PIFELTRO™ (doravirine 100 mg) tablets and DELSTRIGO™ (doravirine 100 mg/lamivudine 300 mg/tenofovir disoproxil fumarate 300 mg) tablets

 

Drug Interactions

Select contraindicationsa

  PIFELTRO + 2 NRTIs DELSTRIGO
  • Androgen receptors
  • Enzalutamideb
  • Anticonvulsants
  • Carbamazepine, oxcarbazepine,
  • phenobarbital, phenytoinb
  • Antimycobacterials
  • Rifampin,b,c rifapentineb
  • Cytotoxic agents
  • Mitotaneb
  • Herbal products
  • St. John’s wortb

Co-administration of PIFELTRO or DELSTRIGO with a CYP3A inducer decreases doravirine plasma concentrations, which may reduce the effectiveness of PIFELTRO and DELSTRIGO.

  • (a) This table is not all-inclusive.
  • (b) At least a 4-week cessation period is recommended prior to initiation of PIFELTRO or DELSTRIGO.
  • (c) The interaction between doravirine and the concomitant drug was evaluated in a clinical study. All other drug-drug interactions shown are anticipated based on the known metabolic and elimination pathways.

Doravirine can be used with many common medications

  PIFELTRO + 2 NRTIs DELSTRIGO
  • Acid-modifying medications
  • Aluminum hydroxide/magnesium
  • hydroxide/simethicone-
  • containing antacids
  • Antifungals
  • Ketoconazole
  • Antihyperglycemics
  • Metformin
  • Antimycobacterials
  • Rifabutind
  • Benzodiazepines
  • Midazolam
  • Hepatitis C antiviral agents
  • Elbasvir/grazoprevir
  • Ledipasvir/sofosbuvir
  • Sofosbuvir/velpatasvir
NOT STUDIED
  • HIV antiviral agents
  • TDF, lamivudine, ritonavir,
  • dolutegravir
NOT STUDIED
  • Efavirenz,h etravirine, nevirapine
NOT RECOMMENDED NOT STUDIED
  • Opioid analgesics
  • Methadone
  • Oral contraceptives
  • Ethinyl estradiol, levonorgestrel
  • Proton pump inhibitors
  • Pantoprazole
  • Statins
  • Atorvastatin
  • Other agents
  • Sorbitol
NOT STUDIED AVOID USEi
  • (d) The interaction between doravirine and the concomitant drug was evaluated in a clinical study. All other drug-drug interactions shown are anticipated based on the known metabolic and elimination pathways.
  • (e) Increase PIFELTRO dosage to one tablet twice daily when co-administered with rifabutin.
  • (f) If DELSTRIGO is co-administered with rifabutin, one tablet of doravirine (PIFELTRO) should be taken approximately 12 hours after the dose of DELSTRIGO.
  • (g) Monitor for adverse reactions associated with TDF.
  • (h) The interaction between PIFELTRO and the concomitant drug was evaluated in a clinical study. All other drug-drug interactions shown are anticipated based on the known metabolic and elimination pathways.
  • (i) Co-administration of single doses of lamivudine and sorbitol resulted in a sorbitol dose-dependent reduction in lamivudine exposures.

Definitions

  • CYP3A = cytochrome P450 3A
  • HIV = human immunodeficiency virus
  • NRTI = nucleoside reverse transcriptase inhibitor
  • TDF = tenofovir disoproxil fumarate
 

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Indications

Indications for PIFELTRO and DELSTRIGO:

PIFELTRO is indicated in combination with other antiretroviral (ARV) agents for the treatment of HIV-1 infection in adult patients with no prior ARV treatment history or to replace the current ARV regimen in those who are virologically suppressed (HIV-1 RNA less than 50 copies per mL) on a stable ARV regimen with no history of treatment failure and no known substitutions associated with resistance to doravirine.

DELSTRIGO is indicated as a complete regimen for the treatment of HIV-1 infection in adult patients with no prior ARV treatment history or to replace the current ARV regimen in those who are virologically suppressed (HIV-1 RNA less than 50 copies per mL) on a stable ARV regimen with no history of treatment failure and no known substitutions associated with resistance to the individual components of DELSTRIGO.

US-DOR-00197 02/20

Selected Safety Information

Warning: Posttreatment Acute Exacerbation of Hepatitis B (HBV)

All patients with HIV-1 should be tested for the presence of HBV before initiating ARV therapy. Severe acute exacerbations of HBV have been reported in patients who are coinfected with HIV-1 and HBV and have discontinued products containing lamivudine or tenofovir disoproxil fumarate (TDF), which are components of DELSTRIGO. Patients coinfected with HIV-1 and HBV who discontinue DELSTRIGO should be monitored with both clinical and laboratory follow-up for at least several months after stopping DELSTRIGO. If appropriate, initiation of anti-HBV therapy may be warranted.

