Sunlenca

Overview

lenacapavir

HIV capsid inhibitor

• CYP3A4 substrate
• UGT1A1 substrate
• P-gp substrate
• CYP3A4 inhibitor, moderate
• BCRP inhibitor
• P-gp inhibitor, weak
• affected by altered fat absorption

Contraindicated

• apalutamide
Sunlenca (lenacapavir)

+

apalutamide

1 interaction

Contraindicated

lenacapavir + apalutamide

contraindicated: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced, P-gp-mediated transport induced, UGT possibly induced)

• butalbital
Sunlenca (lenacapavir)

+

butalbital

1 interaction

Contraindicated

lenacapavir + butalbital

contraindicated: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced, UGT induced)

• carbamazepine
Sunlenca (lenacapavir)

+

carbamazepine

1 interaction

Contraindicated

lenacapavir + carbamazepine

contraindicated: combo may decr. lenacapavir levels, efficacy; may incr. carbamazepine levels, risk of adverse effects x9mo after lenacapavir tx (hepatic metab. induced, UGT induced, P-gp-mediated transport induced; hepatic metab. inhibited)

• cisapride
Sunlenca (lenacapavir)

+

cisapride

1 interaction

Contraindicated

lenacapavir + cisapride

contraindicated during and x9mo after lenacapavir tx: combo may incr. cisapride levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• colchicine
Sunlenca (lenacapavir)

+

colchicine

1 interaction

Contraindicated

lenacapavir + colchicine

CV RISK REDUCTION: avoid combo if renal or hepatic impairment; otherwise, monitor CK, myopathy s/sx; GOUT or FMF: contraindicated if renal or hepatic impairment; otherwise, use alternative or decr. colchicine dose during and x9mo after lenacapavir use as follows: GOUT PROPHYLAXIS: give colchicine 0.3-0.6 mg/day divided qd-bid; ACUTE GOUT: avoid combo if receiving colchicine for prophylaxis; otherwise, give colchicine 1.2 mg x1 only; FMF: decr. max colchicine dose to 1.2 mg/day divided qd-bid: combo may incr. colchicine levels, risk of myopathy, rhabdomyolysis, other life-threatening toxicity (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• eliglustat
Sunlenca (lenacapavir)

+

eliglustat

1 interaction

Contraindicated

lenacapavir + eliglustat

during and x9mo after lenacapavir tx: CYP2D6 EM: contraindicated if also combined w/ moderate or strong CYP2D6 inhibitor; otherwise, monitor ECG; decr. eliglustat dose to 84 mg qd; CYP2D6 IM: contraindicated if also combined w/ moderate or strong CYP2D6 inhibitor; otherwise, avoid combo; CYP2D6 PM: avoid combo: combo may incr. eliglustat levels, risk of PR or QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• encorafenib
Sunlenca (lenacapavir)

+

encorafenib

1 interaction

Contraindicated

lenacapavir + encorafenib

contraindicated: combo may decr. lenacapavir levels, efficacy; may incr. encorafenib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. induced; hepatic metab. inhibited)

• enzalutamide
Sunlenca (lenacapavir)

+

enzalutamide

1 interaction

Contraindicated

lenacapavir + enzalutamide

contraindicated: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced)

• flibanserin
Sunlenca (lenacapavir)

+

flibanserin

1 interaction

Contraindicated

lenacapavir + flibanserin

contraindicated w/in 14 days prior to, during flibanserin tx and x9mo after lenacapavir tx: combo may incr. flibanserin levels, risk of CNS depression, psychomotor impairment, severe hypotension (incl. syncope), other adverse effects (hepatic metab. inhibited)

• fosphenytoin
Sunlenca (lenacapavir)

+

fosphenytoin

1 interaction

Contraindicated

lenacapavir + fosphenytoin

contraindicated: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced, UGT induced, P-gp-mediated transport induced)

• ivosidenib
Sunlenca (lenacapavir)

+

ivosidenib

1 interaction

Contraindicated

lenacapavir + ivosidenib

contraindicated: combo may decr. lenacapavir levels, efficacy; may incr. ivosidenib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects x9mo after lenacapavir tx (hepatic metab. induced; hepatic metab. inhibited)

• lomitapide
Sunlenca (lenacapavir)

+

lomitapide

1 interaction

Contraindicated

lenacapavir + lomitapide

contraindicated during and x9mo after lenacapavir tx: combo may incr. lomitapide levels, risk of adverse effects (hepatic metab. inhibited)

• lumacaftor/ivacaftor
Sunlenca (lenacapavir)

+

lumacaftor/ ivacaftor

1 interaction

Contraindicated

lenacapavir + lumacaftor/ ivacaftor

contraindicated: combo may decr. lenacapavir levels, efficacy; may incr. ivacaftor levels, risk of adverse effects x9mo after lenacapavir tx (hepatic metab. induced, P-gp-mediated transport possibly induced; hepatic metab. inhibited)

• mitotane
Sunlenca (lenacapavir)

+

mitotane

1 interaction

Contraindicated

lenacapavir + mitotane

contraindicated: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced)

• pentobarbital
Sunlenca (lenacapavir)

+

pentobarbital

1 interaction

Contraindicated

lenacapavir + pentobarbital

contraindicated: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced, UGT induced)

• phenytoin
Sunlenca (lenacapavir)

+

phenytoin

1 interaction

Contraindicated

lenacapavir + phenytoin

contraindicated: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced, UGT induced, P-gp-mediated transport induced)

• primidone
Sunlenca (lenacapavir)

+

primidone

1 interaction

Contraindicated

lenacapavir + primidone

contraindicated: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced, UGT induced, P-gp-mediated transport possibly induced)

• rifampin
Sunlenca (lenacapavir)

+

rifampin

1 interaction

Contraindicated

lenacapavir + rifampin

contraindicated: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced, UGT induced, P-gp-mediated transport induced)

• St. John's wort
Sunlenca (lenacapavir)

+

St. John's wort

1 interaction

Contraindicated

lenacapavir + St. John's wort

contraindicated: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced, P-gp-mediated transport induced)

Avoid/Use Alternative

• adagrasib
Sunlenca (lenacapavir)

+

adagrasib

1 interaction

Avoid/Use Alternative

lenacapavir + adagrasib

avoid combo if also combined w/ UGT1A1 inhibitor; otherwise, monitor ECG, electrolytes until adagrasib at steady state (approx. 8 days): combo may incr. adagrasib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects; may incr. lenacapavir levels, risk of adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• alfentanil
Sunlenca (lenacapavir)

+

alfentanil

1 interaction

Avoid/Use Alternative

lenacapavir + alfentanil

use alternative or monitor resp. rate; consider decr. alfentanil dose during and x9mo after lenacapavir tx: combo may incr. alfentanil levels, risk of CNS and resp. depression, psychomotor impairment, delayed recovery from anesthesia, other adverse effects (hepatic metab. inhibited)

• alpelisib
Sunlenca (lenacapavir)

+

alpelisib

1 interaction

Avoid/Use Alternative

lenacapavir + alpelisib

use alternative: combo may incr. alpelisib levels, risk of adverse effects (BCRP-mediated transport possibly inhibited)

• alprazolam
Sunlenca (lenacapavir)

+

alprazolam

1 interaction

Avoid/Use Alternative

lenacapavir + alprazolam

use alternative or monitor resp. rate; consider decr. alprazolam dose during and x9mo after lenacapavir tx: combo may incr. alprazolam levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited)

• amiodarone
Sunlenca (lenacapavir)

+

amiodarone

1 interaction

Avoid/Use Alternative

lenacapavir + amiodarone

use alternative or monitor ECG during and x9mo after lenacapavir tx: combo may incr. levels of both drugs, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• aprepitant
Sunlenca (lenacapavir)

+

aprepitant

1 interaction

Avoid/Use Alternative

lenacapavir + aprepitant

avoid combo w/ oral aprepitant during and x9mo after lenacapavir tx; IV aprepitant use OK: combo may incr. aprepitant levels, risk of adverse effects (hepatic metab. inhibited)

• atazanavir
Sunlenca (lenacapavir)

+

atazanavir

1 interaction

Avoid/Use Alternative

lenacapavir + atazanavir

avoid combo if atazanavir boosted w/ cobicistat or ritonavir: combo may incr. lenacapavir levels, risk of adverse effects (hepatic metab. inhibited, UGT inhibited)

• avapritinib
Sunlenca (lenacapavir)

+

avapritinib

1 interaction

Avoid/Use Alternative

lenacapavir + avapritinib

GIST: use alternative or monitor bleeding s/sx; decr. avapritinib start dose to 100 mg qd during and x9mo after lenacapavir tx; ADVANCED SYSTEMIC MASTOCYTOSIS: use alternative or monitor bleeding s/sx; decr. avapritinib start dose to 50 mg qd during and x9mo after lenacapavir tx; INDOLENT SYSTEMIC MASTOCYTOSIS: avoid combo during and x9mo after lenacapavir tx: combo may incr. avapritinib levels, risk of bleeding (incl. life-threatening), other adverse effects (hepatic metab. inhibited)

• azithromycin
Sunlenca (lenacapavir)

+

azithromycin

1 interaction

Avoid/Use Alternative

lenacapavir + azithromycin

avoid combo if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (P-gp-mediated transport inhibited)

• belumosudil
Sunlenca (lenacapavir)

+

belumosudil

1 interaction

Avoid/Use Alternative

lenacapavir + belumosudil

avoid combo if also combined w/ strong CYP3A4 inhibitor; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (UGT inhibited, P-gp-mediated transport inhibited)

• bisoprolol
Sunlenca (lenacapavir)

+

bisoprolol

1 interaction

Avoid/Use Alternative

lenacapavir + bisoprolol

avoid combo if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (P-gp-mediated transport inhibited)

• bosentan
Sunlenca (lenacapavir)

+

bosentan

1 interaction

Avoid/Use Alternative

lenacapavir + bosentan

avoid combo: combo may decr. lenacapavir levels, efficacy; may incr. bosentan levels, risk of adverse effects x9mo after lenacapavir tx (hepatic metab. induced; hepatic metab. inhibited)

• bosutinib
Sunlenca (lenacapavir)

+

bosutinib

1 interaction

Avoid/Use Alternative

lenacapavir + bosutinib

avoid combo during and x9mo after lenacapavir tx: combo may incr. bosutinib levels, risk of myelosuppression, other adverse effects (hepatic metab. inhibited)

• brigatinib
Sunlenca (lenacapavir)

+

brigatinib

1 interaction

Avoid/Use Alternative

lenacapavir + brigatinib

use alternative or monitor BP, HR; decr. brigatinib dose during and x9mo after lenacapavir tx by approx. 40% as follows: if taking 180 mg, decr. to 120 mg, if taking 120 mg, decr. to 90 mg; if taking 90 mg, decr. to 60 mg: combo may incr. brigatinib levels, risk of HTN, bradycardia, other adverse effects; may decr. lenacapavir levels, efficacy (hepatic metab. inhibited; hepatic metab. induced)

• buspirone
Sunlenca (lenacapavir)

+

buspirone

1 interaction

Avoid/Use Alternative

lenacapavir + buspirone

consider alternative or restart buspirone dose at 2.5 mg bid during and x9mo after lenacapavir tx: combo may incr. buspirone levels, risk of adverse effects (hepatic metab. inhibited)

• cannabidiol
Sunlenca (lenacapavir)

+

cannabidiol

1 interaction

Avoid/Use Alternative

lenacapavir + cannabidiol

avoid combo w/ oral lenacapavir if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (gut P-gp-mediated transport inhibited)

• capivasertib
Sunlenca (lenacapavir)

+

capivasertib

1 interaction

Avoid/Use Alternative

lenacapavir + capivasertib

avoid combo if also combined w/ strong CYP3A4 and P-gp inhibitors; otherwise, monitor glucose and decr. capivasertib dose to 320 mg bid x4 days followed by 3 days off during and x9mo after lenacapavir tx: combo may incr. level of both drugs, risk of severe hyperglycemia, other adverse effects (hepatic metab. inhibited, UGT inhibited)

