médicamenteuses)

CYP3A4 inhibitors such as itraconazole, voriconazole, fluconazole, grapefruit juice, or ketoconazole may increase plasma hormone concentrations. (notice Norgestimate et éthinylestradiol, Interactions médicamenteuses)

Concomitant administration of CYP3A4 inhibitors such as itraconazole, fluconazole, grapefruit juice or ketoconazole may increase plasma hormone concentrations. (notice Norgestrel et éthinylestradiol, Interactions médicamenteuses)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Calcium channel blockers: Diltiazem Others (e.g., felodipine, nicardipine, nifedipine, verapamil) ↓ diltiazem * ↓ desacetyl diltiazem * ↓ N-monodesmethyl diltiazem * ↓ calcium channel blocker Diltiazem dose adjustments should be guided by clinical response (refer to the full prescribing information for diltiazem). (notice Éfavirenz, Interactions médicamenteuses)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

• Decreased exposure of some antiretroviral drugs (e.g., rilpivirine, atazanavir and nelfinavir) when used concomitantly with omeprazole may reduce antiviral effect and promote the development of drug resistance [see Clinical Pharmacology ( 12.3 )]. (notice Oméprazole, Interactions médicamenteuses)

Decreased exposure of some antiretroviral drugs (e.g., rilpivirine, atazanavir and nelfinavir) when used concomitantly with omeprazole may reduce antiviral effect and promote the development of drug resistance [see Clinical Pharmacology ( 12.3 )] . (notice Oméprazole et bicarbonate de sodium, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Drug Interactions and Decreased Vitamin Absorption ORLISTAT may interact with concomitant drugs including cyclosporine, levothyroxine, warfarin, amiodarone, antiepileptic drugs, and antiretroviral drugs [see Drug Interactions (7) ]. (notice Orlistat, Mises en garde et précautions)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Co-administration with strong cytochrome P450 (CYP) 3A4 inhibitors (e.g., ketoconazole) increases the systemic exposure of oxybutynin. (notice Oxybutynine, Interactions médicamenteuses)

Narcotic analgesic: Methadone ↓ methadone * Monitor for signs of methadone withdrawal and increase methadone dose if required to alleviate withdrawal symptoms. * The interaction between efavirenz and the drug was evaluated in a clinical study. (notice Éfavirenz, Interactions médicamenteuses)

• Decreased exposure of some antiretroviral drugs (e.g., rilpivirine atazanavir, and nelfinavir) when used concomitantly with pantoprazole may reduce antiviral effect and promote the development of drug resistance. (notice Pantoprazole, Interactions médicamenteuses)

Exposure of Paricalcitol Injection will increase upon coadministration with strong CYP3A inhibitors [see Clinical Pharmacology (12.3) ] . (notice Paricalcitol, Interactions médicamenteuses)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Narcotic analgesic: Methadone ↓ methadone * Monitor for signs of methadone withdrawal and increase methadone dose if required to alleviate withdrawal symptoms. * The interaction between efavirenz and the drug was evaluated in a clinical study. (notice Éfavirenz, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

Potential for Other Drugs to Affect Efavirenz Drugs that induce CYP3A activity (e.g., phenobarbital, rifampin, rifabutin) would be expected to increase the clearance of efavirenz resulting in lowered plasma concentrations [ see Dosage and Administration ( 2.2 ) ]. (notice Éfavirenz, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

HMG-CoA reductase inhibitors: Atorvastatin PravastatinSimvastatin ↓ atorvastatin * ↓ pravastatin * ↓ simvastatin * Plasma concentrations of atorvastatin, pravastatin and simvastatin decreased. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

HMG-CoA reductase inhibitors: Atorvastatin PravastatinSimvastatin ↓ atorvastatin * ↓ pravastatin * ↓ simvastatin * Plasma concentrations of atorvastatin, pravastatin and simvastatin decreased. (notice Éfavirenz, Interactions médicamenteuses)

CYP 3A4 inducers (e.g. barbiturates, phenytoin, carbamazepine, and rifampin): Drugs such as barbiturates, phenytoin, ephedrine, and rifampin, which induce hepatic microsomal drug metabolizing enzyme activity may enhance metabolism of prednisolone and require that the dosage of Orapred be increased. (notice Prednisolone, Interactions médicamenteuses)

