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ESRD on Biktarvy and Advair, atorvastatin

  • 1.  ESRD on Biktarvy and Advair, atorvastatin

    Posted 07-05-2022 14:39
    I have an 81 yom who was just recently discontinued on Biktarvy due to CrCl 16 by his nephrologist. Although he was well controlled on it, I am looking for alternatives as his med list has lots of drug interactions with alternatives. What would you recommend for someone who is taking mirtazapine, losartan, atorvastatin, Advair & Proair, and Spiriva? He is not currently on dialysis. Thanks for your help in advance!

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    Cameron Staiger, PharmD
    Beaufort SC
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  • 2.  RE: ESRD on Biktarvy and Advair, atorvastatin

    Posted 07-05-2022 15:40
    Dear Cameron,
    I suggest you change him to DTG/RPV (Juluca).
    I generally check HIV Drug Interactions:
    Link below:

    In doing so, only the mirtazapine has a slight interaction (low probability) interaction with rilpivirine.
    Hope this helps,
    David


    --
    W. David Hardy, MD
    Scientific and Medical Consultant
    E-mail: wdavidhardymd@gmail.com
    Telephone:
    310-709-3505 (Mobile)





  • 3.  RE: ESRD on Biktarvy and Advair, atorvastatin

    Posted 07-05-2022 16:02
    Hi. DTG y DOR don´t require renal dose adjustment, and don´t have interactions with any of those drugs.
    3TC doesn´t interact but needs dose adjustment (50-100 mg qd). 

    Have a nice day.

    --
    Isaac Brito, MD, AAHIVS





  • 4.  RE: ESRD on Biktarvy and Advair, atorvastatin

    Posted 07-05-2022 17:48
    Good Afternoon, You do not mention if the patient has any resistance? A possible regimen could be Tivicay 50 mg PO QD and Lamivudine 150 mg PO x 1 dose, then 100 mg PO QD.

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    Michael Roggelin MSN, AGNP-C, FPA-ANP, AAHIVS
    Orlando, FL
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  • 5.  RE: ESRD on Biktarvy and Advair, atorvastatin

    Posted 07-05-2022 19:25
    Off the top of my head without checking I would look at Juluca. 


    ------------------------------
    Angel Ribo PA-C
    Outreach Community Care Networ
    Daytona Beach, FL
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  • 6.  RE: ESRD on Biktarvy and Advair, atorvastatin

    Posted 07-05-2022 21:12
    Edited by Ahmad Akbar Sapie 07-05-2022 21:20
    More information needed:

    ESRD and ART
    1. CrCl = 16 ml/min ( ESRD Stage = 4).  Losartan is recommend for ESRD. Further review is need to know the blood pressure chart to ensure the blood pressure under control.

    Consult nephrologist to start dialysis and  losartan cannot be consume prior of dialysis (reduce the AUC) 

    2. For prolong viral suppression, patient need to take Antiretroviral regimen. Recommend for DTG based regimen ie: DTG/RILPIVIRNE or DTG/3TC

    Depression
    3. It's okay to continue Mirtazipine, but with lower dose. Recommend to switch for SSRI drug groups because protein bound, metabolise by liver and no affected or affecting by dialysis. 

    COPD
    4. Review the severity of the COPD particularly for past 6 months or a year:
    -history of asthma attack 
    -history of hospitalisation
    -lung function test (FEV/FEC)
    -compliance and technique of inhaler
    -i would recommend to add inhale corticosteroids to Spiriva (ICS-LABA) and discontinue Advair/Proair.


    ------------------------------
    Akbar Jaya, BPharm (Hons)
    ------------------------------



  • 7.  RE: ESRD on Biktarvy and Advair, atorvastatin

    Posted 07-05-2022 21:49
    Depending on past genotypes-if he could use ripilvirine ie not on a PPI the juluca is easy for CKD patients.

    ------------------------------
    Judy Davidoff, MD, FAAFP, AAHIVM
    Chase Brexton Health Care
    Baltimore, MD 21201
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  • 8.  RE: ESRD on Biktarvy and Advair, atorvastatin

    Posted 07-05-2022 23:18
    . If he’s compliant without a history of resistance mutations he can probably get by on Dovato alone.
    If you prefer a 3 drug regimen add Edurant or Prezcobix, you may need to lower the atorvastatin dose a little if CK or LFTs rise but should be fine.
    Weird so many HIV drugs are liver dependent not renal.
    Sent from my iPad




  • 9.  RE: ESRD on Biktarvy and Advair, atorvastatin

    Posted 07-06-2022 18:56
    Like many in the group have suggested - I have used Juluca in CKD4/ESRD and there was no contraindication nor renal dosing needed.
    As more of our patients age and have multiple comorbidities like DM2/HTN - renal dosing is going to pose more of an issue.

    Good luck!

    ------------------------------
    Sara Back
    North Central Bronx Hospital
    New York NY
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  • 10.  RE: ESRD on Biktarvy and Advair, atorvastatin

    Posted 07-07-2022 22:57
    I LOVE Tivicay+Pifeltro for my ESRD patients. Very few a/e and fewer interactions… and can be used with PPI since everyone is on one now a days! Good luck!

    ------------------------------
    Randy Gelow
    Phoenix AZ
    randygelow@gmail.com
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  • 11.  RE: ESRD on Biktarvy and Advair, atorvastatin

    Posted 07-08-2022 00:03





  • 12.  RE: ESRD on Biktarvy and Advair, atorvastatin

    Posted 07-08-2022 08:26
    I must admit the reason I do this is simplification of regimens for many patients, trying to remove boosted regimens in older populations with comorbidities, and because many of my patients are resistant to RPV (main reason) but not to DOR.  I appreciate your research articles for review, this is very helpful… thank you David Hardy!

    ------------------------------
    Randy Gelow
    Phoenix AZ
    randygelow@gmail.com
    ------------------------------



  • 13.  RE: ESRD on Biktarvy and Advair, atorvastatin

    Posted 30 days ago
    I agree, it would be my dream to have them combined as a STR! But still, given the efficacy and lack of side effects it is a great simple regimen --
    V. Cafaro Sent from Gmail Mobile