Date of report 06 Feb 2020
Reported case interaction between
 Tenofovir-AF and CYCLOSPORINE

FLS Science

Drugs suspected to be involved in the DDI

Victim
Tenofovir-AF
Daily Dose
10 (mg)
Dose adjustment performed
Yes
Administration Route
Oral
Start date
Dec. 2, 2019
End date
Ongoing
Perpetrator
CYCLOSPORINE
Daily Dose
200 (mg)
Dose adjustment performed
No
Administration Route
Oral
Start date
Unknown
End date
Ongoing

Complete list of drugs taken by the patient

Antiretroviral treatment
Emtricitabine/Tenofovir-AF
Raltegravir
Complete list of all comedications taken by the patient, included that involved in the DDI

Cyclosporine, mycophenolic acid, prednisone

Clinical case description

Gender
Male
Age
31
eGFR (mL/min)
>60
Liver function impairment
No
Description

HIV infection diagnosed in November 2019. CD4 390 cells/mm3, HIV viarl load 95,000 copies/mL. Kidney transplant 20 years before, on treatment with cyclosporin, mycophenolic acid and prednisone. Antiretroviral treatment was started with TAF/FTC + Raltegravir. Since cyclosporin is a strong PgP inhibitor, TAF was dosed at 10 mg/daily, despite it was given in absence of any booster. The patient reached undetectable viral load after one month on treatment, thus the reduced dose of TAF maintained its efficacy.

Clinical Outcome

No unwanted outcome

Editorial Comment

Co-administration of ciclosporin, a potent P-gp inhibitor, is expected to increase plasma concentrations of tenofovir alafenamide. The recommended dose of Descovy is 200/10 mg once daily. (Descovy Summary of Product Characteristics, Gilead Sciences Ltd, April 2016.)

University of Liverpool Recommendation

Potential interaction - may require close monitoring, alteration of drug dosage or timing of administration
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