CYP 3A4 inducers and inhibitors: May, respectively, increase or decrease clearance of corticosteroids, necessitating dose adjustment. (notice Prednisone, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Antimalarials: Artemether/lumefantrine Atovaquone/ proguanil ↓ artemether * ↓ dihydroartemisinin * ↓ lumefantrine * ↓ atovaquone ↓ proguanil Consider alternatives to artemether/ lumefantrine because of the risk of QT interval prolongation. (notice Éfavirenz, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

Prophylaxis with appropriate antihistamines before initiating therapy with efavirenz in pediatric patients should be considered. (notice Éfavirenz, Mises en garde et précautions)

Impact of Other Drugs on Propranolol CYP2D6, CYP1A2 and CYP2C19 Inhibitors: CYP2D6 inhibitors (e.g. bupropion, fluoxetine, paroxetine, quinidine), CYP1A2 inhibitors (e.g., ciprofloxacin, enoxamine, fluvoxamine) and CYP2C19 inhibitors (e.g., fluconazole, fluvoxamine, ticlopidine) increase exposure to propranolol when co-administered with INNOPRAN XL. (notice Propranolol, Interactions médicamenteuses)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

Antimalarials: Artemether/lumefantrine Atovaquone/ proguanil ↓ artemether * ↓ dihydroartemisinin * ↓ lumefantrine * ↓ atovaquone ↓ proguanil Consider alternatives to artemether/ lumefantrine because of the risk of QT interval prolongation. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Decreased exposure of some antiretroviral drugs (e.g., rilpivirine, atazanavir, and nelfinavir) when used concomitantly with rabeprazole may reduce antiviral effect and promote the development of drug resistance. (notice Rabéprazole, Interactions médicamenteuses)

Rifampin (strong CYP enzyme inducer): Decreases exposure to and effects of ramelteon. (notice Rameltéon, Interactions médicamenteuses)

Narcotic analgesic: Methadone ↓ methadone * Monitor for signs of methadone withdrawal and increase methadone dose if required to alleviate withdrawal symptoms. * The interaction between efavirenz and the drug was evaluated in a clinical study. (notice Éfavirenz, Interactions médicamenteuses)

CYP2C8 and CYP3A4 Inhibitors Intervention: Repaglinide tablets dose reductions and increased frequency of glucose monitoring may be required when co‑administered. (notice Répaglinide, Interactions médicamenteuses)

Fixed-Dose Combination of Efavirenz, Emtricitabine, and Tenofovir Once-weekly coadministration of 900 mg PRIFTIN with the antiretroviral fixed-dose combination of efavirenz 600 mg, emtricitabine 200 mg and tenofovir disoproxil fumarate 300 mg in HIV-infected patients did not result in any substantial change in steady state exposures of efavirenz, emtricitabine,… (notice Rifapentine, Interactions médicamenteuses)

Coadministration of EDURANT or EDURANT PED and drugs that induce CYP3A may result in decreased plasma concentrations of rilpivirine and loss of virologic response and possible resistance to rilpivirine or to the class of NNRTIs. (notice Rilpivirine, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

Coadministration of a selective and potent inhibitor of CYP3A4, ketoconazole (100 mg bid for 2 days with ropivacaine infusion administered 1 hour after ketoconazole) caused a 15% reduction in in vivo plasma clearance of ropivacaine. (notice Ropivacaïne, Interactions médicamenteuses)

HMG-CoA reductase inhibitors: Atorvastatin PravastatinSimvastatin ↓ atorvastatin * ↓ pravastatin * ↓ simvastatin * Plasma concentrations of atorvastatin, pravastatin and simvastatin decreased. (notice Éfavirenz, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Strong CYP3A4 Inhibitors: Reduce, interrupt, or discontinue JAKAFI/JAKAFI XR doses as recommended except in patients with acute or chronic graft-versus-host-disease. (notice Ruxolitinib, Interactions médicamenteuses)

Strong Inhibitors of CYP3A4/5 Enzymes Ketoconazole significantly increased saxagliptin exposure. (notice Saxagliptine, Interactions médicamenteuses)

Strong Inhibitors of CYP3A4/5 Enzymes Ketoconazole significantly increased saxagliptin exposure. (notice Saxagliptine et metformine, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

Drugs that induce CYP3A4 (e.g., phenytoin, carbamazepine, nafcillin, phenobarbital, and rifampin) should be used with caution. (notice Sélégiline, Interactions médicamenteuses)

