Biktarvy interactions: Alcohol, medications, and other factors

Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) is a brand-name prescription drug used to treat HIV in certain adults and children.

As with other medications, Biktarvy can interact with certain other drugs. It can also interact with some supplements. An interaction occurs when one substance causes another substance to have a different effect than expected.

For details about Biktarvy’s interactions, keep reading. For additional information about Biktarvy, including details about its uses, see this article.

In some cases, a factor or condition could prevent your doctor from prescribing Biktarvy due to the risk of harm. This is known as a contraindication. The contraindications of Biktarvy include:

Taking dofetilide or rifampin

If you take dofetilide (Tikosyn) or rifampin (Rifadin), doctors typically will not prescribe Biktarvy.

Dofetilide is a medication used to treat irregular heartbeats. Taking Biktarvy with dofetilide can raise the level of dofetilide in your blood. This can increase your risk of serious or life threatening side effects of dofetilide, such as new or worsened irregular heartbeats.

Rifampin is an antibiotic medication used to treat certain infections. Taking Biktarvy with rifampin can lower the level of bictegravir in your blood. (Bictegravir is one of the active drugs in Biktarvy.) This can make Biktarvy less effective at treating HIV.

If you take dofetilide or rifampin, you can ask your doctor about other treatments that may be better choices for you.

Note: Before you start treatment with Biktarvy, it’s important to tell your doctor if this contraindication applies to you. They can determine whether to prescribe Biktarvy.

Biktarvy hasn’t been reported to interact with alcohol. However, if you have certain side effects with Biktarvy, drinking alcohol could make them worse.* Examples of Biktarvy side effects that could be worsened by alcohol include headache, nausea, and diarrhea.

In addition, Biktarvy can sometimes cause liver problems. Drinking excessively can also cause liver problems. If you regularly drink large amounts of alcohol, this could increase your risk of liver problems with Biktarvy.

If you drink alcohol, talk with your doctor about how much, if any, is safe to consume while you’re taking Biktarvy.

* To learn more about Biktarvy’s side effects, see this article.

Before you start treatment with Biktarvy, tell your doctor and pharmacist which prescription, over-the-counter, and other medications you take. By sharing this information with them, you may help prevent possible interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist. They can advise you on whether certain medications are safe to take with Biktarvy.

Here’s a chart of drugs that can interact with Biktarvy. Keep in mind that this chart does not include all drugs that may interact with Biktarvy. Some of these interactions are described in detail just below in “Drug interactions in depth.”

* For more information, see “When to avoid Biktarvy” above.
† To learn more about Biktarvy’s side effects, see this article.

Here’s a closer look at certain drug interactions of Biktarvy.

Antacids

Antacids are medications that neutralize excess stomach acid. They’re used to treat indigestion and heartburn.

Interaction result. Taking Biktarvy with an antacid can make Biktarvy less effective than usual at treating HIV.

Interaction explained. Taking Biktarvy and an antacid at the same time of day can reduce how much Biktarvy your body absorbs. As a result, there won’t be enough Biktarvy in your body for it to be effective against HIV.

Examples of antacid drugs. Here are some antacids that may interact with Biktarvy:

• aluminum hydroxide/magnesium trisilicate (Gaviscon)
• aluminum hydroxide/magnesium hydroxide/simethicone (Mylanta maximum strength liquid antacid/anti-gas)
• calcium carbonate (TUMS)
• calcium carbonate/magnesium hydroxide (Rolaids)

Steps you or your doctor may take. You should take Biktarvy at least 2 hours before or 6 hours after taking an antacid that contains aluminum or magnesium.

You can take Biktarvy at the same time as an antacid that contains calcium. However, if you do, you should take Biktarvy with food.

If you have any questions or concerns about taking Biktarvy with antacids, talk with your doctor or pharmacist.

Nonsteroidal anti-inflammatory drugs (NSAIDs)

Medications called nonsteroidal anti-inflammatory drugs (NSAIDs) are used to help reduce inflammation and relieve pain.

Interaction result. Taking Biktarvy with an NSAID may increase your risk of kidney problems such as acute kidney failure.

Interaction explained. Biktarvy and NSAIDs can both cause kidney-related side effects. Taking these drugs together can make kidney side effects more likely to occur.

