What are the potential interactions between Amiodarone and Biktarvy (bictegravir, emtricitabine, and tenofovir alafenamide) in patients with arrhythmia and HIV-1 infection?

From the Guidelines

Amiodarone and Biktarvy should be used together with caution due to potential drug interactions, and close monitoring of cardiac and renal function is recommended. The primary concern is the interaction between amiodarone, which is metabolized by CYP3A4, and bictegravir, a component of Biktarvy, which is a moderate inhibitor of this enzyme 1. This interaction may increase amiodarone blood levels, potentially leading to QT prolongation and life-threatening arrhythmias.

Some key points to consider when co-administering these medications include:

• Close cardiac monitoring, including baseline and follow-up ECGs, particularly during the first few weeks of co-administration
• Dose adjustment of amiodarone may be necessary based on clinical response and drug levels
• Renal function should be monitored regularly, as both medications can cause kidney dysfunction
• Tenofovir alafenamide levels may also be affected by amiodarone through P-glycoprotein inhibition
• Patients should be educated about symptoms of toxicity, including dizziness, bradycardia, and visual disturbances

It's also important to note that the benefits of treating both conditions simultaneously must be weighed against these interaction risks, and alternative HIV medications might be considered if the patient has significant cardiac disease or is on high-dose amiodarone therapy. However, the provided evidence does not directly address the interaction between amiodarone and Biktarvy, but rather provides information on the pharmacokinetics and potential interactions of the individual components 1.

In clinical practice, the decision to co-administer these medications should be made on a case-by-case basis, taking into account the individual patient's medical history, current medications, and potential risks and benefits. The most recent and highest quality study available should be consulted to inform this decision.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Potential Interactions between Amiodarone and Biktarvy

The potential interactions between Amiodarone and Biktarvy (bictegravir, emtricitabine, and tenofovir alafenamide) in patients with arrhythmia and HIV-1 infection are not directly addressed in the provided studies. However, some information can be inferred:

• Amiodarone is known to interact with several medications, including warfarin, simvastatin, and atorvastatin, as well as many HIV antiretroviral medications 2.
• The pharmacokinetic interaction risks of bictegravir appear to be low 3.
• There is no direct evidence of interactions between amiodarone and bictegravir, emtricitabine, or tenofovir alafenamide in the provided studies.

Considerations for Patients with Arrhythmia and HIV-1 Infection

Some key points to consider when treating patients with arrhythmia and HIV-1 infection:

• Amiodarone is a potent antiarrhythmic medication that can be used to treat various types of arrhythmias, including atrial fibrillation and ventricular tachycardia 4, 5, 6.
• Biktarvy (bictegravir, emtricitabine, and tenofovir alafenamide) is a coformulation used to treat HIV-1 infection in antiretroviral naïve subjects and in those with suppressed viremia 3.
• Patients treated with amiodarone require close supervision by the treating physician due to the risk of non-cardiac toxicity and common drug-drug interactions 4.
• The use of amiodarone in patients with HIV-1 infection should be carefully considered, taking into account the potential interactions with antiretroviral medications 2.

Key Points about Amiodarone and Biktarvy

Some key points about amiodarone and Biktarvy:

• Amiodarone has a high risk of non-cardiac toxicity, including thyroid, liver, and pulmonary toxicity, which requires serial screening 4, 5.
• Biktarvy has a low risk of pharmacokinetic interactions, but its use in combination with amiodarone should be carefully monitored 3.
• The coformulation bictegravir/emtricitabine/tenofovir alafenamide is a new option in the management of patients with HIV-1 infection, but its use in combination with amiodarone requires careful consideration of potential interactions 3.