Increases in sertraline dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

CYP3A4 inhibitors (e.g., ritonavir, ketoconazole, itraconazole, erythromycin) increase SILDENAFIL ORAL FILM exposure. (notice Sildénafil, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Monitor QT interval more frequently when SUTENT is concomitantly administered with strong CYP3A4 inhibitors or drugs known to prolong QT interval. (notice Sunitinib, Mises en garde et précautions)

Strong CYP3A inducers: Efficacy may be reduced ( 7.2 ). (notice Suvorexant, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

…Physicians should be aware that CIALIS for once daily use provides continuous plasma tadalafil levels and should consider this when evaluating the potential for interactions with medications (e.g., nitrates, alpha-blockers, anti-hypertensives and potent inhibitors of CYP3A4) and with substantial consumption of alcohol [see Drug Interactions ( 7.1 , 7.2 , 7.3 )] . (notice Tadalafil, Mises en garde et précautions)

Antimalarials: Artemether/lumefantrine Atovaquone/ proguanil ↓ artemether * ↓ dihydroartemisinin * ↓ lumefantrine * ↓ atovaquone ↓ proguanil Consider alternatives to artemether/ lumefantrine because of the risk of QT interval prolongation. (notice Éfavirenz, Interactions médicamenteuses)

Narcotic analgesic: Methadone ↓ methadone * Monitor for signs of methadone withdrawal and increase methadone dose if required to alleviate withdrawal symptoms. * The interaction between efavirenz and the drug was evaluated in a clinical study. (notice Éfavirenz, Interactions médicamenteuses)

Calcium channel blockers: Diltiazem Others (e.g., felodipine, nicardipine, nifedipine, verapamil) ↓ diltiazem * ↓ desacetyl diltiazem * ↓ N-monodesmethyl diltiazem * ↓ calcium channel blocker Diltiazem dose adjustments should be guided by clinical response (refer to the full prescribing information for diltiazem). (notice Éfavirenz, Interactions médicamenteuses)

CYP3A4 Substrates (e.g., midazolam) and CYP2B6 Substrates (e.g., bupropion, efavirenz): Efficacy of concomitant drugs may be decreased; monitor patients’ response and consider increasing the dosage of the concomitant drug, if necessary. (notice Télotristat, Interactions médicamenteuses)

Co-administration with Inducers or Inhibitors of CYP3A Metabolism Agents Inducing CYP3A Metabolism: Strong inducers of CYP3A4/5 such as dexamethasone, carbamazepine, phenytoin, phenobarbital, rifampin, rifabutin, and rifampacin may decrease exposure of the active metabolite, sirolimus. (notice Temsirolimus, Mises en garde et précautions)

Terbinafine clearance is increased 100% by rifampin, a CYP450 enzyme inducer, and decreased 33% by cimetidine, a CYP450 enzyme inhibitor. (notice Terbinafine, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

CYP3A4 inducers/inhibitors: Monitor for decreased tinidazole effect or increased adverse reactions ( 7.2 ) (notice Tinidazole, Interactions médicamenteuses)

DRUG INTERACTIONS Hepatic microsomal enzyme inducing agents, such as carbamazepine, were found to significantly increase the clearance of thiothixene. (notice Tiotixène, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

CYP2C9: Concomitant use with CYP2C9 inhibitors can decrease torsemide clearance. (notice Torasémide, Interactions médicamenteuses)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

Co-administration of a CYP2C8 enzyme inducer (e.g., rifampin) may decrease exposure to treprostinil. (notice Tréprostinil, Mises en garde et précautions)

Co-administration of other strong CYP3A4 inhibitors (e.g., ritonavir, atazanavir, clarithromycin, indinavir, itraconazole, nefazodone, nelfinavir, saquinavir, telithromycin, cobicistat-containing products) with KENALOG-40 Injection may cause increased plasma concentration of triamcinolone leading to adverse reactions. (notice Triamcinolone, Interactions médicamenteuses)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Drug Interactions with Strong Cytochrome P450 3A4 Inhibitors Caution should be exercised when considering the coadministration of Umeclidinium and Vilanterol ELLIPTA with ketoconazole and other known strong cytochrome P450 3A4 (CYP3A4) inhibitors (including, but not limited to, ritonavir, clarithromycin, conivaptan, indinavir, itraconazole, lopinavir, nefazodone,… (notice Uméclidinium et vilantérol, Mises en garde et précautions)