• carvedilol
Sunlenca (lenacapavir)

+

carvedilol

1 interaction

Avoid/Use Alternative

lenacapavir + carvedilol

avoid combo if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (P-gp-mediated transport inhibited)

• cenobamate
Sunlenca (lenacapavir)

+

cenobamate

1 interaction

Avoid/Use Alternative

lenacapavir + cenobamate

avoid combo: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced)

• ceritinib
Sunlenca (lenacapavir)

+

ceritinib

1 interaction

Avoid/Use Alternative

lenacapavir + ceritinib

avoid combo if also combined w/ UGT1A1 and P-gp inhibitors; otherwise, monitor ECG, electrolytes during and x9mo after lenacapavir tx: combo may incr. levels of both drugs, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• chloramphenicol
Sunlenca (lenacapavir)

+

chloramphenicol

1 interaction

Avoid/Use Alternative

lenacapavir + chloramphenicol

avoid combo if also combined w/ UGT1A1 and P-gp inhibitors; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (hepatic metab. inhibited)

• cladribine oral
Sunlenca (lenacapavir)

+

cladribine oral

1 interaction

Avoid/Use Alternative

lenacapavir + cladribine oral

use alternative or monitor CBC w/ oral lenacapavir: combo may incr. cladribine levels, risk of serious infection, myelosuppression, other adverse effects (gut BCRP-mediated transport inhibited)

• clarithromycin
Sunlenca (lenacapavir)

+

clarithromycin

1 interaction

Avoid/Use Alternative

lenacapavir + clarithromycin

avoid combo if also combined w/ UGT1A1 inhibitor; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• cobicistat
Sunlenca (lenacapavir)

+

cobicistat

1 interaction

Avoid/Use Alternative

lenacapavir + cobicistat

avoid combo if also combined w/ UGT1A1 inhibitor: combo may incr. lenacapavir levels, risk of adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• cobimetinib
Sunlenca (lenacapavir)

+

cobimetinib

1 interaction

Avoid/Use Alternative

lenacapavir + cobimetinib

use alternative or decr. cobimetinib dose to 20 mg/day during and x9mo after lenacapavir tx: combo may incr. cobimetinib levels, risk of adverse effects (hepatic metab. inhibited)

• codeine
Sunlenca (lenacapavir)

+

codeine

1 interaction

Avoid/Use Alternative

lenacapavir + codeine

use alternative or monitor resp. rate, consider decr. codeine dose during and x9mo after lenacapavir tx: combo may incr. codeine and active metabolite morphine levels, incr. risk of, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite morphine)

• conivaptan
Sunlenca (lenacapavir)

+

conivaptan

1 interaction

Avoid/Use Alternative

lenacapavir + conivaptan

consider alternative during and x9mo after lenacapavir tx: combo may incr. conivaptan levels, risk of overly rapid serum sodium correction, neurologic sequelae, other adverse effects (hepatic metab. inhibited)

• cyclosporine
Sunlenca (lenacapavir)

+

cyclosporine

1 interaction

Avoid/Use Alternative

lenacapavir + cyclosporine

avoid combo if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, monitor cyclosporine levels, renal fxn during and x9mo after lenacapavir tx: combo may incr. levels of both drugs, risk of serious infection, nephrotoxicity, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• dabigatran
Sunlenca (lenacapavir)

+

dabigatran

1 interaction

Avoid/Use Alternative

lenacapavir + dabigatran

ATRIAL FIBRILLATION: avoid combo if CrCl <30 mL/min; OTHER INDICATIONS: avoid combo if CrCl <50 mL/min; if dabigatran use for DVT/PE prophylaxis post-hip replacement and CrCl >50 mL/min, consider separating admin. at least 2h apart: combo may incr. dabigatran levels, risk of bleeding (incl. life-threatening), other adverse effects (P-gp-mediated transport inhibited)

• dabrafenib
Sunlenca (lenacapavir)

+

dabrafenib

1 interaction

Avoid/Use Alternative

lenacapavir + dabrafenib

avoid combo: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced)

• danicopan
Sunlenca (lenacapavir)

+

danicopan

1 interaction

Avoid/Use Alternative

lenacapavir + danicopan

avoid combo if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (P-gp-mediated transport inhibited)

• defactinib
Sunlenca (lenacapavir)

+

defactinib

1 interaction

Avoid/Use Alternative

lenacapavir + defactinib

avoid combo during and x9mo after lenacapavir tx: combo may incr. defactinib levels, risk of adverse effects (hepatic metab. inhibited)

• dihydrocodeine
Sunlenca (lenacapavir)

+

dihydrocodeine

1 interaction

Avoid/Use Alternative

lenacapavir + dihydrocodeine

use alternative or monitor resp. rate, consider decr. dihydrocodeine dose during and x9mo after lenacapavir tx: combo may incr. dihydrocodeine and active metabolite dihydromorphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite dihydromorphine)

• dihydroergotamine
Sunlenca (lenacapavir)

+

dihydroergotamine

1 interaction

Avoid/Use Alternative

lenacapavir + dihydroergotamine

avoid combo during and x9mo after lenacapavir tx: combo may incr. dihydroergotamine levels, risk of ergot toxicity, severe vasospasm, ischemia, other adverse effects (hepatic metab. inhibited)

• diosmin
Sunlenca (lenacapavir)

+

diosmin

1 interaction

Avoid/Use Alternative

lenacapavir + diosmin

avoid combo if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (P-gp-mediated transport inhibited)

• disopyramide
Sunlenca (lenacapavir)

+

disopyramide

1 interaction

Avoid/Use Alternative

lenacapavir + disopyramide

use alternative or monitor disopyramide levels, ECG during and x9mo after lenacapavir tx: combo may incr. disopyramide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• domperidone
Sunlenca (lenacapavir)

+

domperidone

1 interaction

Avoid/Use Alternative

lenacapavir + domperidone

avoid combo during and x9mo after lenacapavir tx: combo may incr. domperidone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• doxorubicin
Sunlenca (lenacapavir)

+

doxorubicin

1 interaction

Avoid/Use Alternative

lenacapavir + doxorubicin

avoid combo during and x9mo after lenacapavir tx: combo may incr. doxorubicin levels, risk serious infection, myelosuppression, cardiotoxicity, other adverse effects (hepatic metab. inhibited)

• dronedarone
Sunlenca (lenacapavir)

+

dronedarone

1 interaction

Avoid/Use Alternative

lenacapavir + dronedarone

avoid combo if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, monitor ECG during and x9mo after lenacapavir tx: combo may incr. levels of both drugs, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• efavirenz
Sunlenca (lenacapavir)

+

efavirenz

1 interaction

Avoid/Use Alternative

lenacapavir + efavirenz

avoid combo: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced, UGT induced, P-gp-mediated transport induced)

• elacestrant
Sunlenca (lenacapavir)

+

elacestrant

1 interaction

Avoid/Use Alternative

lenacapavir + elacestrant

avoid combo during and x9mo after lenacapavir tx: combo may incr. elacestrant levels, risk of adverse effects (hepatic metab. inhibited)

• ensartinib
Sunlenca (lenacapavir)

+

ensartinib

1 interaction

Avoid/Use Alternative

lenacapavir + ensartinib

avoid combo during and x9mo after lenacapavir tx: combo may incr. ensartinib levels, risk of bradycardia, hyperglycemia, other adverse effects (hepatic metab. possibly inhibited, P-gp-mediated transport possibly inhibited)

• entrectinib
Sunlenca (lenacapavir)

+

entrectinib

1 interaction

Avoid/Use Alternative

lenacapavir + entrectinib

PEDS PTS w/ ENTRECTINIB START DOSE <200 mg/day: avoid combo; ADULT AND PEDS PTS >2yo: use alternative or monitor ECG, CBC, limit coadmin. to 14 days or less and decr. entrectinib dose as follows: if entrectinib start dose 200 mg qd, decr. to 50 mg qd; if entrectinib start dose 300 mg qd, decr. to 100 mg qd; if entrectinib start dose 400 or 600 mg qd, decr. to 200 mg qd: combo may incr. entrectinib levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects (hepatic metab. inhibited)

• ergotamine
Sunlenca (lenacapavir)

+

ergotamine

1 interaction

Avoid/Use Alternative

lenacapavir + ergotamine

avoid combo during and x9mo after lenacapavir tx: combo may incr. ergotamine levels, risk of ergot toxicity, severe vasospasm, ischemia, other adverse effects (hepatic metab. inhibited)

• erythromycin
Sunlenca (lenacapavir)

+

erythromycin

1 interaction

Avoid/Use Alternative

lenacapavir + erythromycin

avoid combo if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, monitor ECG during and x9mo after lenacapavir tx: combo may incr. levels of both drugs, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• etrasimod
Sunlenca (lenacapavir)

+

etrasimod

1 interaction

Avoid/Use Alternative

lenacapavir + etrasimod

during and x9mo after lenacapavir tx; if CYP2C9 poor metabolizer or if also combined w/ moderate or strong CYP2C9 inhibitor; otherwise, caution advised: combo may incr. etrasimod levels, risk of AV block, bradycardia, QT prolongation, cardiac arrhythmias, serious infection, other adverse effects (hepatic metab. inhibited)

• etravirine
Sunlenca (lenacapavir)

+

etravirine

1 interaction

Avoid/Use Alternative

lenacapavir + etravirine

avoid combo: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced)

• fentanyl
Sunlenca (lenacapavir)

+

fentanyl

1 interaction

Avoid/Use Alternative

lenacapavir + fentanyl

use alternative or monitor resp. rate, consider decr. fentanyl dose during and x9mo after lenacapavir tx: combo may incr. fentanyl levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited)

• fexinidazole
Sunlenca (lenacapavir)

+

fexinidazole

1 interaction

Avoid/Use Alternative

lenacapavir + fexinidazole

use alternative during and x9mo after lenacapavir tx: combo may decr. lenacapavir levels, efficacy; may decr. fexinidazole active metabolite levels, efficacy (hepatic metab. induced; hepatic metab. inhibited, decr. conversion to active metabolites)

• fosaprepitant
Sunlenca (lenacapavir)

+

fosaprepitant

1 interaction

Avoid/Use Alternative

lenacapavir + fosaprepitant

avoid combo during and x9mo after lenacapavir tx: combo may incr. aprepitant levels, risk of adverse effects (hepatic metab. inhibited)

• futibatinib
Sunlenca (lenacapavir)

+

futibatinib

1 interaction

Avoid/Use Alternative

lenacapavir + futibatinib

avoid combo if also combined w/ strong CYP3A4 inhibitor; otherwise, monitor phosphate during and x9mo after lenacapavir tx: combo may incr. futibatinib levels, risk of hyperphosphatemia, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• gemfibrozil
Sunlenca (lenacapavir)

+

gemfibrozil

1 interaction

Avoid/Use Alternative

lenacapavir + gemfibrozil

avoid combo if also combined w/ strong CYP3A4 and P-gp inhibitors; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (UGT inhibited)

• glecaprevir
Sunlenca (lenacapavir)

+

glecaprevir

1 interaction

Avoid/Use Alternative

lenacapavir + glecaprevir

avoid combo if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, caution advised: combo may incr. levels of both drugs, risk of adverse effects (BCRP-mediated transport inhibited, P-gp-mediated transport inhibited)

• hydrocodone
Sunlenca (lenacapavir)

+

hydrocodone

1 interaction

Avoid/Use Alternative

lenacapavir + hydrocodone

use alternative or monitor resp. rate, ECG, consider decr. (benz)hydrocodone dose during and x9mo after lenacapavir tx: combo may incr. hydrocodone levels, risk of CNS and resp. depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• idelalisib
Sunlenca (lenacapavir)

+

idelalisib

1 interaction

Avoid/Use Alternative

lenacapavir + idelalisib

avoid combo if also combined w/ UGT1A1 and P-gp inhibitors; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (hepatic metab. inhibited)

