10 Genvoya Interactions to Know About, From Blood Pressure Medications to Benzodiazepines

GoodRx Health

HIV treatment has become simpler over time. Today, you can take a single tablet to manage the condition. Modern HIV treatments contain multiple medications in one pill.

Genvoya (elvitegravir / cobicistat / emtricitabine / tenofovir alafenamide) is one medication that treats HIV as a complete medication regimen. It consists of four different medications that work together to keep HIV at bay. But more medications can sometimes translate to more drug interactions.

Here, we'll explore common 10 Genvoya interactions that you should be aware of. We'll also touch on tips to minimize your risk of interactions.

Why Genvoya interactions happen

Cobicistat (Tybost) is the culprit behind many Genvoya interactions. Like a sidekick, it enhances the effects of Genvoya's other active ingredients. This makes them more effective. Cobicistat does this by intentionally blocking certain liver enzymes (proteins) that normally break them down.

But these are the same enzymes that break down many other medications. Cobicistat can inadvertently increase the blood levels of other medications by blocking these enzymes. This increases the risk of side effects.

It's a two-way street, though. Other medications can also influence Genvoya. This is because of similar enzyme interactions. Medications that affect your kidney health can also worsen Genvoya's side effects.

1. Other HIV treatments

Genvoya is a complete HIV treatment by itself. This means you shouldn't take other HIV medications in combination with it. Doing so is unnecessary and can lead to a greater risk of side effects.

Make sure to share a complete list of medications you take with an HIV specialist. They can help you avoid taking any unnecessary treatments. Also speak with them before you make any changes to your HIV treatment regimen.

2. Antiarrhythmics

Your heart beats to a rhythm, much like your favorite song. But your heart's rhythm can get out of sync in some cases. This is where antiarrhythmics can help.

Your antiarrhythmic medication may interact with Genvoya, though. Genvoya can cause levels of antiarrhythmic medications in your blood to rise. This makes side effects more likely. Examples of interacting antiarrhythmics include:

• Amiodarone (Pacerone)

• Digoxin (Lanoxin)

• Disopyramide (Norpace)

• Flecainide

• Propafenone

• Quinidine

If you take Genvoya and an antiarrhythmic medication, a cardiologist should monitor your lab work closely. This will help ensure the amount of medication in your blood doesn't get too high.

3. Certain blood pressure medications

Blood pressure medications are one important tool to help lower your blood pressure to your target range. They're among the most commonly prescribed medications overall.

Genvoya may interact with a few blood pressure medications, namely calcium channel blockers and beta blockers. This combination may result in blood pressure that is too low. This interaction includes medications such as:

• Amlodipine (Norvasc)

• Diltiazem (Cardizem)

• Felodipine

• Metoprolol (Lopressor, Toprol XL)

• Atenolol (Tenormin)

• Carvedilol (Coreg)

Like antiarrhythmics, you shouldn't need to avoid these blood pressure medications altogether. Instead, your prescriber will likely want to keep an eye on how you tolerate the combination. They may lower your blood pressure medication dose if needed.

4. Blood thinners

Genvoya interacts with many blood thinners, causing their levels to go up. Blood that is too "thin" increases the risk of bleeding.

Specific management tips vary based on the blood thinner you're prescribed. For example, you shouldn't take rivaroxaban (Xarelto) with Genvoya at all because of a high risk of bleeding. But if you take apixaban (Eliquis), your cardiologist may OK the combination. They may adjust your apixaban dose as a precaution.

Genvoya's effect on warfarin (Coumadin, Jantoven) is less certain. Your cardiologist will likely monitor your lab tests more frequently if you're prescribed Genvoya and warfarin at the same time.

5. PDE5 inhibitors

Sildenafil (Revatio) and tadalafil (Adcirca) are phosphodiesterase 5 (PDE5) inhibitors that treat high blood pressure in the lungs (pulmonary hypertension). Sildenafil (Viagra) and tadalafil (Cialis) also treat erectile dysfunction (ED).

PDE5 inhibitors are beneficial for many people. But taking them with Genvoya may cause PDE5 inhibitor blood levels to surge. Again, this increases side effect risks.

PDE5 inhibitors for pulmonary hypertension

You shouldn't take sildenafil with Genvoya if you're prescribed it for pulmonary hypertension. Dangerously low blood pressure, vision changes, and fainting may occur when taken together.

