Date of report 31 Oct 2023

Reported case interaction between
Bictegravir and Oxcarbazepine

The case describes the potential interaction between BIC/FTC/TAF and oxcarbazepine, an enzyme inducer that could reduce TAF and BIC levels, with the consequent risk of virologic failure and development of resistance mutations. The use of oxcarbazepine in HIV patients complicates ART selection, as its inducing effect may affect PI, INSTI, NNRTI and TAF. Alternatives may include darunavir boosted with ritonavir or other antiepileptic drugs.

This case is useful to highlight that the risk of drug-drug interactions should always be assessed when starting a new medication. Also that we should raise awareness among emergency and primary care physicians to use tools (e.g. Liverpool website) to rule out possible interactions.

Another aspect to keep in mind is to change antiepileptic treatment in a stable patient to avoid interactions with ART, especially in post-exposure prophylaxis. In some patients, finding the right drug and dose of antiepileptic drugs can be complex and the consequences of having a seizure after switching medication is potentially dangerous. In this case, oxcarbazepine was switched to levetiracetam, without subsequent seizures being reported.