Pooh asked
Can I take Genvoya with Sulfamethoxazole/Tmp and Azithromycin?
Answer
Yes, Genvoya can be taken with sulfamethoxazole-trimethoprim and azithromycin with no interactions. The antibiotics are especially important to take for people living with HIV since their immune system may be weakened by the HIV to a certain point where it is very difficult for the body to fight off infections.
CD4 Cell Count
CD4 cells are part of the body's immune system and help fight off infections. For people living with HIV, the CD4 cells may drop to a low number (under 200) due to the HIV attacking them. This is considered acquired immunodeficiency syndrome (AIDS), where the immune system is weakened to a point where it is very difficult to fight off infections.
Although antibiotics can be used to fight off active infections, they are also used when the CD4 count drops below certain numbers in order to prevent infections as well. This is why antibiotics, like sulfamethoxazole-trimethoprim and azithromycin, are very important to take when the CD4 count is low.
Genvoya
Per the prescribing information, Genvoya is used for the treatment of HIV. Although Genvoya does not interact with sulfamethoxazole-trimethoprim or azithromycin, it does have interactions with some other medications, as well as certain warning, contraindications, and side effects.
Warnings and Cautions
- New or worsening kidney function
- Lactic acidosis and hepatotoxicity
- Acute exacerbation of hepatitis B (caution if discontinuing the Genvoya)
Contraindications
Coadministration with certain medications that may either decrease effectiveness of Genvoya to a point where it may not work well enough against HIV, or where Genvoya may increase other medications concentrations too much, including:
- Alfuzosin
- Anticonvulsants: carbamazepine, phenobarbital, phenytoin
- Rifampin
- Antipsychotics: lurasidone, pimozide
- Ergot derivatives: dihydroergotamine, ergotamine, methylergonovine
- Cisapride
- St. John's wort
- Statins: lovastatin, simvastatin
- Sildenafil (when used for pulmonary arterial hypertension)
- Sedative/hypnotics: triazolam, orally administered midazolam
Side Effects
- Nausea (most common side effect)
- Diarrhea
- Headache
- Fatigue
Drug Interactions
- Antacids: separate Genvoya and antacids by at least 2 hours
- Should be used with caution because Genvoya may increase concentrations of: antiarrhythmics (amiodarone, digoxin, flecainide, propafenone, quinidine), antibiotics (clarithromycin, telithromycin), anticonvulsant (ethosuximide), antidepressants (paroxetine, amitriptyline, desipramine, imipramine, nortriptyline, bupropion, trazodone), antifungals (itraconazole, ketoconazole), anti-gout (colchicine), antipsychotics (perphenazine, risperidone, thioridazine, quetiapine), benzodiazepines (diazepam, midazolam), beta-blockers (metoprolol, timolol), calcium channel blockers, corticosteroids, bosentan, atorvastatin, progesterone components of birth control, immunosuppressants, buprenorphine, sedative/hypnotics (buspirone, zolpidem), phosphodiesterase-5 inhibitors (sildenafil, tadalafil, vardenafil)
- Should be used with caution because Genvoya may decrease concentrations of: estrogen component of birth control
- Should be used with caution because concentrations of Genvoya may be decreased: corticosteroids
- Should not be used with Genvoya: anticonvulsant (oxcarbazepine), antifungal (voriconazole), antimycobacterial agents (rifabutin, rifapentine)
Other Points
- It is important to take Genvoya daily around the same time in order to have it be most effective
- Safe sex practices should still be used when being treated with Genvoya because it does not protect against spreading or contracting sexually transmitted infections, as well as spreading HIV if the viral load is not undetectable
- It is important to keep up with follow-up appointments with your doctor for monitoring of Genvoya
- Check with your doctor when starting any new medications (prescribed or over the counter)