Tadalafil for pulmonary hypertension has similar risks, but you may not need to avoid it with Genvoya completely. Your prescriber may reduce your tadalafil dose instead.

PDE5 inhibitors for ED

Some experts recommend avoiding avanafil (Stendra) - another PDE5 inhibitor - with Genvoya. This is because it has similar risks as sildenafil. But other PDE5 inhibitors are typically OK to use with caution. Your prescriber may allow you to occasionally take small doses of sildenafil, tadalafil, or vardenafil (Levitra).

6. Statins

Statins are effective medications for lowering your cholesterol. But Genvoya can increase the risk of statin side effects.

Lovastatin (Altoprev) and simvastatin (Zocor) are the two statins you should avoid taking with Genvoya. Atorvastatin (Lipitor) is OK as long as you take a lower dose (no more than 20 mg a day). Other statins aren't known to interact to the same degree.

Notable statin side effects to keep in mind are muscle pain and a rare but serious condition known as rhabdomyolysis. Rhabdomyolysis can cause your muscles to break down and eventually lead to kidney harm. It's a medical emergency.

If you take Genvoya and a statin together and experience muscle pain (or any other bothersome side effects), tell your prescriber. They can make adjustments to your statin regimen to avoid any serious complications.

7. Antidepressants and antipsychotics

Antidepressants and antipsychotics are two broad medication classes that treat behavioral health conditions, such as depression and schizophrenia.

Antidepressants you may be familiar with include:

• Citalopram (Celexa)

• Fluoxetine (Prozac)

• Paroxetine (Paxil)

• Amitriptyline

• Bupropion (Wellbutrin XL)

Genvoya can increase the levels of antidepressants like these. There is good news, though. This interaction typically doesn't need to be avoided. A psychiatrist may reduce your antidepressant dose and monitor you more closely moving forward. Sertraline (Zoloft) seems to interact less than some other antidepressants, so it may be a good alternative.

Antipsychotics can also interact with Genvoya. A psychiatrist may adjust your quetiapine (Seroquel) dose when you're taking both medications together. Other antipsychotics, such as lurasidone (Latuda) and pimozide, should be avoided while you're taking Genvoya.

8. Benzodiazepines

Benzodiazepines can be useful tools for managing anxiety and certain sleep issues, such as falling and staying asleep. But they can have significant interactions when paired with Genvoya.

Genvoya decreases the breakdown of several benzodiazepine medications, including diazepam (Valium), triazolam (Halcion), and alprazolam (Xanax). This increases the odds of experiencing serious side effects, such as slowed breathing.

As a precaution, your prescriber may switch your benzodiazepine prescription to something else while you're taking Genvoya. This is done on a case-by-case basis.

9. Anti-seizure medications

Carbamazepine (Tegretol) and phenytoin (Dilantin) are common anti-seizure medications. They cause a different interaction than the medications above. They accelerate liver enzymes that break down Genvoya. This can cause Genvoya to be less effective, which can result in undertreated or difficult-to-treat HIV.

It's not recommended to take Genvoya with medications like these. But finding the right anti-seizure regimen can be difficult. Your prescriber may switch your HIV or anti-seizure regimen to make sure there aren't medication conflicts.

Ethosuximide (Zarontin) is another medication that treats seizures. But it has a different interaction with Genvoya. Genvoya can increase the levels of ethosuximide in your blood, which increases the risk of ethosuximide side effects.

10. Medications and supplements that have polyvalent cations

Some medications contain polyvalent cations. These are natural metals, such as calcium, aluminum, and magnesium. Polyvalent cations are found in many multivitamins, antacids, and laxatives.

Medications, supplements, and foods that contain polyvalent cations can reduce Genvoya's effectiveness. They "stick" to Genvoya in your gut, making it harder for your body to absorb it. Examples of polyvalent cation-containing medications include Mylanta (aluminum hydroxide / magnesium hydroxide / simethicone), Tums (calcium carbonate), and sucralfate (Carafate). They can also be found in many dairy products, such as milk and yogurt.

You don't need to avoid these products altogether. Wait 2 hours before or after taking Genvoya before you take something containing polyvalent cations.

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