• infigratinib
Sunlenca (lenacapavir)

+

infigratinib

1 interaction

Avoid/Use Alternative

lenacapavir + infigratinib

avoid combo during and x9mo after lenacapavir tx: combo may incr. infigratinib levels, risk of hyperphosphatemia, other adverse effects (hepatic metab. inhibited)

• itraconazole
Sunlenca (lenacapavir)

+

itraconazole

1 interaction

Avoid/Use Alternative

lenacapavir + itraconazole

avoid combo if also combined w/ UGT1A1 inhibitor; otherwise, consider decr. itraconazole dose during and x9mo after lenacapavir tx: combo may incr. levels of both drugs, risk of adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• ivabradine
Sunlenca (lenacapavir)

+

ivabradine

1 interaction

Avoid/Use Alternative

lenacapavir + ivabradine

avoid combo during and x9mo after lenacapavir tx: combo may incr. ivabradine levels, risk of bradycardia, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• ivacaftor
Sunlenca (lenacapavir)

+

ivacaftor

1 interaction

Avoid/Use Alternative

lenacapavir + ivacaftor

pts <6 mo: avoid combo during and x9mo after lenacapavir tx; pts >6 mo decr. ivacaftor dose during and x9mo after lenacapavir tx as follows: 6 mo-5 yo and 5-6.9 kg: give 25 mg qd; 6 mo-5 yo and 7-13.9 kg: give 50 mg qd; 6 mo-5 yo and >14 kg: give 75 mg qd; 6 yo and older: give 150 mg qd: combo may incr. ivacaftor levels, risk of adverse effects (hepatic metab. inhibited)

• ixabepilone
Sunlenca (lenacapavir)

+

ixabepilone

1 interaction

Avoid/Use Alternative

lenacapavir + ixabepilone

consider alternatives or monitor CBC during and x9mo after lenacapavir tx: combo may incr. ixabepilone levels, risk of serious infection, myelosuppression, other toxicity (hepatic metab. inhibited)

• ketoconazole
Sunlenca (lenacapavir)

+

ketoconazole

1 interaction

Avoid/Use Alternative

lenacapavir + ketoconazole

avoid combo during and up to 1wk after ketoconazole tx: combo may incr. lenacapavir levels, risk of adverse effects (hepatic metab. inhibited, UGT inhibited, P-gp-mediated transport inhibited)

• lapatinib
Sunlenca (lenacapavir)

+

lapatinib

1 interaction

Avoid/Use Alternative

lenacapavir + lapatinib

avoid combo if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, monitor ECG during and x9mo after lenacapavir tx; consider decr. lapatinib dose: combo may incr. levels of both drugs, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited, BCRP-mediated transport inhibited)

• ledipasvir
Sunlenca (lenacapavir)

+

ledipasvir

1 interaction

Avoid/Use Alternative

lenacapavir + ledipasvir

avoid combo w/ oral lenacapavir if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (gut P-gp-mediated transport inhibited)

• lemborexant
Sunlenca (lenacapavir)

+

lemborexant

1 interaction

Avoid/Use Alternative

lenacapavir + lemborexant

avoid combo during and x9mo after lenacapavir tx: combo may incr. lemborexant levels, risk of CNS depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited)

• levoketoconazole
Sunlenca (lenacapavir)

+

levoketoconazole

1 interaction

Avoid/Use Alternative

lenacapavir + levoketoconazole

consider alternative x2wk before and during levoketoconazole tx; otherwise, monitor ECG during and x9mo after lenacapavir tx: combo may incr. levels of both drugs, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• lonafarnib
Sunlenca (lenacapavir)

+

lonafarnib

1 interaction

Avoid/Use Alternative

lenacapavir + lonafarnib

avoid combo if also combined w/ UGT1A1 inhibitor; otherwise, consider alternative or monitor HR, ECG, electrolytes, especially during first week when adding lonafarnib to existing lenacapavir tx: combo may incr. levels of both drugs, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• lopinavir/ritonavir
Sunlenca (lenacapavir)

+

lopinavir/ ritonavir

1 interaction

Avoid/Use Alternative

lenacapavir + lopinavir/ ritonavir

avoid combo: combo may incr. or decr. lenacapavir levels, incr. risk of adverse effects or decr. efficacy (hepatic metab. altered, UGT inhibited, P-gp-mediated transport inhibited)

• lorlatinib
Sunlenca (lenacapavir)

+

lorlatinib

1 interaction

Avoid/Use Alternative

lenacapavir + lorlatinib

avoid combo: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced, UGT induced, P-gp-mediated transport induced)

• lovastatin
Sunlenca (lenacapavir)

+

lovastatin

1 interaction

Avoid/Use Alternative

lenacapavir + lovastatin

use alternative or monitor CK, myopathy sx during and x9mo after lenacapavir tx; use lowest lovastatin start dose, adjust lovastatin max dose to 20 mg/day: combo may incr. lovastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (hepatic metab. inhibited)

• lurbinectedin
Sunlenca (lenacapavir)

+

lurbinectedin

1 interaction

Avoid/Use Alternative

lenacapavir + lurbinectedin

during and x9mo after lenacapavir tx, use alternative or monitor CBC and consider decr. lurbinectedin dose: combo may incr. lurbinectedin levels, risk of myelosuppression, other adverse effects (hepatic metab. inhibited)

• macitentan
Sunlenca (lenacapavir)

+

macitentan

1 interaction

Avoid/Use Alternative

lenacapavir + macitentan

if also combined w/ strong-mod CYP2C9 inhibitor, avoid combo during and x9mo after lenacapavir tx; otherwise, caution advised during and x9mo after lenacapavir tx: combo may incr. macitentan levels, risk of adverse effects (hepatic metab. inhibited)

• mavacamten
Sunlenca (lenacapavir)

+

mavacamten

1 interaction

Avoid/Use Alternative

lenacapavir + mavacamten

avoid combo: combo may decr. lenacapavir levels, efficacy; may incr. mavacamten levels, risk of heart failure, other adverse effects x9mo after lenacapavir tx (hepatic metab. induced; hepatic metab. inhibited)

• mavorixafor
Sunlenca (lenacapavir)

+

mavorixafor

1 interaction

Avoid/Use Alternative

lenacapavir + mavorixafor

avoid combo if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, monitor ECG during and x9mo after lenacapavir tx: combo may incr. levels of both drugs, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• meperidine
Sunlenca (lenacapavir)

+

meperidine

1 interaction

Avoid/Use Alternative

lenacapavir + meperidine

use alternative or monitor resp. rate, ECG; consider decr. meperidine dose during and x9mo after lenacapavir tx: combo may incr. meperidine levels, risk of CNS and respiratory depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• methylergonovine
Sunlenca (lenacapavir)

+

methylergonovine

1 interaction

Avoid/Use Alternative

lenacapavir + methylergonovine

avoid combo during and x9mo after lenacapavir tx: combo may incr. methylergonovine levels, risk of ergot toxicity, severe vasospasm, ischemia, other adverse effects (hepatic metab. inhibited)

• midazolam
Sunlenca (lenacapavir)

+

midazolam

1 interaction

Avoid/Use Alternative

lenacapavir + midazolam

avoid combo if midazolam nasal use during and x9mo after lenacapavir tx; otherwise, monitor resp. rate, consider decr. midazolam dose during and x9mo after lenacapavir tx: combo may incr. midazolam and active metabolite levels, risk of profound CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited)

• mifepristone
Sunlenca (lenacapavir)

+

mifepristone

1 interaction

Avoid/Use Alternative

lenacapavir + mifepristone

avoid combo if also combined w/ UGT1A1 inhibitor w/in 14 days of daily mifepristone use; otherwise, caution advised if daily mifepristone use, during and x9mo after lenacapavir tx: combo may incr. levels of both drugs, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• mitapivat
Sunlenca (lenacapavir)

+

mitapivat

1 interaction

Avoid/Use Alternative

lenacapavir + mitapivat

avoid combo: combo may decr. lenacapavir levels, efficacy; may incr. mitapivat levels, risk of adverse effects x9mo after lenacapavir tx (hepatic metab. induced, UGT possibly induced; hepatic metab. inhibited)

• mobocertinib
Sunlenca (lenacapavir)

+

mobocertinib

1 interaction

Avoid/Use Alternative

lenacapavir + mobocertinib

use alternative or monitor ECG; decr. mobocertinib dose during and x9mo after lenacapavir tx as follows: if taking 160 mg, decr. dose to 80 mg; if taking 120 mg, decr. dose to 40 mg, if taking 80 mg, decr. dose to 40 mg: combo may incr. mobocertinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects; may decr. lenacapavir levels, efficacy (hepatic metab. inhibited; hepatic metab. induced)

• modafinil
Sunlenca (lenacapavir)

+

modafinil

1 interaction

Avoid/Use Alternative

lenacapavir + modafinil

avoid combo: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced)

• nafcillin
Sunlenca (lenacapavir)

+

nafcillin

1 interaction

Avoid/Use Alternative

lenacapavir + nafcillin

avoid combo: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced)

• naloxegol
Sunlenca (lenacapavir)

+

naloxegol

1 interaction

Avoid/Use Alternative

lenacapavir + naloxegol

use alternative or decr. naloxegol dose to 12.5 mg/day during and x9mo after lenacapavir tx: combo may incr. naloxegol levels, risk of adverse effects (hepatic metab. inhibited)

• nefazodone
Sunlenca (lenacapavir)

+

nefazodone

1 interaction

Avoid/Use Alternative

lenacapavir + nefazodone

avoid combo if also combined w/ UGT1A1 inhibitor; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• nelfinavir
Sunlenca (lenacapavir)

+

nelfinavir

1 interaction

Avoid/Use Alternative

lenacapavir + nelfinavir

avoid combo if also combined w/ UGT1A1 inhibitor; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• neratinib
Sunlenca (lenacapavir)

+

neratinib

1 interaction

Avoid/Use Alternative

lenacapavir + neratinib

avoid combo during and x9mo after lenacapavir tx: combo may incr. neratinib levels, risk of adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• nevirapine
Sunlenca (lenacapavir)

+

nevirapine

1 interaction

Avoid/Use Alternative

lenacapavir + nevirapine

avoid combo: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced)

• nirogacestat
Sunlenca (lenacapavir)

+

nirogacestat

1 interaction

Avoid/Use Alternative

lenacapavir + nirogacestat

avoid combo during and x9mo after lenacapavir tx: combo may incr. nirogacestat levels, risk of hypophosphatemia, other adverse effects (hepatic metab. inhibited)

• nisoldipine
Sunlenca (lenacapavir)

+

nisoldipine

1 interaction

Avoid/Use Alternative

lenacapavir + nisoldipine

consider alternative or monitor BP during and x9mo after lenacapavir tx: combo may incr. nisoldipine levels, risk of hypotension, other adverse effects (hepatic metab. inhibited)

• olaparib
Sunlenca (lenacapavir)

+

olaparib

1 interaction

Avoid/Use Alternative

lenacapavir + olaparib

use alternative or decr. olaparib dose to 150 mg bid; monitor CBC during and x9mo after lenacapavir tx: combo may incr. olaparib levels, risk of myelosuppression, other adverse effects (hepatic metab. inhibited)

• oliceridine
Sunlenca (lenacapavir)

+

oliceridine

1 interaction

Avoid/Use Alternative

lenacapavir + oliceridine

use alternative or monitor resp. rate, ECG; consider decr. oliceridine frequency during and x9mo after lenacapavir tx: combo may incr. oliceridine levels, risk of CNS and resp. depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• omaveloxolone
Sunlenca (lenacapavir)

+

omaveloxolone

1 interaction

Avoid/Use Alternative

lenacapavir + omaveloxolone

use alternative or decr. omaveloxolone dose to 100 mg/day during and x9mo after lenacapavir tx: combo may incr. omaveloxolone levels, risk of adverse effects during and x9mo after lenacapavir tx; may decr. lenacapavir levels, efficacy (hepatic metab. inhibited; hepatic metab. induced)

