HIV-protease inhibitors(continued)
▶Atazanavir(unboosted) increases the exposure tocombined
hormonal contraceptives. Adjust dose.rStudy
▶Ritonaviris predicted to decrease the efficacy ofcombined
hormonal contraceptives. For FSRH guidance, see
Contraceptives, interactionsp. 497.rStudy
▶HIV-protease inhibitorsare predicted to increase the exposure
tocorticosteroids(beclometasone)(risk with beclometasone is
likely to be lower than with other corticosteroids).o
Theoretical
▶HIV-protease inhibitorsare predicted to increase the exposure
tocorticosteroids(betamethasone, budesonide, ciclesonide,
deflazacort, dexamethasone, fludrocortisone, fluticasone,
hydrocortisone, methylprednisolone, mometasone,
prednisolone, prednisone, triamcinolone). Avoid or monitor
side effects.rStudy
▶HIV-protease inhibitorsare predicted to affect the
anticoagulant effect ofcoumarins.oStudy
▶HIV-protease inhibitorsare predicted to moderately increase
the exposure tocrizotinib. Avoid.oStudy→Also see
TABLE 9p. 849
▶HIV-protease inhibitors(lopinavir, ritonavir, saquinavir)are
predicted to increase the exposure todabigatran. Avoid.
rTheoretical
▶HIV-protease inhibitorsare predicted to increase the exposure
todabrafenib. Use with caution or avoid.oStudy
▶HIV-protease inhibitorsare predicted to moderately increase
the exposure todaclatasvir. Adjustdaclatasvirdose.o
Study
▶HIV-protease inhibitorsare predicted to markedly to very
markedly increase the exposure todarifenacin. Avoid.r
Study
▶HIV-protease inhibitorsare predicted to markedly increase the
exposure todasatinib. Avoid.rStudy→Also seeTABLE 9
p. 849
▶HIV-protease inhibitorsvery slightly increase the exposure to
delamanid.rStudy→Also seeTABLE 9p. 849
▶Ritonaviris predicted to decrease the efficacy ofdesogestrel.
For FSRH guidance, seeContraceptives, interactionsp. 497.
rTheoretical
▶Ritonaviris predicted to increase the exposure todiazepam.
Avoid.oTheoretical
▶Didanosine(buffered) decreases the exposure toatazanavir.
Didanosineshould be taken 2 hours afteratazanavir.r
Study
▶Didanosine(buffered) is predicted to decrease the exposure to
darunavir(boosted with ritonavir).Didanosineshould be taken
1 hour before or 2 hours afterdarunavir.oTheoretical
▶Tipranavirdecreases the exposure todidanosine. Separate
administration by 2 hours.oStudy
▶Ritonavirincreases the concentration ofdigoxin. Adjust dose
and monitor concentration.rStudy
▶Fosamprenavir(boosted with ritonavir) slightly decreases the
exposure todolutegravir. Avoid if resistant to HIV-integrase
inhibitors.rStudy
▶Tipranavirmoderately decreases the exposure todolutegravir.
Refer to specialist literature.rStudy
▶HIV-protease inhibitorsincrease the risk of QT-prolongation
when given withdomperidone. Avoid.rStudy
▶HIV-protease inhibitorsincrease the exposure todopamine
receptor agonists(bromocriptine).rStudy
▶HIV-protease inhibitorsare predicted to increase the
concentration ofdopamine receptor agonists(cabergoline).
oAnecdotal
▶Ritonaviris predicted to decrease the exposure toduloxetine.
oTheoretical
▶HIV-protease inhibitorsare predicted to increase the exposure
todutasteride. Monitor side effects and adjust dose.o
Theoretical
▶HIV-protease inhibitors(lopinavir, ritonavir, saquinavir)are
predicted to slightly increase the exposure toedoxaban.
rTheoretical
▶Efavirenzdecreases the exposure toHIV-protease inhibitors.
