Bictegravir Drug Interactions – Three Important Ones To Know

Integrase inhibitors have become a mainstay in many HIV patients’ medication regimens. While this is a very important drug class in the management of HIV, one should be aware that there are numerous drug interactiosn to be aware of. In this post, I will lay out the most important bictegravir drug interactions you should know (maybe they will show up on one of your board exams?)

Bictegravir and Enzyme Inducers

The first of the important bictegravir drug interactions involves seizure medications. Many old seizure medications such as carbamazepine, phenytoin, and oxcarbazepine may reduce the concentrations of bictegravir which could lead to treatment failure.

In addition to these seizure medications, there are certainly others that can have enzyme induction properties and reduce the concentration of bictegravir. The supplement St. John’s Wort can have this effect. In addition, the antibiotic rifampin is a notorious enzyme inducer that may reduce the concentration of bictegravir.

Bictegravir Binding Drug Interactions

Calcium and iron are well known to bind to many oral medications. Bictegravir has this same potential concern. When calcium and iron are coadministered with bictegravir (especially in a fasting state), the result can be lower bictegravir concentrations. It is recommended to wait at least 2 hours after taking calcium or iron to avoid this bictegravir drug interaction. Many patients will typically alter the time of day that they take their calcium or iron to ensure that overlapping is not occurring.

Bictegravir Metformin Interaction

Bictegravir can impact diabetes management by increasing the concentrations of metformin. It does this by inhibiting MATE1/2-k. Patients taking bictegravir and metformin together should be monitored for an increased likelihood of metformin adverse effects such as diarrhea and the increased risk for lactic acidosis.

There you have it; my three most important bictegravir drug interactions! If you are looking for more on drug interactions, don’t hesitate to check out one of my most popular books on drug interactions in primary care.

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