• oxcarbazepine
Sunlenca (lenacapavir)

+

oxcarbazepine

1 interaction

Avoid/Use Alternative

lenacapavir + oxcarbazepine

consider alternative anticonvulsant: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced, UGT induced, P-gp-mediated transport possibly induced)

• oxycodone
Sunlenca (lenacapavir)

+

oxycodone

1 interaction

Avoid/Use Alternative

lenacapavir + oxycodone

use alternative or monitor resp. rate; consider decr. oxycodone dose during and x9mo after lenacapavir tx: combo may incr. oxycodone levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited)

• pacritinib
Sunlenca (lenacapavir)

+

pacritinib

1 interaction

Avoid/Use Alternative

lenacapavir + pacritinib

avoid combo during and x9mo after lenacapavir tx: combo may incr. pacritinib levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, bleeding (incl. life-threatening), other adverse effects; may decr. lenacapavir levels, efficacy (hepatic metab. inhibited; hepatic metab. induced)

• palovarotene
Sunlenca (lenacapavir)

+

palovarotene

1 interaction

Avoid/Use Alternative

lenacapavir + palovarotene

during and x9mo after lenacapavir tx, use alternative or decr. palovarotene dose as follows: wt 10-19.9 kg maint. dose 1 mg daily, flare dose 5 mg daily wk 1-4, then 2.5 mg daily wk 5-12; wt 20-39.9 kg maint. dose 1.5 mg daily, flare dose 6 mg daily wk 1-4, then 3 mg daily wk 5-12; wt 40-59.9 kg maint. dose 2 mg daily, flare dose 7.5 mg daily wk 1-4, then 4 mg daily wk 5-12; wt 60 kg and greater or 14 yo and older maint. dose 2.5 mg daily, flare dose 10 mg daily wk 1-4, then 5 mg daily wk 5-12: combo may incr. palovarotene levels, risk of adverse effects (hepatic metab. inhibited)

• pazopanib
Sunlenca (lenacapavir)

+

pazopanib

1 interaction

Avoid/Use Alternative

lenacapavir + pazopanib

avoid combo: combo may incr. pazopanib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects x9mo after lenacapavir tx (hepatic metab. inhibited, BCRP-mediated transport inhibited)

• pemigatinib
Sunlenca (lenacapavir)

+

pemigatinib

1 interaction

Avoid/Use Alternative

lenacapavir + pemigatinib

use alternative or monitor phosphate and decr. pemigatinib dose during and x9mo after lenacapavir tx as follows: if on pemigatinib 13.5 mg qd, decr. to 9 mg qd; if on pemigatinib 9 mg qd, decr. to 4.5 mg qd: combo may incr. pemigatinib levels, risk of hyperphosphatemia, other adverse effects (hepatic metab. inhibited)

• pexidartinib
Sunlenca (lenacapavir)

+

pexidartinib

1 interaction

Avoid/Use Alternative

lenacapavir + pexidartinib

use alternative or monitor LFTs, decr. pexidartinib dose during and x9mo after lenacapavir tx as follows: if on pexidartinib 500 mg/day or 375 mg/day, decr. to 125 mg bid; if on pexidartinib 250 mg/day, decr. to 125 mg qd: combo may incr. pexidartinib levels, risk of hepatotoxicity, other adverse effects; may incr. or decr. lenacapavir levels, incr. risk of adverse effects or decr. efficacy (hepatic metab. inhibited; UGT possibly inhibited, hepatic metab. induced)

• phenobarbital
Sunlenca (lenacapavir)

+

phenobarbital

1 interaction

Avoid/Use Alternative

lenacapavir + phenobarbital

consider alternative anticonvulsant: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced, UGT induced, P-gp-mediated transport possibly induced)

• pibrentasvir
Sunlenca (lenacapavir)

+

pibrentasvir

1 interaction

Avoid/Use Alternative

lenacapavir + pibrentasvir

avoid combo if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, caution advised: combo may incr. levels of both drugs, risk of adverse effects (BCRP-mediated transport inhibited, P-gp-mediated transport inhibited)

• pimozide
Sunlenca (lenacapavir)

+

pimozide

1 interaction

Avoid/Use Alternative

lenacapavir + pimozide

avoid combo during and x9mo after lenacapavir tx: combo may incr. pimozide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• posaconazole
Sunlenca (lenacapavir)

+

posaconazole

1 interaction

Avoid/Use Alternative

lenacapavir + posaconazole

avoid combo if also combined w/ UGT1A1 inhibitor; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• pralsetinib
Sunlenca (lenacapavir)

+

pralsetinib

1 interaction

Avoid/Use Alternative

lenacapavir + pralsetinib

use alternative or consider monitoring ECG, electrolytes and decr. pralsetinib dose as follows during and x9mo after lenacapavir tx: if on pralsetinib 400 mg qd, decr. to 300 mg qd; if on pralsetinib 300 mg qd, decr. to 200 mg qd; if on pralsetinib 200 mg qd, decr. to 100 mg qd: combo may incr. pralsetinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• probenecid
Sunlenca (lenacapavir)

+

probenecid

1 interaction

Avoid/Use Alternative

lenacapavir + probenecid

avoid combo if also combined w/ strong CYP3A4 and P-gp inhibitors; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (UGT inhibited)

• propafenone
Sunlenca (lenacapavir)

+

propafenone

1 interaction

Avoid/Use Alternative

lenacapavir + propafenone

if also combined w/ CYP2D6 inhibitor, avoid combo; otherwise, monitor ECG during and x9mo after lenacapavir tx: combo may incr. levels of both drugs, risk of QT prolongation, cardiac arrhythmias, hypotension, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• quinidine (antiarrhythmic)
Sunlenca (lenacapavir)

+

quinidine (antiarrhythmic)

1 interaction

Avoid/Use Alternative

lenacapavir + quinidine (antiarrhythmic)

avoid combo if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, monitor quinidine levels, ECG during and x9mo after lenacapavir tx: combo may incr. levels of both drugs, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• ranolazine
Sunlenca (lenacapavir)

+

ranolazine

1 interaction

Avoid/Use Alternative

lenacapavir + ranolazine

avoid combo if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, monitor ECG, adjust ranolazine max dose to 1000 mg/day during and x9mo after lenacapavir tx: combo may incr. levels of both drugs, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• regorafenib
Sunlenca (lenacapavir)

+

regorafenib

1 interaction

Avoid/Use Alternative

lenacapavir + regorafenib

avoid combo if also combined w/ strong CYP3A4 and P-gp inhibitors; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (UGT inhibited)

• relugolix
Sunlenca (lenacapavir)

+

relugolix

1 interaction

Avoid/Use Alternative

lenacapavir + relugolix

PROSTATE CANCER: use alternative or monitor ECG, electrolytes and admin. relugolix at least 6h before oral lenacapavir tx; FIBROID-ASSOC. BLEEDING: use alternative or admin. relugolix at least 6h before oral lenacapavir tx: combo may incr. relugolix levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (gut P-gp-mediated transport inhibited)

• repotrectinib
Sunlenca (lenacapavir)

+

repotrectinib

1 interaction

Avoid/Use Alternative

lenacapavir + repotrectinib

avoid combo during and x9mo after lenacapavir tx: combo may incr. repotrectinib levels, risk of adverse effects; may decr. lenacapavir levels, efficacy (hepatic metab. inhibited, P-gp-mediated transport inhibited; hepatic metab. induced)

• ribociclib
Sunlenca (lenacapavir)

+

ribociclib

1 interaction

Avoid/Use Alternative

lenacapavir + ribociclib

avoid combo if also combined w/ UGT1A1 and P-gp inhibitors; otherwise, monitor ECG, electrolytes, CBC during and x9mo after lenacapavir tx: combo may incr. levels of both drugs, risk of QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects (hepatic metab. inhibited)

• rifabutin
Sunlenca (lenacapavir)

+

rifabutin

1 interaction

Avoid/Use Alternative

lenacapavir + rifabutin

avoid combo: combo may decr. lenacapavir levels, efficacy; may incr. rifabutin levels, risk of myelosuppression, uveitis, other adverse effects x9mo after lenacapavir tx (hepatic metab. induced, UGT induced, P-gp-mediated transport possibly induced; hepatic metab. inhibited)

• rifapentine
Sunlenca (lenacapavir)

+

rifapentine

1 interaction

Avoid/Use Alternative

lenacapavir + rifapentine

avoid combo: combo may decr. lenacapavir levels, efficacy (hepatic metab. induced, UGT possibly induced, P-gp-mediated transport possibly induced)

• rivaroxaban
Sunlenca (lenacapavir)

+

rivaroxaban

1 interaction

Avoid/Use Alternative

lenacapavir + rivaroxaban

use alternative if CrCl <80; otherwise, monitor bleeding s/sx during and x9mo after lenacapavir tx: combo may incr. rivaroxaban levels, risk of bleeding, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• selpercatinib
Sunlenca (lenacapavir)

+

selpercatinib

1 interaction

Avoid/Use Alternative

lenacapavir + selpercatinib

during and x9mo after lenacapavir tx, use alternative or monitor ECG, electrolytes; decr. selpercatinib dose as follows: if on selpercatinib 40 mg tid, decr. to 40 mg qd; if on selpercatinib 80 mg bid, decr. to 40 mg bid; if on selpercatinib 120 mg bid, decr. to 80 mg bid; if on selpercatinib 160 mg bid, decr. to 120 mg bid: combo may incr. selpercatinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• selumetinib
Sunlenca (lenacapavir)

+

selumetinib

1 interaction

Avoid/Use Alternative

lenacapavir + selumetinib

use alternative or monitor LVEF, CK, myopathy sx; decr. selumetinib dose as follows: if on selumetinib 25 mg/m^2 bid, decr. to 20 mg/m^2 bid; if on selumetinib 20 mg/m^2 bid, decr. to 15 mg/m^2 bid; see selumetinib pkg insert for specific dose adjustments: combo may incr. selumetinib levels, risk of cardiotoxicity, myopathy, rhabdomyolysis, other adverse effects (hepatic metab. inhibited)

• simvastatin
Sunlenca (lenacapavir)

+

simvastatin

1 interaction

Avoid/Use Alternative

lenacapavir + simvastatin

use alternative or monitor CK, myopathy sx during and x9mo after lenacapavir tx; use lowest simvastatin start dose; adjust max simvastatin dose to 10 mg/day: combo may incr. simvastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (hepatic metab. inhibited, BCRP-mediated transport inhibited)

• siponimod
Sunlenca (lenacapavir)

+

siponimod

1 interaction

Avoid/Use Alternative

lenacapavir + siponimod

if also combined w/ moderate or strong CYP2C9 inhibitor, avoid combo; otherwise, caution advised during and x9mo after lenacapavir tx: combo may incr. siponimod levels, risk of adverse effects (hepatic metab. inhibited)

• sirolimus albumin-bound
Sunlenca (lenacapavir)

+

sirolimus albumin-bound

1 interaction

Avoid/Use Alternative

lenacapavir + sirolimus albumin-bound

avoid combo: combo may incr. sirolimus albumin-bound levels, risk of serious infection, myelosuppression, bleeding (incl. life-threatening), other adverse effects x9mo after lenacapavir tx (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• sonidegib
Sunlenca (lenacapavir)

+

sonidegib

1 interaction

Avoid/Use Alternative

lenacapavir + sonidegib

use alternative during and x9mo after lenacapavir tx: combo may incr. sonidegib levels, risk of adverse effects (hepatic metab. inhibited)

• sorafenib
Sunlenca (lenacapavir)

+

sorafenib

1 interaction

Avoid/Use Alternative

lenacapavir + sorafenib

avoid combo if also combined w/ strong CYP3A4 inhibitor; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (UGT inhibited, P-gp-mediated transport possibly inhibited)

• sotorasib
Sunlenca (lenacapavir)

+

sotorasib

1 interaction

Avoid/Use Alternative

lenacapavir + sotorasib

avoid combo: combo may incr. or decr. lenacapavir levels, incr. risk of adverse effects or decr. efficacy (P-gp-mediated transport inhibited, hepatic metab. induced)

