- Risk of interactions if the antiretroviral treatment includes drugs with pharmacokinetic boosters like cobicistat or ritonavir
- Risk of overexposure to hydroxychloroquine and resulting QT prolongation when combined with ritonavir or cobicistat boosters
- Association of rilpivirine with hydroxychloroquine ot lopinavir/r may cause QT prolongation
- The combination of lopinavir/r and bictegravir is not recommended 
- Some non nucleoside reverse transcriptase inhibitor may induce 	CYP3A4 decreasing lopinavir and hydroxychloroquine exposure

Antiretrovirals

- Due to the association of sofosbuvir with brutal bradycardia, use in combination with hydroxychloroquine is risky
- Voxilaprevir is an inhibitor of intestinal CYP3A4 and can increase hydroxychloroquine exposure
- Glecaprevir/pibrentasvir is a weak inhibitor of CYP3A4 and may lead to hydroxychloroquine accumulation
- Lopinavir/r may increase voxilaprevir exposure by inhibiting OATP1B1, CYP3A4 and P-gp so the combination is not recommended
- Combination of lopinavir/r and glecaprevir/pibrentasvir bi therapy is not recommended due to risk of increasing the exposure of glecaprevir by a factor of 4.5

Viral Hepatitis B and C Drugs

- Therapeutic drug monitoring needed for combinations of rifampicin with lopinavir or hydroxychloroquine
- Rifampicin reduces exposure to remdesivir, co administration is not recommended
- Take caution with co-administration of of hydroxychloroquine and ethambutol due to risk of ocular side effects
- Increased risk of torsades de pointes in combinations of hydroxychloroquine and QT prolonging anti-tuberculosis drugs like moxifloxacin, delamanid, and bedaquiline

Anti-tuberculosis Drugs

- Antiretrovirals
- Viral Hepatitis B and C Drugs
- Anti-tuberculosis Drugs

Rutgers University

- antipyretics and analgesics
- drugs in cardiovascular diseases
- drugs in infectious diseases
- anti cancer drugs
- drugs in transplantation and autoimmune diseases
- drugs in neuropsychiatric diseases
- drugs in respiratory diseases

Assessment and Management of the Risk of Drug-Drug Interactions with Other Widely Used Drugs

- Anticancer treatment must be suspended for patients with COVID-19 in ICU
- Highly cytotoxic chemotherapy should be avoided in COVID-19 infection
- Possible additive cardiotoxicity between protein kinase inhibitors and hydroxychloroquine, azithromycin or lopinavir
- Many anticancer drugs can inhibit or induce CYPs which can change the bioavailability or elimination of lopinavir/r, hydroxychloroquine, favipiravir, or remdesivir

Anti-Cancer drugs: cytotoxic, targeted therapy

- When co-administered with hydroxychloroquine, calcineurin inhibitors and m-TOR inhibitors can cause QT prolongation
- Increased exposure of hydroxychloroquine with ciclosporin
- Must reduce dose of lopinavir/r with immunosuppressants due to its strong inhibition of CYP3A, OATP1B1, and OATP1B3 to prevent nephrotoxicity and neurotoxicity  
- Therapeutic drug monitoring needed in combination with lopinavir/r
- Baricitinib may increase immunosuppression in combination with immunosuppressants 
- Combination of anakinra and methotrexate or TNF-alpha not recommended 

Drugs in organ transplantation and autoimmune disease

Antidepressants:
- Do not combine citalopram or escitalopram with hydroxychloroquine due to risk of torsades de pointes by increasing the QT interval

Anxiolytics:
- Use of hydroxyzine with hydroxychloroquine is contraindicated due to the torsadogenic risk

Antipsychotics:
- Increased torsadogenic potential of most neuroleptics with hydroxychloroquine but combination not contraindicated

Addiction medication:
- Methadone not recommended with hydroxychloroquine due to dose dependent cardiotoxicity like torsades de pointes

Anti migraines:
- Use of azithromycin is contraindicated with ergot derivatives, ergotamine and dihydroergotamine

Antiepileptics: 
- Risk of interactions from old anticonvulsants including but not limited to phenytoin and phenobarbital due to enzyme inducing effects

Drugs in neuropsychiatric diseases

Anti-asthmatics:
- Ritonavir was show to increase the plasma exposure of fluticasone by more than 100 times and thus this combination should be avoided
- Strong CYP3A4 inhibitors like lopinavir/r can increase exposure of budesonide and salmeterol
- Increased salmeterol exposure can lead to QT prolongation and palpitations
- Theophylline exposure may be altered by lopinavir/r so both must be used with caution

Drugs in respiratory diseases

- Paracetamol
- NSAIDs
- Opioid Analgesics 

Antipyretics and Analgesics

- Anticoagulants and antiplatelet drugs
- Lipid lowering drugs
- Anti-hypertensives
- Drugs in heart failure
- Drugs in angina pectoris
- Anti-arrhythmic drugs
- Oral anti-diabetics

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