Click any combination to see the risk level, mechanism, and recommendation. You can also use the selectors to jump directly to a specific pair.
| Substance | Bictegravir (BIC) | Cabotegravir (CAB) | Dolutegravir (DTG) | Efavirenz (EFV) | Emtricitabine | Lamivudine | Lenacapavir | Raltegravir | Tenofovir |
|---|---|---|---|---|---|---|---|---|---|
| Cannabis | |||||||||
| Cocaine | |||||||||
| GHB / GBL | |||||||||
| Heroin and opioids | |||||||||
| Inhalants | |||||||||
| Ketamine | |||||||||
| LSD | |||||||||
| MDMA (Ecstasy) | |||||||||
| Methamphetamine | |||||||||
| Poppers |
The levels summarise how much caution each combination requires. They are not about people or “good” or “bad” decisions: they indicate the likely level of risk, harm, or need for monitoring.
Quick reading
Start with the row for the psychoactive or care-related substance you want to review.
Locate the medication, ART regimen, or other substance you want to compare it with.
Each coloured cell summarises the level of caution for that combination.
Click any combination to read the specific mechanism and recommendation.
Before combining
This matrix is a guidance tool and does not replace individual medical assessment.
Key messages
May increase psychoactive effects and sedation. Extra caution with efavirenz.
Raises cardiovascular risk. Use extra caution, especially with efavirenz.
Risk of hyperthermia and serotonin syndrome. Higher concern with protease inhibitors.
Watch for cardiovascular effects and nervous system overstimulation.
May increase sedation and neuropsychiatric effects. Use caution with efavirenz.
Higher risk of deep sedation, loss of consciousness, and respiratory depression.
Higher risk of overdose, respiratory depression, and death. Keep naloxone available.
Do not combine with sildenafil, tadalafil, or vardenafil. Risk of dangerous blood pressure drop.
May intensify psychological and sensory effects. Context matters a lot.
Risk of neurological, liver, and kidney damage. Higher concern with chronic use.
Harm reduction