Refer to specialist literature.rStudy→Also seeTABLE 9
p. 849▶HIV-protease inhibitorsslightly to moderately increase the
exposure toelbasvir. Avoid.oStudy
▶HIV-protease inhibitorsare predicted to markedly increase the
exposure toeletriptan. Avoid.rStudy
▶HIV-protease inhibitorsare predicted to increase the exposure
toeliglustat. Avoid or adjust dose—consult product literature.
rStudy
▶HIV-protease inhibitors(atazanavir, lopinavir, ritonavir,
saquinavir, tipranavir)are predicted to increase the exposure
toeluxadoline. Avoid.oTheoretical
▶HIV-protease inhibitors(atazanavir, lopinavir)(boosted with
ritonavir) increase the concentration ofelvitegravir. Refer to
specialist literature.oStudy
▶HIV-protease inhibitorsare predicted to increase the risk of
ergotism when given withergometrine. Avoid.r
Theoretical
▶HIV-protease inhibitorsare predicted to increase the risk of
ergotism when given withergotamine. Avoid.rTheoretical
▶HIV-protease inhibitorsare predicted to slightly increase the
exposure toerlotinib. Use with caution and adjust dose.
oStudy
▶Ritonaviris predicted to decrease the efficacy ofetonogestrel.
For FSRH guidance, seeContraceptives, interactionsp. 497.
rTheoretical
▶Etravirineincreases the exposure tofosamprenavir(boosted
with ritonavir). Refer to specialist literature.oStudy
▶Tipranavirdecreases the exposure toetravirine. Avoid.r
Study
▶HIV-protease inhibitorsare predicted to increase the
concentration ofeverolimus. Avoid.rStudy
▶HIV-protease inhibitorsare predicted to moderately increase
the exposure tofesoterodine. Adjustfesoterodinedose with
potent inhibitors of CYP3A4; avoid in hepatic and renal
impairment.rStudy
▶HIV-protease inhibitors(lopinavir, ritonavir, saquinavir)are
predicted to increase the exposure tofidaxomicin. Avoid.
oStudy
▶Ritonaviris predicted to increase the exposure toflurazepam.
Avoid.oTheoretical
▶HIV-protease inhibitorsare predicted to increase the exposure
tofosaprepitant.oTheoretical
▶HIV-protease inhibitorsare predicted to increase the exposure
togefitinib.oStudy
▶HIV-protease inhibitors(atazanavir, darunavir, lopinavir)
(boosted with ritonavir) increase the exposure toglecaprevir.
Avoid.rStudy
▶Ritonavirpotentially increases the exposure toglecaprevir.
rTheoretical
▶HIV-protease inhibitorsare predicted to moderately to
markedly increase the exposure tograzoprevir. Avoid.r
Study
▶HIV-protease inhibitorsare predicted to increase the exposure
toguanfacine. Adjustguanfacinedose,p. 231.oStudy
▶H 2 receptor antagonistsdecrease the exposure toatazanavir.
Monitor and adjust dose.oStudy
▶Ritonaviris predicted to increase the exposure tohaloperidol.
rTheoretical
▶Ritonaviris predicted to decrease the effects ofhormone
replacement therapy.oAnecdotal
▶HIV-protease inhibitorsare predicted to very markedly increase
the exposure toibrutinib. Avoid potent inhibitors of CYP3A4
or adjustibrutinibdose.rStudy
▶HIV-protease inhibitorsare predicted to increase the exposure
toimatinib.oStudy
▶HIV-protease inhibitorsare predicted to increase the risk of
toxicity when given withirinotecan. Avoid.oStudy
▶Ritonaviris predicted to decrease the exposure toiron chelators
(deferasirox). Monitor serum ferritin and adjust dose.
oTheoretical
▶HIV-protease inhibitorsare predicted to increase the exposure
toivabradine. Avoid.rStudy
▶HIV-protease inhibitorsare predicted to increase the exposure
toivacaftor. Adjustivacaftorp. 186orlumacaftor with ivacaftor
p. 187dose with potent inhibitors of CYP3A4.rStudy930 HIV-protease inhibitors—HIV-protease inhibitors BNFC 2018 – 2019
Interactions|Appendix 1A1