• sufentanil
Sunlenca (lenacapavir)

+

sufentanil

1 interaction

Avoid/Use Alternative

lenacapavir + sufentanil

consider alternative or monitor resp. rate, consider decr. sufentanil dose or frequency during and x9mo after lenacapavir tx: combo may incr. sufentanil levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited)

• tadalafil
Sunlenca (lenacapavir)

+

tadalafil

1 interaction

Avoid/Use Alternative

lenacapavir + tadalafil

PAH: avoid combo during and x9mo after lenacapavir tx; ED: monitor BP during and x9mo after lenacapavir tx: combo may incr. tadalafil levels, risk of hypotension, priapism, other adverse effects (hepatic metab. inhibited)

• tazemetostat
Sunlenca (lenacapavir)

+

tazemetostat

1 interaction

Avoid/Use Alternative

lenacapavir + tazemetostat

during and x9mo after lenacapavir tx, use alternative or monitor ECG, CBC; decr. tazemetostat dose as follows: if taking 800 mg bid, decr. tazemetostat dose to 400 mg bid; if taking 600 mg bid, decr. tazemetostat dose to 400 mg qam plus 200 mg qpm: combo may incr. tazemetostat levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects; may decr. lenacapavir levels, efficacy (hepatic metab. inhibited; hepatic metab. induced)

• tepotinib
Sunlenca (lenacapavir)

+

tepotinib

1 interaction

Avoid/Use Alternative

lenacapavir + tepotinib

avoid combo if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (P-gp-mediated transport inhibited)

• tipranavir
Sunlenca (lenacapavir)

+

tipranavir

1 interaction

Avoid/Use Alternative

lenacapavir + tipranavir

avoid combo: combo may decr. lenacapavir levels, efficacy (UGT induced, P-gp-mediated transport induced)

• tolvaptan
Sunlenca (lenacapavir)

+

tolvaptan

1 interaction

Avoid/Use Alternative

lenacapavir + tolvaptan

HYPONATREMIA USE: avoid combo during and x9mo after lenacapavir tx; AUTOSOMAL DOMINANT POLYCYSTIC KIDNEY DZ USE: decr. tolvaptan total daily dose by 50% during and x9mo after lenacapavir tx as follows: if taking 60 mg/day, decr. to 15 mg qam and 15 mg qpm; if taking 90 mg/day, decr. to 30 mg qam and 15 mg qpm; if taking 120 mg/day, decr. to 45 mg qam and 15 mg qpm: combo may incr. tolvaptan levels, risk of adverse effects (hepatic metab. inhibited)

• topotecan
Sunlenca (lenacapavir)

+

topotecan

1 interaction

Avoid/Use Alternative

lenacapavir + topotecan

avoid combo w/ oral topotecan: combo may incr. topotecan levels, risk of serious infection, myelosuppression, other adverse effects (gut BCRP-mediated transport inhibited, gut P-gp-mediated transport inhibited)

• tramadol
Sunlenca (lenacapavir)

+

tramadol

1 interaction

Avoid/Use Alternative

lenacapavir + tramadol

use alternative or monitor resp. rate, ECG, consider decr. tramadol dose during and x9mo after lenacapavir tx: combo may incr. tramadol and active metabolite levels, risk of CNS and resp. depression, psychomotor impairment, seizures, serotonin syndrome, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited, may incr. production of active metabolite)

• tucatinib
Sunlenca (lenacapavir)

+

tucatinib

1 interaction

Avoid/Use Alternative

lenacapavir + tucatinib

avoid combo if also combined w/ UGT1A1 inhibitor; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• turmeric
Sunlenca (lenacapavir)

+

turmeric

1 interaction

Avoid/Use Alternative

lenacapavir + turmeric

avoid combo w/ oral turmeric: combo may incr. or decr. lenacapavir levels, incr. risk of adverse effects or decr. efficacy (P-gp-mediated transport altered)

• vardenafil
Sunlenca (lenacapavir)

+

vardenafil

1 interaction

Avoid/Use Alternative

lenacapavir + vardenafil

max vardenafil dose 5 mg/24h during and x9mo after lenacapavir tx; avoid combo w/ ODT form during and x9mo after lenacapavir tx: combo may incr. vardenafil levels, risk of QT prolongation, cardiac arrhythmias, hypotension, priapism, other adverse effects (hepatic metab. inhibited)

• venetoclax
Sunlenca (lenacapavir)

+

venetoclax

1 interaction

Avoid/Use Alternative

lenacapavir + venetoclax

monitor CBC, tumor lysis syndrome s/sx; CLL/SLL: consider alternative or decr. venetoclax dose by at least 50% during and x9mo after lenacapavir tx; AML: decr. venetoclax dose by at least 50% during and x9mo after lenacapavir tx: combo may incr. venetoclax levels, risk of serious infection, myelosuppression, tumor lysis syndrome, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• verapamil
Sunlenca (lenacapavir)

+

verapamil

1 interaction

Avoid/Use Alternative

lenacapavir + verapamil

avoid combo if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, caution advised during and x9mo after lenacapavir tx: combo may incr. levels of both drugs, risk of hypotension, bradycardia, AV block, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• vimseltinib
Sunlenca (lenacapavir)

+

vimseltinib

1 interaction

Avoid/Use Alternative

lenacapavir + vimseltinib

avoid combo if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, give vimseltinib at least 4h before lenacapavir: combo may incr. lenacapavir levels, risk of adverse effects (P-gp-mediated transport inhibited)

• voriconazole
Sunlenca (lenacapavir)

+

voriconazole

1 interaction

Avoid/Use Alternative

lenacapavir + voriconazole

avoid combo if also combined w/ UGT1A1 and P-gp inhibitors: combo may incr. lenacapavir levels, risk of adverse effects (hepatic metab. inhibited)

• voxilaprevir
Sunlenca (lenacapavir)

+

voxilaprevir

1 interaction

Avoid/Use Alternative

lenacapavir + voxilaprevir

avoid combo w/ oral lenacapavir if also combined w/ strong CYP3A4 and UGT1A1 inhibitors; otherwise, caution advised: combo may incr. lenacapavir levels, risk of adverse effects (gut P-gp-mediated transport inhibited)

Monitor/Modify Tx

• abemaciclib
Sunlenca (lenacapavir)

+

abemaciclib

1 interaction

Monitor/Modify Tx

lenacapavir + abemaciclib

during and x9mo after lenacapavir tx, consider decr. abemaciclib 200 mg bid dose to 150 mg bid, abemaciclib 150 mg bid dose to 100 mg bid, abemaciclib 100 mg bid dose to 50 mg bid; monitor CBC: combo may incr. abemaciclib levels, risk of myelosuppression, other adverse effects (hepatic metab. inhibited)

• acalabrutinib
Sunlenca (lenacapavir)

+

acalabrutinib

1 interaction

Monitor/Modify Tx

lenacapavir + acalabrutinib

decr. acalabrutinib dose to 100 mg qd; monitor CBC during and x9mo after lenacapavir tx: combo may incr. acalabrutinib levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metab. inhibited)

• afatinib
Sunlenca (lenacapavir)

+

afatinib

1 interaction

Monitor/Modify Tx

lenacapavir + afatinib

decr. afatinib dose by 10 mg/day if not tolerated: combo may incr. afatinib levels, risk of adverse effects (P-gp-mediated transport inhibited)

• alfuzosin
Sunlenca (lenacapavir)

+

alfuzosin

1 interaction

Monitor/Modify Tx

lenacapavir + alfuzosin

monitor BP, ECG during and x9mo after lenacapavir tx: combo may incr. alfuzosin levels, risk of QT prolongation, cardiac arrhythmias, hypotension (incl. orthostasis, syncope), other adverse effects (hepatic metab. inhibited)

• apixaban
Sunlenca (lenacapavir)

+

apixaban

1 interaction

Monitor/Modify Tx

lenacapavir + apixaban

monitor bleeding s/sx during and x9mo after lenacapavir tx: combo may incr. apixaban levels, risk of bleeding, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• aripiprazole bimonthly injection
Sunlenca (lenacapavir)

+

aripiprazole bimonthly injection

1 interaction

Monitor/Modify Tx

lenacapavir + aripiprazole bimonthly injection

if CYP2D6 PM or if also combined w/ strong CYP2D6 inhibitor and concurrent use >14 days, consider decr. aripiprazole dose to 720 mg q2mo during and x9mo after lenacapavir tx: combo may incr. aripiprazole levels, risk of adverse effects (hepatic metab. inhibited)

• aripiprazole oral
Sunlenca (lenacapavir)

+

aripiprazole oral

1 interaction

Monitor/Modify Tx

lenacapavir + aripiprazole oral

consider decr. PO aripiprazole dose during and x9mo after lenacapavir tx; if also CYP2D6 PM or if also combined w/ strong CYP2D6 inhibitor, consider decr. PO aripiprazole dose up to 75% during and x9mo after lenacapavir tx; no dose adjustment if depression adjunct tx use: combo may incr. aripiprazole levels, risk of adverse effects (hepatic metab. inhibited)

• artemether/lumefantrine
Sunlenca (lenacapavir)

+

artemether/ lumefantrine

1 interaction

Monitor/Modify Tx

lenacapavir + artemether/ lumefantrine

monitor ECG during and x9mo after lenacapavir tx: combo may incr. artemether/lumefantrine levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects; may decr. lenacapavir levels, efficacy (hepatic metab. inhibited; hepatic metab. induced)

• atorvastatin
Sunlenca (lenacapavir)

+

atorvastatin

1 interaction

Monitor/Modify Tx

lenacapavir + atorvastatin

monitor CK, myopathy sx during and x9mo after lenacapavir tx: combo may incr. atorvastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (hepatic metab. inhibited, BCRP-mediated transport inhibited, P-gp-mediated transport inhibited)

• avanafil
Sunlenca (lenacapavir)

+

avanafil

1 interaction

Monitor/Modify Tx

lenacapavir + avanafil

monitor BP; adjust max avanafil dose to 50 mg/24h during and x9mo after lenacapavir tx: combo may incr. avanafil levels, risk of hypotension, priapism, other adverse effects (hepatic metab. inhibited)

• avatrombopag
Sunlenca (lenacapavir)

+

avatrombopag

1 interaction

Monitor/Modify Tx

lenacapavir + avatrombopag

during and x9mo after lenacapavir tx: CHRONIC IMMUNE THROMBOCYTOPENIA: if also combined w/ a mod-strong CYP2C9 inhibitor, decr. start dose to 20 mg 3x/wk; otherwise, monitor platelets, thrombosis s/sx; otherwise, monitor platelets, thrombosis s/sx; CHRONIC LIVER DZ: monitor platelets, thrombosis s/sx: combo may incr. avatrombopag levels, risk of thromboembolism, other adverse effects (hepatic metab. inhibited)

• axitinib
Sunlenca (lenacapavir)

+

axitinib

1 interaction

Monitor/Modify Tx

lenacapavir + axitinib

consider decr. axitinib dose during and x9mo after lenacapavir tx: combo may incr. axitinib levels, risk of adverse effects (hepatic metab. inhibited)

• brexpiprazole
Sunlenca (lenacapavir)

+

brexpiprazole

1 interaction

Monitor/Modify Tx

lenacapavir + brexpiprazole

if CYP2D6 poor metabolizer or if also combined w/ moderate or strong CYP2D6 inhibitor, decr. brexpiprazole dose 75% during and x9mo after lenacapavir tx: combo may incr. brexpiprazole levels, risk of adverse effects (hepatic metab. inhibited)

• bromocriptine
Sunlenca (lenacapavir)

+

bromocriptine

1 interaction

Monitor/Modify Tx

lenacapavir + bromocriptine

limit bromocriptine max dose to 1.6 mg/day if diabetes tx during and x9mo after lenacapavir tx; otherwise, caution advised during and x9mo after lenacapavir tx: combo may incr. bromocriptine levels, risk of adverse effects (hepatic metab. inhibited)