  • PIFELTRO and DELSTRIGO are contraindicated when co-administered with drugs that are strong cytochrome P450 (CYP)3A enzyme inducers (including the anticonvulsants carbamazepine, oxcarbazepine, phenobarbital, and phenytoin; the androgen receptor inhibitor enzalutamide; the antimycobacterials rifampin and rifapentine; the cytotoxic agent mitotane; and the herbal product St. John’s wort (Hypericum perforatum)), as significant decreases in doravirine plasma concentrations may occur, which may decrease the effectiveness of DELSTRIGO and PIFELTRO.
  • DELSTRIGO is contraindicated in patients with a previous hypersensitivity reaction to lamivudine.
  • Renal impairment, including cases of acute renal failure and Fanconi syndrome, have been reported with the use of TDF. DELSTRIGO should be avoided with concurrent or recent use of a nephrotoxic agent (eg, high-dose or multiple NSAIDs). Cases of acute renal failure after initiation of high-dose or multiple NSAIDs have been reported in patients with risk factors for renal dysfunction who appeared stable on TDF.
  • Prior to or when initiating DELSTRIGO, and during treatment, assess serum creatinine, estimated creatinine clearance, urine glucose, and urine protein in all patients. In patients with chronic kidney disease, also assess serum phosphorus. Discontinue DELSTRIGO in patients who develop clinically significant decreases in renal function or evidence of Fanconi syndrome. Discontinue DELSTRIGO if estimated creatinine clearance declines below 50 mL/min.
  • In clinical trials in HIV-1 infected adults, TDF was associated with slightly greater decreases in bone mineral density (BMD) and increases in biochemical markers of bone metabolism. Serum parathyroid hormone levels and 1,25 Vitamin D levels were also higher. Cases of osteomalacia associated with proximal renal tubulopathy have been reported with the use of TDF.
  • Immune reconstitution syndrome can occur, including the occurrence of autoimmune disorders with variable time to onset, which may necessitate further evaluation and treatment.
  • Because DELSTRIGO is a complete regimen, co-administration with other antiretroviral medications for the treatment of HIV-1 infection is not recommended.
  • Co-administration of PIFELTRO with efavirenz, etravirine, or nevirapine is not recommended.
  • If DELSTRIGO is co-administered with rifabutin, take one tablet of DELSTRIGO once daily, followed by one tablet of doravirine (PIFELTRO) approximately 12 hours after the dose of DELSTRIGO.
  • If PIFELTRO is co-administered with rifabutin, increase PIFELTRO dosage to one tablet twice daily (approximately 12 hours apart).
  • Consult the full Prescribing Information prior to and during treatment for more information on potential drug-drug interactions.
  • Because DELSTRIGO is a fixed-dose combination tablet and the dosage of lamivudine and TDF cannot be adjusted, DELSTRIGO is not recommended in patients with estimated creatinine clearance less than 50 mL/min.
  • The most common adverse reactions with DELSTRIGO (incidence ≥5%, all intensities) were dizziness (7%), nausea (5%), and abnormal dreams (5%). The most common adverse reactions with PIFELTRO (incidence ≥5%, all intensities) were nausea (7%), dizziness (7%), headache (6%), fatigue (6%), diarrhea (6%), abdominal pain (5%), and abnormal dreams (5%).
  • The safety of DELSTRIGO in virologically-suppressed adults was based on Week 48 data from subjects in the DRIVE-SHIFT trial. Overall, the safety profile in virologically-suppressed adult subjects was similar to that in subjects with no ARV treatment history.
  • Serum ALT and AST Elevations: In the DRIVE-SHIFT trial, 22% and 16% of subjects in the immediate switch group experienced ALT and AST elevations greater than 1.25 X ULN, respectively, through 48 weeks on DELSTRIGO. For these ALT and AST elevations, no apparent patterns with regard to time to onset relative to switch were observed. One percent of subjects had ALT or AST elevations greater than 5 X ULN through 48 weeks on DELSTRIGO. The ALT and AST elevations were generally asymptomatic, and not associated with bilirubin elevations. In comparison, 4% and 4% of subjects in the delayed switch group experienced ALT and AST elevations of greater than 1.25 X ULN through 24 weeks on their baseline regimen.
  • There is a pregnancy exposure registry that monitors pregnancy outcomes in individuals exposed to PIFELTRO or DELSTRIGO during pregnancy. Healthcare providers are encouraged to register patients by calling the Antiretroviral Pregnancy Registry (APR) at 1-800-258-4263.
  • Mothers infected with HIV-1 should be instructed not to breastfeed if they are receiving PIFELTRO or DELSTRIGO due to the potential for HIV-1 transmission.

Before prescribing PIFELTRO, please read the accompanying Prescribing Information. The Patient Information also is available. Before prescribing DELSTRIGO, please read the accompanying Prescribing Information, including the Boxed Warning about posttreatment acute exacerbation of Hepatitis B. The Patient Information also is available.

US-DOR-0061104/20