Acute renal failure and CNS toxicity have been reported in patients with underlying renal dysfunction who have received inappropriately high doses of valacyclovir for their level of renal function. Sucralfate reacts with hydrochloric acid in the stomach to form an adherent, paste-like substance capable of acting as an acid buffer. The risk of adverse effects (e.g., leukopenia) from concomitant use may be greater in patients with renal impairment, as MPAG and acyclovir concentrations undergo renal tubular secretion. Concurrent administration of oral dexlansoprazole and antacids may reduce the bioavailability of dexlansoprazole; except when the antacids are given at least 30 minutes to one hour before dexlansoprazole administration. thrombotic thrombocytopenic purpura (TTP) / Delayed / Incidence not knownhemolytic-uremic syndrome / Delayed / Incidence not knownrenal failure (unspecified) / Delayed / Incidence not knownanuria / Delayed / Incidence not knownseizures / Delayed / Incidence not knownerythema multiforme / Delayed / Incidence not knownvasculitis / Delayed / Incidence not knownangioedema / Rapid / Incidence not knownaplastic anemia / Delayed / Incidence not knownvisual impairment / Early / Incidence not knowncoma / Early / Incidence not knownanaphylactoid reactions / Rapid / Incidence not known, neutropenia / Delayed / 0.6-18.0elevated hepatic enzymes / Delayed / 1.0-16.0depression / Delayed / 5.0-7.0thrombocytopenia / Delayed / 0.1-3.0dehydration / Delayed / 2.0-2.0anemia / Delayed / 0.2-0.8hallucinations / Early / Incidence not knownencephalopathy / Delayed / Incidence not knownconfusion / Early / Incidence not knowndelirium / Early / Incidence not knownhepatitis / Delayed / Incidence not knownimpaired cognition / Early / Incidence not knownataxia / Delayed / Incidence not knowndysarthria / Delayed / Incidence not knownpsychosis / Early / Incidence not knownsinus tachycardia / Rapid / Incidence not knownmania / Early / Incidence not knownhypertension / Early / Incidence not knowndyspnea / Early / Incidence not known, headache / Early / 11.0-38.0pharyngitis / Delayed / 16.0-16.0nausea / Early / 4.0-15.0abdominal pain / Early / 3.0-11.0sinusitis / Delayed / 9.0-9.0dysmenorrhea / Delayed / 5.0-8.0fatigue / Early / 8.0-8.0rash / Early / 8.0-8.0vomiting / Early / 3.0-6.0arthralgia / Delayed / 5.0-6.0diarrhea / Early / 5.0-5.0dizziness / Early / 2.0-4.0fever / Early / 4.0-4.0rhinorrhea / Early / 2.0-2.0agitation / Early / Incidence not knownphotosensitivity / Delayed / Incidence not knownurticaria / Rapid / Incidence not knownalopecia / Delayed / Incidence not knowntremor / Early / Incidence not knownpruritus / Rapid / Incidence not known. Most common adverse reactions (incidence ≥5%; all grades) in clinical studies through Week 144 were diarrhea (6%), nausea (6%), and headache (5%). The concentration of acyclovir triphosphate is 40- to 100- times higher in HSV-infected cells than non-infected cells. Among 234 virologically suppressed adult women in Study 1961, 1 participant met the criteria for resistance testing, was tested, and no amino acid substitutions emerged that were associated with BIKTARVY resistance through Week 48. Efficacy of treatment initiation after 72 hours of sign/symptom onset has not been established. Also, do not administer valacyclovir for at least 14 days after vaccination. Found inside â Page 196Lopinavir tablet pharmacokinetics with an increased dose during pregnancy. J Acquir Immune Defic Syndr. ... Population pharmacokinetics of tenofovir in HIV-1-infected pregnant women and their neonates (ANRS 12109). Clin Pharmacol Ther. The alterations in these enzymes occur due to point mutations or base insertions or deletions in the specific genes. Patients treated concomitantly with these drugs should be monitored for changes in thyroid function. . Although the magnitude of this interactions is not great, an occasional patient may be affected and the interaction may lead to subtherapeutic ethotoin concentrations. Doravirine; Lamivudine; Tenofovir disoproxil fumarate: (Moderate) Since tenofovir is primarily eliminated by the kidneys, concurrent administration of tenofovir disoproxil with valacyclovir may increase serum concentrations of tenofovir via competition for renal tubular secretion. Updated June 3, 2021. The potential exists for the two drugs to compete for tubular secretion, which could further increase the concentration of both drugs in patients with renal dysfunction. BOXED WARNING on post treatment acute exacerbation of hepatitis B. Antacids should not be administered within 30 minutes of sucralfate. CrCl > 30 ml/min: Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.CrCl <= 30 ml/min: Sucralfate contains aluminum; systemically absorbed in small amounts. Calcium Gluconate: (Major) Oral antacids, including calcium salts, potentially interfere with gastric mucosal binding of sucralfate. Alternative agents such as foscarnet or cidofovir may be suitable since they are not structurally related to these antivirals. Monitor patients receiving concomitant nephrotoxic agents for changes in serum creatinine and phosphorus, and urine glucose and protein. [29970] The 500 mg once daily regimen appears to be less effective than other regimens in patients with 10 or more episodes per year. Both emtricitabine and valacyclovir are excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. Theophylline, Aminophylline: (Major) Sucralfate, because it contains aluminum in its structure and due to its mechanism of action, can bind with certain drugs in the GI tract, including aminophylline, reducing its bioavailability. SMC2093 Bictegravir-emtricitabine-tenofovir alafenamide (Biktarvy ®) for the treatment of adults infected with HIV-1 without any known mutations associated with resistance to the individual components (September 2018)Recommended This interaction appears to be the result of chelation by the aluminum content of sucralfate. Endoscopy was not used in this study. © document.write(new Date().getFullYear()) PDR, LLC. Taking these drugs simultaneously may result in reduced bioavailability of dolutegravir. Found inside â Page 244Tenofovir and lamivudine have widespread evidence of fetal safety during gestational treatment for HIV, ... pregnant women Agent Dose Details Pregnancy category B Tenofovir disoproxil 300mg PO daily fumarate (TDF) (tenofovir (dose the ... Diphenhydramine; Naproxen: (Moderate) Concomitant administration of sucralfate and enteric-coated or delayed-release naproxen tablets can delay the absorption of naproxen. While no drug interactions due to competition for renal excretion have been observed, coadministration of these medications may increase concentrations of both drugs. The U.S. National Institutes of Health (NIH) recommends antiretroviral therapy (ART) for all people with HIV/AIDS. Coadministration of mycophenolate mofetil (MMF) and acyclovir to healthy volunteers resulted in no significant change in mycophenolic acid concentrations or AUC. Scottish Medicines Consortium (SMC) Decisions SMC No. TabletsThe sucralfate tablet is scored and may be cut into two pieces for ease of administration. The recommended dosage of DESCOVY for treatment of HIV-1 is one tablet taken . Emtricitabine/tenofovir is used both to treat and to prevent HIV/AIDS. Patients or carers should be given advice on how to administer tenofovir granules. Emtricitabine and tenofovir have been shown to be present in human breast milk. Consider the potential for drug interaction prior to and during concurrent use of these medications. Thoroughly updated with current regulations, references to the latest pharmacological data, and new medicinal products, this edition is a comprehensive resource covering latest knowledge and findings related to drugs during lactation and ... Aluminum is cleared by the kidneys in patients with normal renal function. †Among 634 treatment-naïve adults in Studies 1489 and 1490, 8 treatment-failure subjects were tested and no amino acid substitutions emerged that were associated with BIKTARVY resistance through Week 144. Sucralfate should be given 2 hours before or after the oral administration of theophylline. 1 g PO four times per day, given 1 hour before meals and at bedtime for 4—8 weeks or less if healing has been effectively demonstrated. For full details see funding body website. 1 g PO 3 times daily for 7 days. Guidelines recommend 1 g PO four times daily as an option; however, this must be combined with monitoring and the use of preemptive therapy when necessary. Thyroid hormones: (Moderate) Administer levothyroxine at least 4 hours apart from a dose of sucralfate. HIV prevention. Both emtricitabine and valacyclovir are excreted via the kidneys by a combination of glomerular filtration and active tubular secretion. This interaction can be minimized by staggering the doses of these agents as much as possible. Lansoprazole should be taken no less than 30 minutes before sucralfate if these drugs are to be used concomitantly. There were 756 pregnancies followed in women exposed to systemic acyclovir during the first trimester of pregnancy. However, the systemic exposure of the glucuronide metabolite of mycophenolate (MPAG) and of acyclovir was increased 10.6% and 21.9%, respectively. At least 30 minutes should elapse after an alendronate dose before taking aluminum-containing drugs. It is not intended to be a substitute for the exercise of professional judgment. Found inside â Page 17Tenofovir was also found to be safe during pregnancy as pregnancy category B. Dose: 300 mg once daily Advantages: High response rate, few side effects, oral administration, and usable in the third trimester of pregnancy Disadvantages: ... Digoxin: (Moderate) Sucralfate, because it contains aluminum in its structure and due to its mechanism of action, can bind with digoxin in the GI tract, reducing its bioavailability. Each 1 g tablet contains roughly 207 mg of aluminum. It binds to plasma protein in the range 13.5 to 17.9%. NOTE: Sucralfate can interfere with the absorption of other medications if administered concomitantly (see Drug Interactions). Oral administration of the related drug acyclovir has been studied in infants and children. Coadministration of tenofovir alafenamide with drugs that are eliminated by active tubular secretion may increase concentrations of tenofovir and/or the co-administered drug. This interaction appears to be the result of chelation by the aluminum content of sucralfate. Learn more about HCP and patient resources. Department of Health and Human Services. Talimogene laherparepvec is a live, attenuated herpes simplex virus that is sensitive to acyclovir; coadministration with antiviral agents may cause a decrease in efficacy.
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