In addition, two of the active drugs in Biktarvy, emtricitabine and tenofovir alafenamide, are removed from your body by your kidneys. If you have kidney problems due to an NSAID, emtricitabine and tenofovir alafenamide may build up in your system. This can further increase the risk of kidney-related side effects with Biktarvy.

Examples of NSAIDs. Here are some NSAIDs that may interact with Biktarvy:

• diclofenac (Zorvolex, Zipsor, Cataflam, others)
• ibuprofen (Advil, Ibu-Tab, Motrin)
• naproxen (Aleve, Naprosyn, Anaprox DS, others)

Steps you or your doctor may take. You should not take an NSAID with Biktarvy unless your doctor recommends it. If you need a pain reliever while taking Biktarvy, ask your doctor or pharmacist to recommend a suitable medication. For example, they may suggest taking acetaminophen (Tylenol), as this doesn’t interact with Biktarvy.

If your doctor approves you taking an NSAID with Biktarvy, they’ll usually prescribe the lowest possible dose of the NSAID. And they’ll likely monitor your kidney function during your treatment.

Certain antivirals

Antivirals are drugs that treat infections caused by viruses. Biktarvy can interact with certain antivirals used to treat infections such as cold sores, genital herpes, shingles, chickenpox, and cytomegalovirus.

Interaction result. Taking Biktarvy with certain antivirals may increase your risk of kidney problems such as acute kidney failure.

Interaction explained. Biktarvy and certain antivirals can both affect your kidneys. Taking these drugs together can make kidney-related side effects more likely to occur.

In addition, two of the active drugs in Biktarvy, emtricitabine and tenofovir alafenamide, are removed from your body by your kidneys. If you have kidney problems from an antiviral, emtricitabine and tenofovir alafenamide may build up in your body. This can further increase the risk of kidney-related side effects with Biktarvy.

Examples of antiviral drugs. Here are some antiviral drugs that may interact with Biktarvy:

• acyclovir (Zovirax)
• ganciclovir
• valacyclovir (Valtrex)
• valganciclovir (Valcyte)
• cidofovir

Steps you or your doctor may take. While you’re taking Biktarvy, your doctor will usually avoid prescribing antivirals that can affect your kidneys unless no suitable alternatives are available. If you need to take one of these antivirals with Biktarvy, your doctor will likely prescribe the lowest possible dose. And they’ll usually monitor your kidney function while you take the drugs together.

Biktarvy may have other interactions, such as with supplements, foods, vaccines, or even lab tests. You’ll find details below. Keep in mind that the following information does not include all other possible interactions with Biktarvy.

Biktarvy interactions with supplements

Before you start treatment with Biktarvy, tell your doctor and pharmacist which supplements, herbs, and vitamins you take. By sharing this information with them, you may help prevent possible interactions.

Calcium, iron, and magnesium supplements

Taking Biktarvy with calcium, iron, or magnesium supplements can stop your body from absorbing Biktarvy correctly. This can make the drug less effective than usual at treating HIV.

If you need to take Biktarvy with a calcium or iron supplement, you can take them at the same time. If you do, you should take them with food.

If you need to take Biktarvy with a magnesium supplement, you should take Biktarvy at least 2 hours before or 6 hours after the magnesium supplement.

Your doctor and pharmacist can help address any questions or concerns you have about taking Biktarvy with supplements.

Biktarvy interactions with herbs

You should not take St. John’s wort during Biktarvy treatment.

Taking Biktarvy with St. John’s wort can speed up the removal of Biktarvy from your body. This can make Biktarvy less effective than usual at treating HIV. It can also allow HIV to develop resistance to the active drugs in Biktarvy. The term “resistance” means the virus is less sensitive to a drug or doesn’t respond to it. This can make HIV harder to treat with other medications.

If you’re taking St. John’s wort, talk with your doctor. They may be able to suggest a different treatment while you take Biktarvy.

Biktarvy and vitamins

There have been no specific reports of vitamins interacting with Biktarvy. However, it’s possible that interactions with vitamins could be recognized in the future. This is why it’s important to check with your doctor or pharmacist before taking any of these products during Biktarvy treatment.

Biktarvy and food

No food interactions have been reported with Biktarvy. If you’d like to learn more about eating certain foods during treatment with Biktarvy, talk with your doctor.

Biktarvy and vaccines

Vaccines were not reported to interact with Biktarvy. However, to be safe, it’s important to talk with your doctor or pharmacist before getting any vaccines while taking Biktarvy.