Immunosuppressants: Cyclosporine, tacrolimus, sirolimus and others metabolized by CYP3A ↓ immunosuppressant Dose adjustments of the immunosuppressant may be required. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Calcium channel blockers: Diltiazem Others (e.g., felodipine, nicardipine, nifedipine, verapamil) ↓ diltiazem * ↓ desacetyl diltiazem * ↓ N-monodesmethyl diltiazem * ↓ calcium channel blocker Diltiazem dose adjustments should be guided by clinical response (refer to the full prescribing information for diltiazem). (notice Éfavirenz, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

CYP3A4 Substrates Clinical Impact Viloxazine is a weak inhibitor of CYP3A4 which increases the exposure of CYP3A4 substrates when coadministered [see Clinical Pharmacology (12.3) ]. (notice Viloxazine, Interactions médicamenteuses)

Inhibitors of CYP3A4: May cause earlier onset and/or increased severity of adverse reactions ( 7.1 ) (notice Vinorelbine, Interactions médicamenteuses)

Antidepressant: Bupropion Sertraline ↓ bupropion * ↓ sertraline * Increases in bupropion dosage should be guided by clinical response. (notice Éfavirenz, Interactions médicamenteuses)

Zafirlukast exposure is likely to be increased by other moderate and strong CYP2C9 inhibitors. (notice Zafirlukast, Précautions)

Multiple-dose administration of the potent CYP3A4 inducer rifampin (600 mg every 24 hours, q24h, for 14 days), however, reduced zaleplon C max and AUC by approximately 80%. (notice Zaléplone, Interactions médicamenteuses)

QT Prolonging Drugs There is limited information available on the potential for a pharmacodynamic interaction between efavirenz and drugs that prolong the QTc interval. (notice Éfavirenz, Interactions médicamenteuses)

Patients who are receiving concomitant anticonvulsant medications primarily metabolized by the liver, such as phenytoin and phenobarbital, may require periodic monitoring of plasma levels [see Drug Interactions ( 7.1 ) ] . (notice Éfavirenz, Mises en garde et précautions)

Analysis of long-term data from Study 006 (median follow-up 180 weeks, 102 weeks, and 76 weeks for patients treated with efavirenz + zidovudine + lamivudine, efavirenz + indinavir, and indinavir + zidovudine + lamivudine, respectively) showed that, beyond 24 weeks of therapy, the incidences of new-onset nervous system symptoms among efavirenz-treated patients… (notice Éfavirenz, Mises en garde et précautions)

Appropriate antihistamines and/or corticosteroids may improve the tolerability and hasten the resolution of rash. (notice Éfavirenz, Mises en garde et précautions)

Appropriate antihistamines and/or corticosteroids may improve the tolerability and hasten the resolution of rash. (notice Éfavirenz, Mises en garde et précautions)

Appropriate antihistamines and/or corticosteroids may improve the tolerability and hasten the resolution of rash. (notice Éfavirenz, Mises en garde et précautions)

Appropriate antihistamines and/or corticosteroids may improve the tolerability and hasten the resolution of rash. (notice Éfavirenz, Mises en garde et précautions)

Hormonal contraceptives: Oral Ethinyl estradiol/ Norgsetimate Implant Etonogestrel ↑ active metabolites of norgestimate * ↓ etonogestrel A reliable method of barrier contraception should be used in addition to hormonal contraceptives. (notice Éfavirenz, Interactions médicamenteuses)

The effect of potent CYP3A4 inhibitors on dutasteride has not been studied. (notice Dutastéride, Interactions médicamenteuses)

Effects of Other Drugs on HALAVEN No drug-drug interactions are expected with CYP3A4 inhibitors, CYP3A4 inducers or P-glycoprotein (P-gp) inhibitors. (notice Éribuline, Interactions médicamenteuses)

Hormonal contraceptives: Oral Ethinyl estradiol/ Norgsetimate Implant Etonogestrel ↑ active metabolites of norgestimate * ↓ etonogestrel A reliable method of barrier contraception should be used in addition to hormonal contraceptives. (notice Éfavirenz, Interactions médicamenteuses)

Hormonal contraceptives: Oral Ethinyl estradiol/ Norgsetimate Implant Etonogestrel ↑ active metabolites of norgestimate * ↓ etonogestrel A reliable method of barrier contraception should be used in addition to hormonal contraceptives. (notice Éfavirenz, Interactions médicamenteuses)

