Limit alcoholic beverages. Skipping or changing your dose without approval from your doctor may cause the amount of virus to increase, make the infection more difficult to treat (resistant), or worsen side effects.For the best effect, take this medication at evenly spaced times. Management: Avoid concomitant use of opioid agonists and benzodiazepines or other CNS depressants when possible. Management: Seek alternatives to the CYP3A4 substrate when possible.
If an atypical antipsychotic is necessary, consider using clozapine, quetiapine, or ziprasidone at lower initial doses, or a non-dopamine antagonist (eg, pimavanserin).Aprepitant: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors).Azelastine (Nasal): CNS Depressants may enhance the CNS depressant effect of Azelastine (Nasal). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined. Use with caution in patients at risk for aspiration pneumonia (ie, Alzheimer disease), particularly in patients >75 years of age (Herzig 2017; Maddalena 2004).• Extrapyramidal symptoms: May cause extrapyramidal symptoms (EPS), including pseudoparkinsonism, acute dystonic reactions, akathisia, and tardive dyskinesia (risk of these reactions is generally much lower relative to typical/conventional antipsychotics; frequencies reported are similar to placebo). Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined.

Management: Monitor for QTc interval prolongation and ventricular arrhythmias when these agents are combined.

Kaiser Permanente health plans around the country: Kaiser Foundation Health Plan, Inc., in Northern and Southern California and Hawaii • Kaiser Foundation Health Plan of Colorado • Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305, 404-364-7000 • Kaiser Foundation Health Plan of the Mid-Atlantic States, Inc., in Maryland, Virginia, and Washington, D.C., 2101 E. Jefferson St., Rockville, MD 20852 • Kaiser Foundation Health Plan of the Northwest, 500 NE Multnomah St., Suite 100, Portland, OR 97232 • Kaiser Foundation Health Plan of Washington or Kaiser Foundation Health Plan of Washington Options, Inc., 601 Union St., Suite 3100, Seattle, WA 98101 Unless otherwise noted, frequency of adverse effects is reported for adult patients; spectrum and incidence of adverse effects similar in children (with significant exceptions noted).Cardiovascular: Increased diastolic blood pressure (≥10 mm Hg; children and adolescents: 41% to 47%), increased systolic blood pressure (≥20 mm Hg; children and adolescents: 7% to 15%), tachycardia (1% to 11%)Endocrine & metabolic: Decreased HDL cholesterol (≤40 mg/dL: 9% to 20%), hyperglycemia (≥200 mg/dL post glucose challenge or fasting glucose ≥126 mg/dL: 2% to 3%), increased LDL cholesterol (≥160 mg/dL: 4% to 8%), increased serum triglycerides (≥200 mg/dL: 8% to 22%), total cholesterol increased (≥240 mg/dL: 7% to 18%), weight gain (dose related; 4% to 28%)Gastrointestinal: Constipation (2% to 11%), increased appetite (2% to 12%), xerostomia (adults: 9% to 44%; children and adolescents: 4% to 10%)Hematologic & oncologic: Decreased hemoglobin (8% to 11%)Nervous system: Agitation (6% to 20%), dizziness (7% to 19%), drowsiness (16% to 57%), extrapyramidal reaction (1% to 13%), fatigue (3% to 14%), headache (17% to 21%), withdrawal syndrome (12%)Cardiovascular: Hypertension (2%), hypotension (3%), increased heart rate (1% to 9%), orthostatic hypotension (adults: 2% to 7%; children and adolescents: <1%), palpitations (4%), peripheral edema (4%), syncope (1% to 2%)Dermatologic: Acne vulgaris (children and adolescents: 2% to 3%), diaphoresis (2%), hyperhidrosis (2%), pallor (children and adolescents: 1% to 2%), skin rash (4%)Endocrine & metabolic: Decreased libido (≤2%), hyperprolactinemia (4%), hypothyroidism (≤2%), increased thirst (children and adolescents: 2%)Gastrointestinal: Abdominal pain (1% to 7%), anorexia (1% to 3%), decreased appetite (2%), diarrhea (children and