• budesonide
Sunlenca (lenacapavir)

+

budesonide

1 interaction

Monitor/Modify Tx

lenacapavir + budesonide

monitor hypercorticism s/sx during and x9mo after lenacapavir tx: combo may incr. budesonide levels, risk of systemic corticosteroid effects, incl. Cushing syndrome, adrenal suppression, serious infection, other adverse effects (hepatic metab. inhibited)

• buprenorphine
Sunlenca (lenacapavir)

+

buprenorphine

1 interaction

Monitor/Modify Tx

lenacapavir + buprenorphine

monitor resp. rate, ECG; consider decr. buprenorphine dose during and x9mo after lenacapavir tx: combo may incr. buprenorphine levels, risk of CNS and resp. depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• butorphanol
Sunlenca (lenacapavir)

+

butorphanol

1 interaction

Monitor/Modify Tx

lenacapavir + butorphanol

monitor resp. rate, consider decr. butorphanol dose during and x9mo after lenacapavir tx: combo may incr. butorphanol levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited)

• cabozantinib
Sunlenca (lenacapavir)

+

cabozantinib

1 interaction

Monitor/Modify Tx

lenacapavir + cabozantinib

monitor ECG, BP, bleeding s/sx during and x9mo after lenacapavir tx: combo may incr. cabozantinib levels, risk of QT prolongation, cardiac arrhythmias, HTN, GI or other bleeding (incl. life-threatening), other adverse effects (hepatic metab. inhibited)

• cariprazine
Sunlenca (lenacapavir)

+

cariprazine

1 interaction

Monitor/Modify Tx

lenacapavir + cariprazine

if starting cariprazine tx, adjust dose during and x9mo after lenacapavir tx: SCHIZOPHRENIA/BIPOLAR MANIA: start cariprazine 1.5 mg qod, then may incr. to 1.5 mg qd; BIPOLAR DEPRESSION/DEPRESSION ADJUNCT: start cariprazine 1.5 mg qod; if on stable cariprazine tx and starting lenacapavir, adjust cariprazine dose during and x9mo after lenacapavir tx: ALL INDICATIONS: if on cariprazine 1.5 mg or 3 mg qd, decr. dose to 1.5 mg qod; if on cariprazine 4.5 mg or 6 mg qd, decr. dose to 1.5 mg qd: combo may incr. cariprazine and active metabolite levels, risk of adverse effects (hepatic metab. inhibited)

• cilostazol
Sunlenca (lenacapavir)

+

cilostazol

1 interaction

Monitor/Modify Tx

lenacapavir + cilostazol

decr. cilostazol dose to 50 mg bid during and x9mo after lenacapavir tx: combo may incr. cilostazol levels, risk of adverse effects (hepatic metab. inhibited)

• clonazepam
Sunlenca (lenacapavir)

+

clonazepam

1 interaction

Monitor/Modify Tx

lenacapavir + clonazepam

monitor resp. rate during and x9mo after lenacapavir tx: combo may incr. clonazepam levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited)

• clozapine
Sunlenca (lenacapavir)

+

clozapine

1 interaction

Monitor/Modify Tx

lenacapavir + clozapine

monitor ECG, BP, HR; consider decr. clozapine dose during and x9mo after lenacapavir tx: combo may incr. clozapine levels, risk of QT prolongation, cardiac arrhythmias, hypotension, bradycardia, other adverse effects (hepatic metab. inhibited)

• copanlisib
Sunlenca (lenacapavir)

+

copanlisib

1 interaction

Monitor/Modify Tx

lenacapavir + copanlisib

monitor CBC during and x9mo after lenacapavir tx: combo may incr. copanlisib levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metab. inhibited)

• crizotinib
Sunlenca (lenacapavir)

+

crizotinib

1 interaction

Monitor/Modify Tx

lenacapavir + crizotinib

monitor ECG, electrolytes, CBC during and x9mo after lenacapavir tx: combo may incr. crizotinib levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects (hepatic metab. inhibited)

• daridorexant
Sunlenca (lenacapavir)

+

daridorexant

1 interaction

Monitor/Modify Tx

lenacapavir + daridorexant

adjust max daridorexant dose to 25 mg/day during and x9mo after lenacapavir tx: combo may incr. daridorexant levels, risk of CNS depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited)

• dasatinib
Sunlenca (lenacapavir)

+

dasatinib

1 interaction

Monitor/Modify Tx

lenacapavir + dasatinib

monitor ECG, CBC during and x9mo after lenacapavir tx: combo may incr. dasatinib levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects (hepatic metab. inhibited)

• deflazacort
Sunlenca (lenacapavir)

+

deflazacort

1 interaction

Monitor/Modify Tx

lenacapavir + deflazacort

decr. deflazacort to 1/3 usual dose during and x9mo after lenacapavir tx: combo may incr. deflazacort active metabolite levels, risk of systemic corticosteroid effects incl. Cushing syndrome and adrenal suppression (hepatic metab. inhibited)

• digoxin
Sunlenca (lenacapavir)

+

digoxin

1 interaction

Monitor/Modify Tx

lenacapavir + digoxin

monitor digoxin levels, HR: combo may incr. digoxin levels, risk of bradycardia, AV block, other adverse effects (P-gp-mediated transport inhibited)

• docetaxel
Sunlenca (lenacapavir)

+

docetaxel

1 interaction

Monitor/Modify Tx

lenacapavir + docetaxel

monitor CBC; consider decr. docetaxel dose during and x9mo after lenacapavir tx: combo may incr. docetaxel levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metab. inhibited)

• dofetilide
Sunlenca (lenacapavir)

+

dofetilide

1 interaction

Monitor/Modify Tx

lenacapavir + dofetilide

monitor ECG during and x9mo after lenacapavir tx: combo may incr. dofetilide levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• edoxaban
Sunlenca (lenacapavir)

+

edoxaban

1 interaction

Monitor/Modify Tx

lenacapavir + edoxaban

monitor bleeding s/sx: combo may incr. edoxaban levels, risk of bleeding, other adverse effects (P-gp-mediated transport inhibited)

• elexacaftor/tezacaftor/ivacaftor
Sunlenca (lenacapavir)

+

elexacaftor/ tezacaftor/ ivacaftor

1 interaction

Monitor/Modify Tx

lenacapavir + elexacaftor/ tezacaftor/ ivacaftor

decr. elexacaftor/tezacaftor/ivacaftor dose during and x9mo after lenacapavir tx as follows: 2-5 YO: decr. dose by alternating one elexacaftor/tezacaftor/ivacaftor packet or one ivacaftor packet at each morning dose, no evening doses; 6 YO AND OLDER: decr. dose by alternating two elexacaftor/tezacaftor/ivacaftor tabs or one ivacaftor tab at each morning dose, no evening doses: combo may incr. elexacaftor/tezacaftor/ivacaftor levels, risk of adverse effects (hepatic metab. inhibited)

• enfortumab vedotin
Sunlenca (lenacapavir)

+

enfortumab vedotin

1 interaction

Monitor/Modify Tx

lenacapavir + enfortumab vedotin

if also combined w/ strong CYP3A4 inhibitor, monitor CBC, glucose: combo may incr. enfortumab vedotin levels, risk of myelosuppression, neuropathy, hyperglycemia, other adverse effects (P-gp-mediated transport inhibited)

• eplerenone
Sunlenca (lenacapavir)

+

eplerenone

1 interaction

Monitor/Modify Tx

lenacapavir + eplerenone

monitor potassium, Cr in 3-7 days after eplerenone tx start; in post-MI CHF pts, max eplerenone dose 25 mg/day during and x9mo after lenacapavir tx; in HTN pts, start eplerenone 25 mg qd, max dose 50 mg/day during and x9mo after lenacapavir tx: combo may incr. eplerenone levels, risk of hyperkalemia, other adverse effects (hepatic metab. inhibited)

• erdafitinib
Sunlenca (lenacapavir)

+

erdafitinib

1 interaction

Monitor/Modify Tx

lenacapavir + erdafitinib

monitor phosphate during and x9mo after lenacapavir tx: combo may incr. erdafitinib levels, risk of hyperphosphatemia, other adverse effects (hepatic metab. inhibited)

• estazolam
Sunlenca (lenacapavir)

+

estazolam

1 interaction

Monitor/Modify Tx

lenacapavir + estazolam

monitor resp. rate; consider decr. estazolam dose during and x9mo after lenacapavir tx: combo may incr. estazolam levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited)

• estradiol (contraceptive)
Sunlenca (lenacapavir)

+

estradiol (contraceptive)

1 interaction

Monitor/Modify Tx

lenacapavir + estradiol (contraceptive)

monitor thrombosis s/sx during and x9mo after lenacapavir tx: combo may incr. estradiol levels, risk of thromboembolism, other adverse effects (hepatic metab. inhibited)

• ethinyl estradiol (contraceptive)
Sunlenca (lenacapavir)

+

ethinyl estradiol (contraceptive)

1 interaction

Monitor/Modify Tx

lenacapavir + ethinyl estradiol (contraceptive)

monitor thrombosis s/sx during and x9mo after lenacapavir tx, especially if oral ethinyl estradiol dose >35 mcg/day: combo may incr. ethinyl estradiol levels, risk of thromboembolism, other adverse effects (hepatic metab. inhibited)

• everolimus
Sunlenca (lenacapavir)

+

everolimus

1 interaction

Monitor/Modify Tx

lenacapavir + everolimus

BREAST CA, PNET, RENAL CELL CA, or RENAL ANGIOMYOLIPOMA w/ TSC: decr. everolimus dose to 2.5 mg/day, may then incr. to 5 mg/day if tolerated, monitor CBC during and x9mo after lenacapavir tx; TSC-ASSOC. SEGA or TSC-ASSOC. PARTIAL-ONSET SEIZURES: monitor everolimus levels, CBC during and x9mo after lenacapavir tx and decr. everolimus dose 50%; give every other day if already on lowest available dose; TRANSPLANT: monitor everolimus levels, CBC during and x9mo after lenacapavir tx: combo may incr. everolimus levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• fedratinib
Sunlenca (lenacapavir)

+

fedratinib

1 interaction

Monitor/Modify Tx

lenacapavir + fedratinib

if fedratinib also combined w/ CYP2C19 inhibitor, monitor CBC, LFTs during and x9mo after lenacapavir tx: combo may incr. fedratinib levels, risk myelosuppression, hepatotoxicity, other adverse effects (hepatic metab. inhibited)

• felodipine
Sunlenca (lenacapavir)

+

felodipine

1 interaction

Monitor/Modify Tx

lenacapavir + felodipine

monitor BP, HR during and x9mo after lenacapavir tx: combo may incr. felodipine levels, risk of hypotension, reflex tachycardia, other adverse effects (hepatic metab. inhibited)

• finerenone
Sunlenca (lenacapavir)

+

finerenone

1 interaction

Monitor/Modify Tx

lenacapavir + finerenone

monitor potassium during and x9mo after lenacapavir tx: combo may incr. finerenone levels, risk of hyperkalemia, other adverse effects (hepatic metab. inhibited)

• fluvastatin
Sunlenca (lenacapavir)

+

fluvastatin

1 interaction

Monitor/Modify Tx

lenacapavir + fluvastatin

monitor CK, myopathy sx: combo may incr. fluvastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (BCRP-mediated transport inhibited)

• gepirone
Sunlenca (lenacapavir)

+

gepirone

1 interaction

Monitor/Modify Tx

lenacapavir + gepirone

monitor ECG, electrolytes; decr. gepirone dose 50% during and x9mo after lenacapavir tx: combo may incr. gepirone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• gilteritinib
Sunlenca (lenacapavir)

+

gilteritinib

1 interaction

Monitor/Modify Tx

lenacapavir + gilteritinib

monitor ECG during and x9mo after lenacapavir tx: combo may incr. gilteritinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• glasdegib
Sunlenca (lenacapavir)

