Potential Clinically Relevant Interactions between Antimalarial and Antiretroviral Drugs*

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Potential Clinically Relevant Interactions between Antimalarial and Antiretroviral Drugs
Antimalarial DrugProtease InhibitorsNRTINNRTI
QuininePIs: increase quinine levelsNo available dataEfavirenz, Nevirapine: reduces quinine levels
Atovaquone/ProguanilLopinavir/Ritonavir, Atazanavir/Ritonavir: reduces atovaquone and proguanil levels Efavirenz: reduces atovaquone and proguanil levels
MefloquineRitonavir: reduces ritonavir levels Efavirenz, Nevirapine: reduces mefloquine levels
Lumefantrine, HalofantrinePIs: increase lumefantrine or halofantrine levels, which can prolong QT interval Efavirenz, Nevirapine: increases lumefantrine or halofantrine levels, which can prolong QT interval
Amodiaquine plus Artesunate  Efavirenz: increases amodiaquine concentration which can increase hepatic toxicity; do not co-administer
Chloroquine, Pyrimethamine, Sulfadoxine-PyrimethamineRitonavir: alters anti-malarial drug metabolism, may increase chloroquine levels  
Sulfadoxine-Pyrimethamine Zidovudine: possibly increases risk of anemiaNevirapine: possibly increases adverse skin or liver adverse reactions; do not start both drugs simultaneously
ArtemisininPIs: alter artemisinin metabolism Nevirapine: may decrease artemisinin levels
DapsoneSaquinavir: alters dapsone metabolism  
Key: NRTI=nucleoside reverse transcriptase inhibitor; NNRTI=non-nucleoside reverse transcriptase inhibitor; PI= protease inhibitor

* Modified from: Flateau, C., G. Le Loup, et al. Consequences of HIV infection on malaria and therapeutic implications: a systematic review. Lancet Infect Dis. 2011. 11(7);541-556.