Biktarvy and lab tests

There have been no specific reports of Biktarvy affecting lab tests. However, if you have any lab tests during Biktarvy treatment, it’s still important to let the healthcare professional know that you’re taking this medication.

Biktarvy and cannabis or CBD

Cannabis (often called marijuana) and cannabis products, such as cannabidiol (CBD), have not been specifically reported to interact with Biktarvy. However, as with any drug or supplement, talk with your doctor before taking cannabis in combination with Biktarvy. The impact of cannabis may affect how well you stick to your Biktarvy treatment plan.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions and other factors may increase the risk of interactions with Biktarvy. Before you take this drug, be sure to talk with your doctor about your health history. Biktarvy may not be the right treatment option if you have certain medical conditions or other factors affecting your health.

Health conditions or factors that might interact with Biktarvy include the following.

Hepatitis B. If you have hepatitis B and stop taking Biktarvy, this could make hepatitis B worse. Biktarvy has a boxed warning for this risk. A boxed warning is the most serious warning from the Food and Drug Administration (FDA). See the boxed warning at the start of this article to learn more.

Liver problems. Biktarvy can sometimes cause and worsen liver problems. The drug isn’t recommended for people with severe liver problems. If you have a liver problem, talk with your doctor about whether Biktarvy is right for you.

Kidney problems. Biktarvy can sometimes affect the kidneys, causing problems such as acute kidney failure. If you already have a kidney problem, you may have an increased risk of kidney-related side effects with Biktarvy. These side effects could also worsen an existing kidney problem.

Biktarvy is not recommended for people with severe kidney problems. If you have a kidney problem, talk with your doctor about whether the drug is right for you.

Mental health conditions. On rare occasions, some people taking Biktarvy have had suicidal thoughts or actions. If you have a history of mental health conditions such as depression, you may have an increased risk of these side effects. Be sure to talk with your doctor about whether Biktarvy is right for you.

Past infections. HIV weakens your immune system. Taking Biktarvy to treat HIV can strengthen your immune system, and this can sometimes lead to immune reconstitution syndrome. This is a condition that can develop when your strengthened immune system reacts to past infections that may still be in your body.

If you’ve had past infections such as tuberculosis or cytomegalovirus, you can usually take Biktarvy. However, you should tell your doctor if you have symptoms of infections, such as fever or cough, during Biktarvy treatment. Your doctor may prescribe medication to treat them.

Pregnancy. It’s not known if Biktarvy is safe to take during pregnancy. However, if you have HIV and are pregnant, your doctor will usually recommend that you take medication to treat HIV. This significantly reduces the risk of passing HIV to your child. If you’re pregnant or planning to become pregnant, talk with your doctor about risks and benefits of taking Biktarvy.

Breastfeeding. If you have HIV, you should not breastfeed your child, regardless of the HIV treatment you use. HIV can pass into breast milk to a breastfed child. Your doctor can advise you on how to feed your child.

Allergic reaction. If you’ve had an allergic reaction to Biktarvy or any of its ingredients, your doctor will likely not prescribe this drug. Taking Biktarvy could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

You can take certain steps to help prevent interactions with Biktarvy. Your doctor and pharmacist are key resources, so reach out to them before starting treatment. For example, you should plan to do the following:

• Let them know if you drink alcohol or take cannabis.
• Tell them about any other medications you take, as well as any supplements, herbs, and vitamins.
• Create a medication list, which your doctor and pharmacist can help you fill out.

It’s also important to read Biktarvy’s label and other paperwork that may come with the drug. The label may have colored stickers that mention an interaction. And the paperwork, sometimes called the medication guide or patient package insert, may contain details about interactions. (If Biktarvy doesn’t come with paperwork, you can ask your pharmacist to print a copy.) If you have questions about this information, ask your doctor or pharmacist.

You can also help prevent interactions with Biktarvy by taking it exactly as your doctor prescribes.

Besides learning about interactions, you may want to find out more about Biktarvy. These resources might help:

• Overview of Biktarvy. For a general overview of Biktarvy, you can see this article.
• Side effects. If you’re interested in the side effects of Biktarvy, see this article. Another option is to refer to the Biktarvy prescribing information.
• Dosage specifics. To learn about the dosage of Biktarvy, see this article.
• Drug comparison. Find information abouthow Biktarvy compares with Genvoya and Truvada.
• Facts about HIV. To learn more about HIV, see our hub on the topic.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.