Drug interactions
Bedaquiline + Efavirenz
Severity: Major
Bedaquiline and Efavirenz: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Efavirenz induces CYP3A4 and can lower bedaquiline exposure, which may reduce antimycobacterial activity and risk treatment failure or resistance. Both drugs can also prolong the QT interval, so combined use adds arrhythmia risk.
What this interaction means in plain words
Bedaquiline and Efavirenz can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Bedaquiline belongs to Anti Bacterial; Efavirenz belongs to Anti Virals.
Why it happens
Efavirenz induces CYP3A4-mediated bedaquiline metabolism, and both agents have additive QTc-prolonging effects.
What to do
Avoid the combination where possible and choose an alternative antiretroviral such as an integrase inhibitor-based regimen. If it cannot be avoided, obtain baseline and periodic ECGs and monitor electrolytes and treatment response.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Efavirenz
- Cobimetinib + Efavirenz Contraindicated
- Dienogest / estradiol valerate + Efavirenz Contraindicated
- Dihydroergotamine intranasal + Efavirenz Contraindicated
- Dihydroergotamine + Efavirenz Contraindicated
- Doravirine + Efavirenz Contraindicated
- Efavirenz + Elbasvir / grazoprevir Contraindicated
Other interactions of Bedaquiline
- Bedaquiline + Ziprasidone Contraindicated
- Alfuzosin + Bedaquiline Major
- Amiodarone + Bedaquiline Major
- Amisulpride + Bedaquiline Major
- Amitriptyline + Bedaquiline Major
- Amobarbital + Bedaquiline Major
Frequently asked questions
Can I take Bedaquiline with Efavirenz?
MediHelp rates the interaction as major. Bedaquiline and Efavirenz can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Efavirenz induces CYP3A4 and can lower bedaquiline exposure, which may reduce antimycobacterial activity and risk treatment failure or resistance. Both drugs can also prolong the QT interval, so combined use adds arrhythmia risk.
How serious is the interaction between Bedaquiline and Efavirenz?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination where possible and choose an alternative antiretroviral such as an integrase inhibitor-based regimen. If it cannot be avoided, obtain baseline and periodic ECGs and monitor electrolytes and treatment response.
What other medicines interact with Efavirenz?
MediHelp also lists interactions of Efavirenz with, for example, Cobimetinib, Dienogest / estradiol valerate, Dihydroergotamine intranasal. The full list is on the Efavirenz page.
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