An in vitro study using human liver microsomes suggests that famciclovir is not an inhibitor of CYP3A4 enzymes. (notice Famciclovir, Interactions médicamenteuses)

Appropriate antihistamines and/or corticosteroids may improve the tolerability and hasten the resolution of rash. (notice Éfavirenz, Mises en garde et précautions)

Appropriate antihistamines and/or corticosteroids may improve the tolerability and hasten the resolution of rash. (notice Éfavirenz, Mises en garde et précautions)

Appropriate antihistamines and/or corticosteroids may improve the tolerability and hasten the resolution of rash. (notice Éfavirenz, Mises en garde et précautions)

Hormonal contraceptives: Oral Ethinyl estradiol/ Norgsetimate Implant Etonogestrel ↑ active metabolites of norgestimate * ↓ etonogestrel A reliable method of barrier contraception should be used in addition to hormonal contraceptives. (notice Éfavirenz, Interactions médicamenteuses)

Appropriate antihistamines and/or corticosteroids may improve the tolerability and hasten the resolution of rash. (notice Éfavirenz, Mises en garde et précautions)

Analysis of long-term data from Study 006 (median follow-up 180 weeks, 102 weeks, and 76 weeks for patients treated with efavirenz + zidovudine + lamivudine, efavirenz + indinavir, and indinavir + zidovudine + lamivudine, respectively) showed that, beyond 24 weeks of therapy, the incidences of new-onset nervous system symptoms among efavirenz-treated patients… (notice Éfavirenz, Mises en garde et précautions)

Analysis of long-term data from Study 006 (median follow-up 180 weeks, 102 weeks, and 76 weeks for patients treated with efavirenz + zidovudine + lamivudine, efavirenz + indinavir, and indinavir + zidovudine + lamivudine, respectively) showed that, beyond 24 weeks of therapy, the incidences of new-onset nervous system symptoms among efavirenz-treated patients… (notice Éfavirenz, Mises en garde et précautions)

Hormonal contraceptives: Oral Ethinyl estradiol/ Norgsetimate Implant Etonogestrel ↑ active metabolites of norgestimate * ↓ etonogestrel A reliable method of barrier contraception should be used in addition to hormonal contraceptives. (notice Éfavirenz, Interactions médicamenteuses)

Hormonal contraceptives: Oral Ethinyl estradiol/ Norgsetimate Implant Etonogestrel ↑ active metabolites of norgestimate * ↓ etonogestrel A reliable method of barrier contraception should be used in addition to hormonal contraceptives. (notice Éfavirenz, Interactions médicamenteuses)

Hormonal contraceptives: Oral Ethinyl estradiol/ Norgsetimate Implant Etonogestrel ↑ active metabolites of norgestimate * ↓ etonogestrel A reliable method of barrier contraception should be used in addition to hormonal contraceptives. (notice Éfavirenz, Interactions médicamenteuses)

When phenytoin or other hepatic enzyme inducers such as rifampin and phenobarbital have been taken concurrently with mexiletine, lowered mexiletine plasma levels have been reported. (notice Mexilétine, Interactions médicamenteuses)

Potential for Glycerol Phenylbutyrate to Affect Other Drugs Drugs with narrow therapeutic index that are substrates of CYP3A4 Glycerol phenylbutyrate is a weak inducer of CYP3A4 in humans. (notice Phénylbutyrate de glycérol, Interactions médicamenteuses)

Hormonal contraceptives: Oral Ethinyl estradiol/ Norgsetimate Implant Etonogestrel ↑ active metabolites of norgestimate * ↓ etonogestrel A reliable method of barrier contraception should be used in addition to hormonal contraceptives. (notice Éfavirenz, Interactions médicamenteuses)

CYP3A4 Substrates An in vitro study has suggested that rifaximin induces CYP3A4 [see Clinical Pharmacology ( 12.3 )] . (notice Rifaximine, Interactions médicamenteuses)

Strong CYP3A inducers: Strong inducers of CYP3A (for example, rifampin, phenytoin, carbamazepine, phenobarbital or St. (notice Riociguat, Interactions médicamenteuses)

However, no formal drug-drug interaction studies between zileuton and CYP3A4 inhibitors, such as ketaconazole, have been conducted. (notice Zileuton, Interactions médicamenteuses)