+

glasdegib

1 interaction

Monitor/Modify Tx

lenacapavir + glasdegib

monitor CBC, ECG during and x9mo after lenacapavir tx: combo may incr. glasdegib levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects (hepatic metab. inhibited)

• guanfacine
Sunlenca (lenacapavir)

+

guanfacine

1 interaction

Monitor/Modify Tx

lenacapavir + guanfacine

decr. guanfacine ER dose 50% during and x9mo after lenacapavir tx; consider decr. dose for immed.-release form: combo may incr. guanfacine levels, risk of adverse effects (hepatic metab. inhibited)

• hydrocortisone
Sunlenca (lenacapavir)

+

hydrocortisone

1 interaction

Monitor/Modify Tx

lenacapavir + hydrocortisone

consider decr. hydrocortisone dose during and x9mo after lenacapavir tx: combo may incr. hydrocortisone levels, risk of systemic corticosteroid effects, incl. Cushing syndrome and adrenal suppression, other adverse effects (hepatic metab. inhibited)

• ibrutinib
Sunlenca (lenacapavir)

+

ibrutinib

1 interaction

Monitor/Modify Tx

lenacapavir + ibrutinib

B-CELL MALIGNANCIES: decr. ibrutinib dose to 280 mg qd during and x9mo after lenacapavir tx; CHRONIC GVHD: consider decr. ibrutinib dose during and x9mo after lenacapavir tx: combo may incr. ibrutinib levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metab. inhibited)

• iloperidone
Sunlenca (lenacapavir)

+

iloperidone

1 interaction

Monitor/Modify Tx

lenacapavir + iloperidone

monitor ECG during and x9mo after lenacapavir tx: combo may incr. iloperidone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• imatinib
Sunlenca (lenacapavir)

+

imatinib

1 interaction

Monitor/Modify Tx

lenacapavir + imatinib

monitor CBC during and x9mo after lenacapavir tx: combo may incr. imatinib levels, risk of myelosuppression, other adverse effects (BCRP-mediated transport inhibited)

• irinotecan
Sunlenca (lenacapavir)

+

irinotecan

1 interaction

Monitor/Modify Tx

lenacapavir + irinotecan

monitor CBC during and x9mo after lenacapavir tx: combo may incr. irinotecan and active metabolite levels, risk of serious infection, myelosuppression, other toxicities (hepatic metab. inhibited, BCRP-mediated transport inhibited)

• lefamulin
Sunlenca (lenacapavir)

+

lefamulin

1 interaction

Monitor/Modify Tx

lenacapavir + lefamulin

ORAL LEFAMULIN: monitor ECG during and x9mo after lenacapavir tx; IV lefamulin use OK: combo may incr. lefamulin levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• lidocaine
Sunlenca (lenacapavir)

+

lidocaine

1 interaction

Monitor/Modify Tx

lenacapavir + lidocaine

monitor lidocaine levels if lidocaine antiarrhythmic use during and x9mo after lenacapavir tx; otherwise, monitor BP, HR: combo may incr. lidocaine levels, risk of hypotension, bradycardia, other adverse effects; risk may be higher w/ continuous infusion or higher doses for local anesthesia (hepatic metab. inhibited)

• lumateperone
Sunlenca (lenacapavir)

+

lumateperone

1 interaction

Monitor/Modify Tx

lenacapavir + lumateperone

monitor ECG during and x9mo after lenacapavir tx; decr. lumateperone dose to 21 mg qd: combo may incr. lumateperone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• lurasidone
Sunlenca (lenacapavir)

+

lurasidone

1 interaction

Monitor/Modify Tx

lenacapavir + lurasidone

monitor ECG during and x9mo after lenacapavir tx; decr. lurasidone start dose to 20 mg or decr. usual lurasidone dose 50%, max 80 mg/day: combo may incr. lurasidone levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• mefloquine
Sunlenca (lenacapavir)

+

mefloquine

1 interaction

Monitor/Modify Tx

lenacapavir + mefloquine

monitor ECG during and x9mo after lenacapavir tx: combo may incr. mefloquine levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• methadone
Sunlenca (lenacapavir)

+

methadone

1 interaction

Monitor/Modify Tx

lenacapavir + methadone

monitor resp. rate, ECG, consider decr. methadone dose during and x9mo after lenacapavir tx: combo may incr. methadone levels, risk of CNS and resp. depression, psychomotor impairment, QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• methotrexate
Sunlenca (lenacapavir)

+

methotrexate

1 interaction

Monitor/Modify Tx

lenacapavir + methotrexate

monitor CBC, renal fxn: combo may incr. methotrexate levels, risk of serious infection, myelosuppression, nephrotoxicity, other adverse effects (BCRP-mediated transport inhibited)

• midostaurin
Sunlenca (lenacapavir)

+

midostaurin

1 interaction

Monitor/Modify Tx

lenacapavir + midostaurin

monitor ECG, CBC during and x9mo after lenacapavir tx: combo may incr. midostaurin levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects (hepatic metab. inhibited)

• mitoxantrone
Sunlenca (lenacapavir)

+

mitoxantrone

1 interaction

Monitor/Modify Tx

lenacapavir + mitoxantrone

monitor CBC, cardiac fxn, incl. LVEF: combo may incr. mitoxantrone levels, risk of serious infection, myelosuppression, cardiotoxicity, other adverse effects (BCRP-mediated transport inhibited)

• morphine
Sunlenca (lenacapavir)

+

morphine

1 interaction

Monitor/Modify Tx

lenacapavir + morphine

monitor resp. rate, consider decr. morphine dose: combo may incr. morphine levels, risk of CNS and resp. depression, psychomotor impairment, other adverse effects (P-gp-mediated transport inhibited)

• nifedipine
Sunlenca (lenacapavir)

+

nifedipine

1 interaction

Monitor/Modify Tx

lenacapavir + nifedipine

consider lowest nifedipine start dose, monitor BP during and x9mo after lenacapavir tx: combo may incr. nifedipine levels, risk of hypotension, other adverse effects (hepatic metab. inhibited)

• nilotinib
Sunlenca (lenacapavir)

+

nilotinib

1 interaction

Monitor/Modify Tx

lenacapavir + nilotinib

monitor ECG, CBC during and x9mo after lenacapavir tx: combo may incr. nilotinib levels, risk of QT prolongation, cardiac arrhythmias, myelosuppression, other adverse effects (hepatic metab. inhibited)

• nimodipine
Sunlenca (lenacapavir)

+

nimodipine

1 interaction

Monitor/Modify Tx

lenacapavir + nimodipine

monitor BP during and x9mo after lenacapavir tx: combo may incr. nimodipine levels, risk of hypotension, other adverse effects (hepatic metab. inhibited)

• nortriptyline
Sunlenca (lenacapavir)

+

nortriptyline

1 interaction

Monitor/Modify Tx

lenacapavir + nortriptyline

monitor nortriptyline levels during and x9mo after lenacapavir tx: combo may incr. nortriptyline levels, risk of adverse effects (hepatic metab. inhibited)

• orlistat
Sunlenca (lenacapavir)

+

orlistat

1 interaction

Monitor/Modify Tx

lenacapavir + orlistat

monitor antiretroviral efficacy w/ oral lenacapavir: combo may decr. lenacapavir levels, efficacy (mechanism unknown, absorption possibly altered)

• osilodrostat
Sunlenca (lenacapavir)

+

osilodrostat

1 interaction

Monitor/Modify Tx

lenacapavir + osilodrostat

monitor ECG during and x9mo after lenacapavir tx: combo may incr. osilodrostat levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• palbociclib
Sunlenca (lenacapavir)

+

palbociclib

1 interaction

Monitor/Modify Tx

lenacapavir + palbociclib

monitor CBC during and x9mo after lenacapavir tx: combo may incr. palbociclib levels, risk of myelosuppression, other adverse effects (hepatic metab. inhibited)

• panobinostat
Sunlenca (lenacapavir)

+

panobinostat

1 interaction

Monitor/Modify Tx

lenacapavir + panobinostat

monitor ECG, CBC during and x9mo after lenacapavir tx: combo may incr. panobinostat levels, risk of QT prolongation, cardiac arrhythmias, serious infection, myelosuppression, other adverse effects (hepatic metab. inhibited)

• pimavanserin
Sunlenca (lenacapavir)

+

pimavanserin

1 interaction

Monitor/Modify Tx

lenacapavir + pimavanserin

consider monitoring ECG: combo may incr. pimavanserin levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• pirtobrutinib
Sunlenca (lenacapavir)

+

pirtobrutinib

1 interaction

Monitor/Modify Tx

lenacapavir + pirtobrutinib

monitor CBC during and x9mo after lenacapavir tx: combo may incr. pirtobrutinib levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metab. inhibited)

• ponatinib
Sunlenca (lenacapavir)

+

ponatinib

1 interaction

Monitor/Modify Tx

lenacapavir + ponatinib

monitor CBC during and x9mo after lenacapavir tx: combo may incr. ponatinib levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metab. inhibited)

• pravastatin
Sunlenca (lenacapavir)

+

pravastatin

1 interaction

Monitor/Modify Tx

lenacapavir + pravastatin

monitor CK, myopathy sx: combo may incr. pravastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (BCRP-mediated transport inhibited)

• quetiapine
Sunlenca (lenacapavir)

+

quetiapine

1 interaction

Monitor/Modify Tx

lenacapavir + quetiapine

monitor ECG; consider decr. quetiapine dose during and x9mo after lenacapavir tx: combo may incr. quetiapine levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• quinidine (CYP2D6 inhibitor)
Sunlenca (lenacapavir)

+

quinidine (CYP2D6 inhibitor)

1 interaction

Monitor/Modify Tx

lenacapavir + quinidine (CYP2D6 inhibitor)

monitor ECG during and x9mo after lenacapavir tx: combo may incr. quinidine levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• quinine
Sunlenca (lenacapavir)

+

quinine

1 interaction

Monitor/Modify Tx

lenacapavir + quinine

monitor ECG during and x9mo after lenacapavir tx: combo may incr. quinine levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• quizartinib
Sunlenca (lenacapavir)

+

quizartinib

1 interaction

Monitor/Modify Tx

lenacapavir + quizartinib

monitor ECG, electrolytes during and x9mo after lenacapavir: combo may incr. quizartinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• red yeast rice
Sunlenca (lenacapavir)

+

red yeast rice

1 interaction

Monitor/Modify Tx

lenacapavir + red yeast rice

monitor CK, myopathy sx w/ large amounts of red yeast rice, during and x9mo after lenacapavir tx: combo may incr. lovastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (hepatic metab. inhibited, red yeast rice contains varying amounts of lovastatin)

• repaglinide
Sunlenca (lenacapavir)

+

repaglinide

1 interaction

Monitor/Modify Tx

lenacapavir + repaglinide

monitor glucose during and x9mo after lenacapavir tx: combo may incr. repaglinide levels, risk of hypoglycemia, other adverse effects (hepatic metab. inhibited)

• rimegepant
Sunlenca (lenacapavir)

+

rimegepant

1 interaction

Monitor/Modify Tx

lenacapavir + rimegepant

separate rimegepant doses by at least 48h during and x9mo after lenacapavir tx: combo may incr. rimegepant levels, risk of adverse effects (hepatic metab. inhibited)

• riociguat
Sunlenca (lenacapavir)

+

riociguat

1 interaction

Monitor/Modify Tx

lenacapavir + riociguat

consider decr. riociguat start dose to 0.5 mg PO tid; monitor BP during and x9mo after lenacapavir tx: combo may incr. riociguat levels, risk of severe hypotension, other adverse effects (hepatic metab. inhibited, BCRP-mediated transport inhibited)

• rosuvastatin
Sunlenca (lenacapavir)

+

rosuvastatin

1 interaction

Monitor/Modify Tx

lenacapavir + rosuvastatin

monitor CK, myopathy sx: combo may incr. rosuvastatin levels, risk of myopathy, rhabdomyolysis, other adverse effects (BCRP-mediated transport inhibited)

• ruxolitinib
Sunlenca (lenacapavir)

