Biktarvy (bictegravir/emtricitabine/tenofovir alafenamide) is a brand-name tablet prescribed for HIV. Biktarvy has interactions with some other drugs and certain supplements. Examples include ibuprofen and antacids.
Biktarvy is prescribed to treat HIV in certain adults and children.
An interaction occurs when one substance causes another substance to have a different effect than expected.
Keep reading for details about Biktarvy’s interactions and what you can’t take with Biktarvy. For additional information about Biktarvy, including details about its uses, see this article.
Sometimes, 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
Typically, doctors will not prescribe Biktarvy if you take dofetilide (Tikosyn) or rifampin (Rifadin).
Dofetilide is a medication used to treat arrhythmia (irregular heartbeat). 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 arrhythmia.
Rifampin is an antibiotic used for certain infections. Taking Biktarvy with rifampin can lower the level of bictegravir in your blood. (Bictegravir is one of the active ingredients 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 either of these contraindications apply to you. They can determine whether to prescribe Biktarvy.
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 “Drug interactions in depth” below.
Drug class or drug name | Drug examples | Interaction result with Biktarvy |
dofetilide (Tikosyn) | — | can increase the risk of side effects of dofetilide* |
sucralfate (Carafate) | — | can make Biktarvy less effective |
antimycobacterials | • rifampin (Rifadin)* • rifabutin (Mycobutin) • rifapentine (Priftin) | can make Biktarvy less effective |
certain anticonvulsants | • carbamazepine (Tegretol, Equetro, Carbatrol, others) • oxcarbazepine (Trileptal, Oxtellar XR) • phenobarbital • phenytoin (Dilantin, Phenytek) | can make Biktarvy less effective |
antacids | • aluminum hydroxide/magnesium trisilicate (Gaviscon) • aluminum hydroxide/magnesium hydroxide/simethicone (Mylanta maximum strength liquid antacid/anti-gas) • calcium carbonate/magnesium hydroxide (Rolaids) • calcium carbonate (TUMS) | can make Biktarvy less effective |
metformin (Riomet, Fortamet, Glumetza, also found in combination products) | — | can increase the risk of side effects of metformin |
aminoglycoside antibiotics | • gentamicin • tobramycin • amikacin | can increase the risk of side effects of Biktarvy and aminoglycoside antibiotics |
certain antivirals | • acyclovir (Zovirax) • ganciclovir • valacyclovir (Valtrex) • valganciclovir (Valcyte) • cidofovir | can increase the risk of side effects of Biktarvy and certain antivirals |
nonsteroidal anti-inflammatory drugs (NSAIDs) | • diclofenac (Zorvolex, Zipsor, Cataflam, others) • ibuprofen (Advil, Ibu-Tab, Motrin) • naproxen (Aleve, Naprosyn, Anaprox DS, others) | can increase the risk of side effects of Biktarvy and NSAIDs |
* For more information, see “When to avoid Biktarvy” above.
Here’s a closer look at certain drug interactions of Biktarvy.
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 ingredients 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:
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 of you taking an NSAID with Biktarvy, they’ll usually recommend the lowest possible dose of the NSAID. And they’ll likely monitor your kidney function during your treatment.
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.
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 ingredients 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, aluminum, 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 supplement containing magnesium or aluminum, 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 ingredients 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 can interact with some supplements, however, as noted above.
Biktarvy and food
Grapefruit and grapefruit juice can interact with Biktarvy. Grapefruit can increase the amount of Biktarvy in your system, which can increase your risk of side effects of the drug.
If you consume grapefruit, talk with your doctor about this before starting Biktarvy.
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 your healthcare professional know that you’re taking this medication.
Biktarvy and cannabis or CBDCannabis (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.
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.
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 possible symptoms of infection, 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 child who’s breastfed. 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.
Suicide prevention
If you know someone at immediate risk of self-harm, suicide, or hurting another person:
- Ask the tough question: “Are you considering suicide?”
- Listen to the person without judgment.
- Call 911 or the local emergency number, or text TALK to 741741 to communicate with a trained crisis counselor.
- Stay with the person until professional help arrives.
- Try to remove any weapons, medications, or other potentially harmful objects if it’s safe to do so.
If you or someone you know is having thoughts of suicide, a prevention hotline can help. The 988 Suicide and Crisis Lifeline is available 24 hours a day at 988. During a crisis, people who are hard of hearing can use their preferred relay service or dial 711 then 988.
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 use 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
If Biktarvy doesn’t come with paperwork, you can ask your pharmacist to print a copy. If you need help reading or understanding 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.
- Cost: For details about the cost of Biktarvy treatment, refer to 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 about how Biktarvy compares with Genvoya and Truvada.
- Reproductive health: To learn about Biktarvy and pregnancy, breastfeeding, and birth control, see this article.
- 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.