Coadministration has not been assessed in a pharmacokinetic clinical study. Paclitaxel is primarily metabolized by CYP2C8 and to a lesser extent by CYP3A4. In vitro data suggest that paclitaxel activates PXR and therefore could potentially decrease bictegravir concentrations due to induction of CYP3A4 and UGT1A1. A case series of 25 patients receiving paclitaxel and integrase inhibitors (including 6 receiving a bictegravir, emtricitabine, tenofovir alafenamide) showed that the coadministration of paclitaxel did not result in virological failure possibly explained by paclitaxel intermittent dosing and short elimination half-life. Monitor response to antiretroviral therapy. Emtricitabine and tenofovir alafenamide are unlikely to interact with this metabolic pathway.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Clindamycin is metabolized by CYP3A4. Bictegravir does not inhibit or induce CYP450 enzymes; emtricitabine and tenofovir alafenamide do not interact with clindamycin’s metabolic pathway. 

Coadministration has not been studied but based on metabolism and clearance, a clinically significant interaction is unlikely. Ticagrelor undergoes extensive CYP3A4 metabolism. Bictegravir does not inhibit or induce CYP450 enzymes; emtricitabine and tenofovir alafenamide do not interact with ticagrelor’s metabolic pathway.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Carboplatin is excreted primarily by renal glomerular filtration and therefore there is little potential for a pharmacokinetic interaction. Note: coadministration with nephrotoxic agents is unlikely to be of concern for tenofovir alafenamide which results in 90% lower systemic levels of tenofovir compared to tenofovir-DF. 

Coadministration with bictegravir/emtricitabine/tenofovir alafenamide has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Coadministration of sertraline (50 mg single dose) and emtricitabine/tenofovir alafenamide (200/10 mg once daily, with elvitegravir/cobicistat) increased sertraline Cmax by 14% and decreased AUC by 7%.

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ibuprofen is metabolized mainly by CYP2C9 and to a lesser extent by CYP2C8 and direct glucuronidation. Bictegravir does not inhibit or induce CYP450 or UGT enzymes. In addition, coadministration with an NSAID is unlikely to be of concern for nephrotoxicity as tenofovir alafenamide results in 90% lower systemic levels of tenofovir compared to tenofovir-DF.