+

ruxolitinib

1 interaction

Monitor/Modify Tx

lenacapavir + ruxolitinib

monitor CBC during and x9mo after lenacapavir tx: combo may incr. ruxolitinib levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metab. inhibited)

• ruxolitinib topical
Sunlenca (lenacapavir)

+

ruxolitinib topical

1 interaction

Monitor/Modify Tx

lenacapavir + ruxolitinib topical

monitor CBC during and x9mo after lenacapavir tx: combo may incr. ruxolitinib levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metab. inhibited)

• sertraline
Sunlenca (lenacapavir)

+

sertraline

1 interaction

Monitor/Modify Tx

lenacapavir + sertraline

monitor ECG during and x9mo after lenacapavir tx: combo may incr. sertraline levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• sildenafil
Sunlenca (lenacapavir)

+

sildenafil

1 interaction

Monitor/Modify Tx

lenacapavir + sildenafil

PULMONARY HTN: caution advised during and x9mo after lenacapavir tx; ED: consider decr. sildenafil start dose to 25 mg during and x9mo after lenacapavir tx: combo may incr. sildenafil levels, risk of hypotension, priapism, other adverse effects (hepatic metab. inhibited)

• sirolimus
Sunlenca (lenacapavir)

+

sirolimus

1 interaction

Monitor/Modify Tx

lenacapavir + sirolimus

monitor sirolimus levels during and x9mo after lenacapavir tx: combo may incr. sirolimus levels, risk of serious infection, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• sparsentan
Sunlenca (lenacapavir)

+

sparsentan

1 interaction

Monitor/Modify Tx

lenacapavir + sparsentan

monitor BP, potassium, renal fxn: combo may incr. sparsentan levels, risk of hypotension (incl. orthostasis, syncope), hyperkalemia, edema, nephrotoxicity, other adverse effects (hepatic metab. inhibited)

• sunitinib
Sunlenca (lenacapavir)

+

sunitinib

1 interaction

Monitor/Modify Tx

lenacapavir + sunitinib

consider monitoring ECG, electrolytes during and x9mo after lenacapavir tx: combo may incr. sunitinib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• suvorexant
Sunlenca (lenacapavir)

+

suvorexant

1 interaction

Monitor/Modify Tx

lenacapavir + suvorexant

decr. suvorexant dose to 5 mg, max 10 mg/day during and x9mo after lenacapavir tx: combo may incr. suvorexant levels, risk of CNS depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited)

• suzetrigine
Sunlenca (lenacapavir)

+

suzetrigine

1 interaction

Monitor/Modify Tx

lenacapavir + suzetrigine

start suzetrigine 100 mg x1 at least 1h before or 2h after food, after 12h give 50 mg q12h x3 doses, then after 12h give 50mg q24h: combo may incr. suzetrigine and active metabolite levels, risk of adverse effects; may decr. lenacapavir levels, efficacy (hepatic metab. inhibited; hepatic metab. induced)

• tacrolimus
Sunlenca (lenacapavir)

+

tacrolimus

1 interaction

Monitor/Modify Tx

lenacapavir + tacrolimus

monitor tacrolimus levels, ECG, renal fxn during and x9mo after lenacapavir tx: combo may incr. tacrolimus levels, risk of QT prolongation, cardiac arrhythmias, nephrotoxicity, other adverse effects (hepatic metab. inhibited, P-gp-mediated transport inhibited)

• talazoparib
Sunlenca (lenacapavir)

+

talazoparib

1 interaction

Monitor/Modify Tx

lenacapavir + talazoparib

monitor CBC: combo may incr. talazoparib levels, risk of myelosuppression, other adverse effects (BCRP-mediated transport inhibited, P-gp-mediated transport inhibited)

• tamsulosin
Sunlenca (lenacapavir)

+

tamsulosin

1 interaction

Monitor/Modify Tx

lenacapavir + tamsulosin

monitor BP during and x9mo after lenacapavir tx, especially w/ tamsulosin dose >0.4 mg: combo may incr. tamsulosin levels, risk of hypotension (incl. orthostasis, syncope), other adverse effects (hepatic metab. inhibited)

• temsirolimus
Sunlenca (lenacapavir)

+

temsirolimus

1 interaction

Monitor/Modify Tx

lenacapavir + temsirolimus

monitor CBC; consider decr. temsirolimus dose during and x9mo after lenacapavir tx: combo may incr. temsirolimus and active metabolite sirolimus levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metab. inhibited)

• tenofovir disoproxil
Sunlenca (lenacapavir)

+

tenofovir disoproxil

1 interaction

Monitor/Modify Tx

lenacapavir + tenofovir disoproxil

monitor renal fxn w/ oral lenacapavir: combo may incr. tenofovir levels, risk of nephrotoxicity, other adverse effects (gut BCRP-mediated transport inhibited, gut P-gp-mediated transport inhibited)

• tezacaftor/ivacaftor
Sunlenca (lenacapavir)

+

tezacaftor/ ivacaftor

1 interaction

Monitor/Modify Tx

lenacapavir + tezacaftor/ ivacaftor

decr. dose during and x9mo after lenacapavir tx by alternating tezacaftor/ivacaftor tab and ivacaftor tab at morning dose, no evening doses: combo may incr. tezacaftor/ivacaftor levels, risk of adverse effects (hepatic metab. inhibited)

• tofacitinib
Sunlenca (lenacapavir)

+

tofacitinib

1 interaction

Monitor/Modify Tx

lenacapavir + tofacitinib

monitor CBC; if also combined w/ strong CYP2C19 inhibitor, adjust tofacitinib dose during and x9mo after lenacapavir tx as follows: RHEUMATOID or PSORIATIC ARTHRITIS: decr. tofacitinib dose to 5 mg qd; ULCERATIVE COLITIS: decr. tofacitinib 22 mg qd dose to 11 mg qd; decr. tofacitinib 11 mg qd dose to 5 mg qd; decr. tofacitinib 10 mg bid dose to 5 mg bid; decr. tofacitinib 5 mg bid dose to 5 mg qd; JUVENILE IDIOPATHIC ARTHRITIS: decr. usual tofacitinib bid dose to qd: combo may incr. tofacitinib levels, risk of serious infection, myelosuppression, other adverse effects (hepatic metab. inhibited)

• toremifene
Sunlenca (lenacapavir)

+

toremifene

1 interaction

Monitor/Modify Tx

lenacapavir + toremifene

monitor ECG during and x9mo after lenacapavir tx: combo may incr. toremifene levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects (hepatic metab. inhibited)

• trabectedin
Sunlenca (lenacapavir)

+

trabectedin

1 interaction

Monitor/Modify Tx

lenacapavir + trabectedin

monitor CBC, cardiac fxn, LFTs during and x9mo after lenacapavir tx: combo may incr. trabectedin levels, risk of myelosuppression, cardiotoxicity, hepatotoxicity, other adverse effects (hepatic metab. inhibited)

• trazodone
Sunlenca (lenacapavir)

+

trazodone

1 interaction

Monitor/Modify Tx

lenacapavir + trazodone

monitor ECG, BP during and x9mo after lenacapavir tx: combo may incr. trazodone levels, risk of QT prolongation, cardiac arrhythmias, hypotension (incl. orthostasis, syncope), other adverse effects (hepatic metab. inhibited)

• triazolam
Sunlenca (lenacapavir)

+

triazolam

1 interaction

Monitor/Modify Tx

lenacapavir + triazolam

monitor resp. rate during and x9mo after lenacapavir tx; consider decr. triazolam dose: combo may incr. triazolam levels, risk of CNS depression, psychomotor impairment, other adverse effects (hepatic metab. inhibited)

• ubrogepant
Sunlenca (lenacapavir)

+

ubrogepant

1 interaction

Monitor/Modify Tx

lenacapavir + ubrogepant

limit ubrogepant dose to 50 mg during and x9mo after lenacapavir tx, may give second 50 mg dose after 24h if needed: combo may incr. ubrogepant levels, risk of adverse effects (hepatic metab. inhibited, BCRP-mediated transport inhibited, P-gp-mediated transport inhibited)

• vanzacaftor/tezacaftor/deutivacaftor
Sunlenca (lenacapavir)

+

vanzacaftor/ tezacaftor/ deutivacaftor

1 interaction

Monitor/Modify Tx

lenacapavir + vanzacaftor/ tezacaftor/ deutivacaftor

during and x9mo after lenacapavir tx, adjust vanzacaftor/tezacaftor/deutivacaftor dose as follows: 6-11 YO AND WT <40 KG: decr. vanzacaftor/tezacaftor/deutivacaftor dose to two tablets (4 mg/20 mg/50 mg each) qod; 6-11 YO AND WT 40 KG AND ABOVE: decr. vanzacaftor/tezacaftor/deutivacaftor dose to one tablet (10 mg/50 mg/125 mg) qod; 12 YO AND OLDER: decr. vanzacaftor/tezacaftor/deutivacaftor dose to one tablet (10 mg/50 mg/125 mg) qod: combo may incr. vanzacaftor/tezacaftor/deutivacaftor levels, risk of adverse effects (hepatic metab. inhibited)

• vemurafenib
Sunlenca (lenacapavir)

+

vemurafenib

1 interaction

Monitor/Modify Tx

lenacapavir + vemurafenib

monitor ECG during and x9mo after lenacapavir tx: combo may incr. vemurafenib levels, risk of QT prolongation, cardiac arrhythmias, other adverse effects; may incr. or decr. lenacapavir levels, incr. risk of adverse effects or decr. efficacy (hepatic metab. inhibited; P-gp-mediated transport inhibited, hepatic metab. induced)

• vinblastine
Sunlenca (lenacapavir)

+

vinblastine

1 interaction

Monitor/Modify Tx

lenacapavir + vinblastine

monitor CBC during and x9mo after lenacapavir tx: combo may incr. vinblastine levels, risk of serious infection, myelosuppression, autonomic neuropathy, other adverse effects; may decr. lenacapavir levels, efficacy (hepatic metab. inhibited; hepatic metab. induced)

• vincristine
Sunlenca (lenacapavir)

+

vincristine

1 interaction

Monitor/Modify Tx

lenacapavir + vincristine

monitor CBC during and x9mo after lenacapavir tx: combo may incr. vincristine levels, risk of serious infection, myelosuppression, autonomic neuropathy, other adverse effects (hepatic metab. inhibited)

• vinorelbine
Sunlenca (lenacapavir)

+

vinorelbine

1 interaction

Monitor/Modify Tx

lenacapavir + vinorelbine

monitor CBC during and x9mo after lenacapavir tx: combo may incr. vinorelbine levels, risk of serious infection, myelosuppression, autonomic neuropathy, other adverse effects (hepatic metab. inhibited)

• voclosporin
Sunlenca (lenacapavir)

+

voclosporin

1 interaction

Monitor/Modify Tx

lenacapavir + voclosporin

monitor ECG, renal fxn; decr. voclosporin morning dose to 15.8 mg and evening dose to 7.9 mg during and x9mo after lenacapavir tx: combo may incr. voclosporin levels, risk of QT prolongation, cardiac arrhythmias, serious infection, nephrotoxicity, other adverse effects (hepatic metab. inhibited)

• warfarin
Sunlenca (lenacapavir)

+

warfarin

1 interaction

Monitor/Modify Tx

lenacapavir + warfarin

monitor INR, bleeding s/sx, especially during initiation/titration, during and x9mo after lenacapavir tx: combo may incr. warfarin levels, risk of bleeding (incl. life-threatening), other adverse effects (hepatic metab. inhibited)

• zanubrutinib
Sunlenca (lenacapavir)

+

zanubrutinib

1 interaction

Monitor/Modify Tx

lenacapavir + zanubrutinib

decr. zanubrutinib dose to 80 mg bid; monitor CBC during and x9mo after lenacapavir tx: combo may incr. zanubrutinib levels, risk of serious infection, myelosuppression, other adverse effects; may decr. lenacapavir levels, efficacy (hepatic metab. inhibited; hepatic metab. induced)