7 Descovy Interactions and How to Manage Them

Descovy is a combination medication that contains two antiretroviral medications — emtricitabine and tenofovir alafenamide — in a single pill. It’s used for HIV prevention, also known as pre-exposure prophylaxis (PrEP), in adults and adolescents. It can also treat HIV when combined with other antiretroviral medications. Descovy keeps HIV at bay by preventing the virus from copying itself and spreading.

While Descovy is an effective treatment, it can interact with certain medications and supplements. Most interactions make Descovy less effective, which can make it harder to manage HIV. Other interactions can raise the risk of kidney problems or other side effects.

Here, we’ll review seven notable Descovy interactions and how to manage them. This list doesn’t include all of the medication’s possible interactions, however. So be sure to talk with your HIV specialist about interactions that you should be aware of with Descovy.

1. Protease inhibitors

Protease inhibitors are a commonly prescribed group of medications for treating HIV and other viral health conditions. But they have a variety of potential interactions with Descovy.

Some protease inhibitors, such as tipranavir (Aptivus), can lower the concentration of Descovy in your body. This can make it less effective at preventing and treating HIV.

However, some medications that contain ritonavir — such as Paxlovid (nirmatrelvir / ritonavir) — can actually increase Descovy concentrations in your body. This may lead to new or worsening Descovy side effects.

Handling interactions between Descovy and protease inhibitors is complex. Make sure your HIV specialist is aware of all medications (and supplements) that you’re taking. They can tell you if you should avoid an interaction altogether or if a dosage adjustment is necessary.

2. Other antivirals

In addition to protease inhibitors, several other antivirals can interact with Descovy, including acyclovir (Zovirax), valacyclovir (Valtrex), and valganciclovir (Valcyte). These medications are often used to address herpes, shingles, and other viral infections.

Like Descovy, these antivirals leave your body through your kidneys. Taking the medications together can make it harder for your kidneys to remove them from your body, which may raise your risk of side effects, including kidney damage.

If you need to take Descovy with any of these antiviral medications, it's important to stay well hydrated to help your kidneys remove the medications properly. Possible signs and symptoms of kidney problems include swelling in your legs or ankles, chest pain, and less frequent urination. Let your HIV specialist know right away if you experience any of these issues. You should also let your HIV specialist know if you have a history of kidney problems before starting treatment with Descovy.

3. Several antibiotics

Several antibiotics can interact with Descovy. The top ones to keep in mind are rifampin (Rifadin), rifabutin (Mycobutin), and rifapentine (Priftin), which are typically used to treat tuberculosis.

These antibiotics can lower the amount of Descovy in the body, which can hinder its ability to prevent and treat HIV effectively. It’s recommended to avoid these antibiotics while taking Descovy.

Other antibiotics that can interact with Descovy include gentamicin, amikacin, and vancomycin. These antibiotics are given intravenously (into the vein). Like Descovy, they’re removed from the body through the kidneys. If these medications are administered with Descovy, the combination could lead to kidney problems.

If you have an infection that requires taking antibiotics, the healthcare professional who’s treating your infection will likely recommend an alternative to the above antibiotics (if possible).

4. Anti-seizure medications

Anti-seizure medications treat a number of health conditions, such as seizures and mood disorders. Some of these medications can reduce Descovy levels in the body, limiting its effectiveness.

The most commonly prescribed anti-seizure medications that can interact with Descovy are carbamazepine (Tegretol), oxcarbazepine (Trileptal), and phenytoin (Dilantin, Phenytek). Phenobarbital can interact with Descovy, as well.

If you need to take an anti-seizure medication with Descovy, the healthcare professional who manages your seizures may recommend an anti-seizure medication that doesn’t have the potential to cause an interaction. They may opt to prescribe you to a medication such as gabapentin (Neurontin), lamotrigine (Lamictal), or levetiracetam (Keppra), for example.

5. St. John’s wort

St. John’s wort is an over-the-counter (OTC) herbal supplement that’s sometimes marketed as a treatment for depression. But St. John’s wort can cause several interactions, including issues with Descovy. St. John’s wort can lower Descovy levels in the body, which decreases the medication’s ability to fight HIV as intended.

Let your HIV specialist know if you’re taking St. John’s wort. Since it’s not recommended to take St. John’s wort and Descovy at the same time, they’ll likely recommend an alternative antidepressant. There are also other natural ways to manage depression, including mindfulness practices, acupuncture, and journaling.

6. NSAIDs

Descovy has occasionally been linked to kidney problems. This is more common in people who have a history of kidney problems or are taking other medications that can harm the kidneys, like nonsteroidal anti-inflammatory drugs (NSAIDs).

In general, taking NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), frequently or at higher dosages is not recommended because of the risk of kidney problems. But that risk is increased when NSAIDs are combined with Descovy.

Before starting treatment with Descovy, tell your HIV specialist if you’re taking an NSAID. Depending on what you’re taking the NSAID for, they may recommend switching to a different pain reliever, such as acetaminophen (Tylenol), that doesn’t carry the risk of this interaction.

7. Certain cancer medications

Certain cancer medications, such as apalutamide (Erleada) and lorlatinib (Lorbrena), may also interact with Descovy. Apalutamide is a medication commonly used to treat advanced prostate cancer. Lorlatinib treats non-small cell lung cancer.

These medications can cause an interaction because they affect a protein that can alter how well your body absorbs Descovy. This can lead to lower concentrations of Descovy and hinder how effectively it prevents and treats HIV.

Let your HIV specialist know if you take any cancer medications before starting treatment with Descovy, so they can check for potential interactions. Depending on the severity of the interaction, you may need to switch to an alternative cancer medication.

When to contact your HIV specialist about a Descovy interaction

It’s always a good idea to check with your HIV specialist if you are concerned about a potential medication interaction. You should do this before making any changes to your medication routine. Your specialist can review your medication list to help you manage and avoid potential interactions.

If you start experiencing new or worsening side effects while taking Descovy, there’s a chance it could be due to an interaction. Let your specialist know about your side effects, so they can discuss potential next steps with you. Though, if you have symptoms that feel severe or life-threatening, call 911 or go to the nearest ER.

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Written by:

Sonja Jacobsen, PharmD, BCPS, BCOP

Sonja Jacobsen, PharmD, BCPS, BCOP,  is a clinical oncology pharmacy specialist currently practicing in Seattle. She has been practicing as a pharmacist since 2015 and is licensed to practice in Washington state and North Carolina.

Edited by:

Joshua Murdock, PharmD, BCBBS

Joshua Murdock, PharmD, BCBBS, is a licensed pharmacist in Arizona, Colorado, and Rhode Island. He has worked in the pharmacy industry for more than 10 years and currently serves as a pharmacy editor for GoodRx.

Reviewed by:

Austin Ulrich, PharmD, BCACP

Austin Ulrich, PharmD, BCACP, is a board-certified ambulatory care clinical pharmacist. In his early career, he provided direct patient care in a variety of settings, including hospital and community pharmacies, and in a primary care clinic as a clinical pharmacist.

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