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**rilpivirine + metformin** is a combination of two pharmaceutical drugs: rilpivirine, a non-nucleoside reverse transcriptase inhibitor (NNRTI) used primarily as part of antiretroviral therapy for HIV-1 infection, and metformin, a biguanide commonly used for the treatment of type 2 diabetes mellitus. Rilpivirine acts by binding to and inhibiting the reverse transcriptase enzyme of HIV-1, thereby preventing viral replication in infected cells. Metformin lowers blood glucose levels mainly by decreasing hepatic glucose production and increasing insulin sensitivity in peripheral tissues. There is no evidence of a marketed fixed-dose combination product with these two agents; this entry refers to their co-administration. Rilpivirine is metabolized predominantly by CYP3A4, while metformin is primarily renal excreted unchanged. Drug-drug interaction studies show no clinically significant pharmacokinetic interaction between rilpivirine and metformin, meaning that their combined use does not generally require dose adjustment for either drug[3]. Both drugs have additional safety profiles: rilpivirine is associated with the risk of QT interval prolongation, and metformin can cause gastrointestinal side effects and, rarely, lactic acidosis.
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