…Efavirenz No dosage adjustment is recommended when efavirenz is given with the following: aluminum/magnesium hydroxide antacids, azithromycin, cetirizine, famotidine, fluconazole, lorazepam, nelfinavir, nucleoside reverse transcriptase inhibitors (abacavir, emtricitabine, lamivudine, stavudine, tenofovir disoproxil fumarate, zidovudine), paroxetine, and raltegravir. (notice Éfavirenz, Interactions médicamenteuses)

Drugs Without Clinically Significant Interactions with Efavirenz No dosage adjustment is recommended when efavirenz is given with the following: aluminum/magnesium hydroxide antacids, azithromycin, cetirizine, famotidine, fluconazole, lorazepam, nelfinavir, nucleoside reverse transcriptase inhibitors (abacavir, emtricitabine, lamivudine, stavudine, tenofovir… (notice Éfavirenz, Interactions médicamenteuses)

Drugs Without Clinically Significant Interactions with Efavirenz No dosage adjustment is recommended when efavirenz is given with the following: aluminum/magnesium hydroxide antacids, azithromycin, cetirizine, famotidine, fluconazole, lorazepam, nelfinavir, nucleoside reverse transcriptase inhibitors (abacavir, emtricitabine, lamivudine, stavudine, tenofovir… (notice Éfavirenz, Interactions médicamenteuses)

…Significant Interactions with Efavirenz No dosage adjustment is recommended when efavirenz is given with the following: aluminum/magnesium hydroxide antacids, azithromycin, cetirizine, famotidine, fluconazole, lorazepam, nelfinavir, nucleoside reverse transcriptase inhibitors (abacavir, emtricitabine, lamivudine, stavudine, tenofovir disoproxil fumarate, zidovudine),… (notice Éfavirenz, Interactions médicamenteuses)

…Significant Interactions with Efavirenz No dosage adjustment is recommended when efavirenz is given with the following: aluminum/magnesium hydroxide antacids, azithromycin, cetirizine, famotidine, fluconazole, lorazepam, nelfinavir, nucleoside reverse transcriptase inhibitors (abacavir, emtricitabine, lamivudine, stavudine, tenofovir disoproxil fumarate, zidovudine),… (notice Éfavirenz, Interactions médicamenteuses)

…Efavirenz No dosage adjustment is recommended when efavirenz is given with the following: aluminum/magnesium hydroxide antacids, azithromycin, cetirizine, famotidine, fluconazole, lorazepam, nelfinavir, nucleoside reverse transcriptase inhibitors (abacavir, emtricitabine, lamivudine, stavudine, tenofovir disoproxil fumarate, zidovudine), paroxetine, and raltegravir. (notice Éfavirenz, Interactions médicamenteuses)

Drugs Without Clinically Significant Interactions with Efavirenz No dosage adjustment is recommended when efavirenz is given with the following: aluminum/magnesium hydroxide antacids, azithromycin, cetirizine, famotidine, fluconazole, lorazepam, nelfinavir, nucleoside reverse transcriptase inhibitors (abacavir, emtricitabine, lamivudine, stavudine, tenofovir… (notice Éfavirenz, Interactions médicamenteuses)

Effect of Other Drugs on Micafungin in Sodium Chloride Injection CYP3A4, CYP2C9 and CYP2C19 Inhibitors Co-administration of Micafungin in Sodium Chloride Injection with cyclosporine, itraconazole, voriconazole and fluconazole did not alter the pharmacokinetics of micafungin. (notice Micafungine, Interactions médicamenteuses)

…adjustment is needed when SINGULAIR is co-administered with theophylline, prednisone, prednisolone, oral contraceptives, fexofenadine, digoxin, warfarin, gemfibrozil, itraconazole, thyroid hormones, sedative hypnotics, non-steroidal anti-inflammatory agents, benzodiazepines, decongestants, and Cytochrome P450 (CYP) enzyme inducers [see Clinical Pharmacology (12.3) ]. (notice Montélukast, Interactions médicamenteuses)

…Efavirenz No dosage adjustment is recommended when efavirenz is given with the following: aluminum/magnesium hydroxide antacids, azithromycin, cetirizine, famotidine, fluconazole, lorazepam, nelfinavir, nucleoside reverse transcriptase inhibitors (abacavir, emtricitabine, lamivudine, stavudine, tenofovir disoproxil fumarate, zidovudine), paroxetine, and raltegravir. (notice Éfavirenz, Interactions médicamenteuses)