adolescents: 5%), dyspepsia (2% to 7%), dysphagia (2%), gastroenteritis (2%), gastroesophageal reflux disease (2%), nausea (5% to 10%), periodontal abscess (adolescents: 1% to 3%), toothache (2% to 3%), viral gastroenteritis (4%), vomiting (3% to 8%)Genitourinary: Pollakiuria (2%), urinary tract infection (2%)Hematologic & oncologic: Leukopenia (≥1%), neutropenia (≤2%)Hepatic: Increased serum alanine aminotransferase (5%), increased serum aspartate aminotransferase (3%), increased serum transaminases (1% to 6%)Nervous system: Abnormal dreams (2% to 3%), abnormality in thinking (2%), aggressive behavior (children and adolescents: 1% to 3%), akathisia (1% to 5%), anxiety (2% to 4%), ataxia (2%), confusion (2%), decreased mental acuity (2%), depression (2% to 3%), disorientation (2%), disturbance in attention (2%), drug-induced Parkinson's disease (≤6%), dysarthria (2% to 5%), dystonic reaction (1% to 3%), falling (2%), hypersomnia (2% to 3%), hypertonia (4%), hypoesthesia (2%), irritability (3% to 5%), lack of concentration (2%), lethargy (2% to 5%), migraine (2%), pain (7%), paresthesia (2% to 3%), restless leg syndrome (2%), restlessness (2%), twitching (4%), vertigo (2%)Neuromuscular & skeletal: Arthralgia (1% to 4%), asthenia (1% to 10%), back pain (1% to 5%), dyskinesia (3% to 4%), limb pain (2%), muscle rigidity (3%), muscle spasm (2% to 3%), myalgia (2%), neck pain (2%), stiffness (children and adolescents: 3%), tremor (2% to 8%)Ophthalmic: Amblyopia (2% to 3%), blurred vision (2% to 4%)Respiratory: Cough (1% to 3%), dyspnea (1% to 3%), epistaxis (adolescents: 3%), nasal congestion (3% to 6%), paranasal sinus congestion (2% to 3%), pharyngitis (4% to 6%), rhinitis (3% to 4%), sinus headache (2%), sinusitis (2%), upper respiratory tract infection (3%)Frequency not defined: Nervous system: Suicidal ideation, suicidal tendenciesCardiovascular: Cardiomyopathy, colonic ischemia, myocarditis, prolonged QT interval on ECGDermatologic: Acute generalized exanthematous pustulosis, Stevens-Johnson syndrome, toxic epidermal necrolysisEndocrine & metabolic: Hyponatremia, ketoacidosis, SIADHGastrointestinal: Intestinal obstruction, pancreatitisHematologic & oncologic: Agranulocytosis, decreased platelet countHepatic: Hepatic failure, hepatic necrosis, hepatitisImmunologic: Drug reaction with eosinophilia and systemic symptomsNervous system: Diabetes mellitus with hyperosmolar coma, neuroleptic malignant syndrome, retrograde amnesia, sleep apnea, tardive dyskinesiaRespiratory: Obstructive sleep apnea syndrome (Health Canada 2016; Shirani 2011)Elderly patients with dementia-related psychosis treated with antipsychotic drugs are at an increased risk of death.
Diclofenac (Systemic): May enhance the nephrotoxic effect of Tenofovir Products. To decrease your risk of spreading HIV disease to others, do all of the following: (1) continue to take all HIV medications exactly as prescribed by your doctor, (2) always use an effective barrier method (latex or polyurethane Read the Patient Information Leaflet if available from your It is very important to keep taking this medication (and other For the best effect, take this medication at evenly spaced times. A dose of 600 mg/kg/day is equivalent to 19 times the human dose based on body surface area comparisons. PIFELTRO™ (doravirine 100 mg) tablets and DELSTRIGO™ (doravirine 100 mg/lamivudine 300 mg/tenofovir disoproxil fumarate 300 mg) tablets Close Indications Swallow tablet whole; do not break, crush, or chew.Bariatric surgery: Some institutions may have specific protocols that conflict with these recommendations; refer to institutional protocols as appropriate. Acute renal failure has occurred in HIV-infected patients with risk factors for renal impairment who were on a stable tenofovir disoproxil fumarate regimen to which a high dose or multiple NSAID therapy was added.

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