BIKTARVY and Doxycycline: Safety of Co-administration
BIKTARVY (bictegravir, emtricitabine, and tenofovir alafenamide) can be safely co-administered with doxycycline without dose adjustments, as there are no significant drug-drug interactions between these medications.
Mechanism and Interaction Profile
- BIKTARVY contains bictegravir, which is an integrase strand transfer inhibitor (InSTI) with minimal drug-drug interactions with medications metabolized through the CYP450 pathway 1
- Doxycycline is not known to have significant interactions with InSTI-based regimens like BIKTARVY 2
- Unboosted InSTI-based regimens like BIKTARVY are recommended specifically because they have fewer drug-drug interactions compared to other antiretroviral classes 2
- Bictegravir does not significantly induce or inhibit CYP450 enzymes, making it compatible with many medications including antibiotics like doxycycline 1
Clinical Recommendations
- InSTI-based regimens such as BIKTARVY are preferred when co-administered with other medications due to their favorable drug interaction profiles 2
- No dose adjustments are required for either BIKTARVY or doxycycline when used together 1
- For patients requiring both HIV treatment and antibiotics for conditions such as sexually transmitted infections, skin infections, or malaria prophylaxis, BIKTARVY maintains its efficacy without compromising the effectiveness of doxycycline 2
Important Considerations
- While BIKTARVY has minimal interactions with doxycycline, be aware that certain other medications may interact with either drug independently 1
- Unlike some antiretrovirals (such as atazanavir) that have significant interactions with acid-reducing agents, BIKTARVY and doxycycline can be taken without specific timing requirements related to antacids 3
- BIKTARVY has demonstrated high efficacy and tolerability in clinical trials, with viral suppression rates of 84-88% at 96 weeks, making it a reliable option for patients who may require concomitant medications like doxycycline 4, 5
Monitoring Recommendations
- Regular monitoring of HIV viral load is recommended to ensure continued virological suppression when BIKTARVY is co-administered with any medication, including doxycycline 2
- Monitor for the common side effects of each medication independently, as their adverse effect profiles do not significantly overlap or potentiate each other 4
- Common side effects of BIKTARVY include nausea (8-11%), diarrhea (15-18%), and headache (13-16%), while doxycycline may cause gastrointestinal symptoms and photosensitivity 4, 5
Special Populations
- For patients with HIV/HBV coinfection, BIKTARVY is particularly advantageous as it contains tenofovir alafenamide, which is active against both viruses, and can be safely used with doxycycline 6
- In patients with renal impairment, BIKTARVY can be used if creatinine clearance is above 30 mL/min/1.73 m², while doxycycline does not require dose adjustment in renal impairment 2