BNF for Children (BNFC) 2018-2019

▶HIV-protease inhibitorsare predicted to increase the exposure
tolapatinib. Avoid.oStudy→Also seeTABLE 9p. 849
▶Ritonaviris predicted to decrease the efficacy of
levonorgestrel. For FSRH guidance, seeContraceptives,
interactionsp. 497.rTheoretical
▶HIV-protease inhibitorsare predicted to markedly increase the
exposure tolomitapide. Avoid.rStudy
▶HIV-protease inhibitorsare predicted to increase the exposure
tolurasidone. Avoid.rStudy
▶HIV-protease inhibitorsare predicted to increase the exposure
tomacitentan.oStudy
▶Macrolides(clarithromycin)increase the exposure tosaquinavir
andsaquinavirincreases the exposure tomacrolides
(clarithromycin). Avoid.rStudy→Also seeTABLE 9p. 849
▶Macrolides(erythromycin)are predicted to increase the
exposure tosaquinavir. Avoid.rTheoretical→Also see
TABLE 9p. 849
▶Atazanaviris predicted to increase the exposure tomacrolides
(clarithromycin). Adjust dose in renal impairment.rStudy
▶Ritonavirincreases the exposure tomacrolides(clarithromycin).
Adjust dose in renal impairment.rStudy
▶Tipranavir(boosted with ritonavir) increases the exposure to
macrolides(clarithromycin)andmacrolides(clarithromycin)
increase the exposure totipranavir(boosted with ritonavir).
Monitor; adjust dose in renal impairment.rStudy
▶HIV-protease inhibitors(darunavir, fosamprenavir, lopinavir)
(boosted with ritonavir) are predicted to increase the
exposure tomacrolides(clarithromycin). Adjust dose in renal
impairment.rStudy
▶HIV-protease inhibitors(atazanavir, darunavir, fosamprenavir,
lopinavir, ritonavir, tipranavir)are predicted to increase the
exposure tomacrolides(erythromycin).rTheoretical
▶Darunavir(boosted with ritonavir) markedly increases the
exposure tomaraviroc. Refer to specialist literature.r
Study
▶Maravirocpotentially decreases the exposure tofosamprenavir
andfosamprenavirpotentially decreases the exposure to
maraviroc. Avoid.rStudy
▶HIV-protease inhibitors(atazanavir, saquinavir)moderately to
markedly increase the exposure tomaraviroc. Refer to
specialist literature.rStudy
▶Lopinavir(boosted with ritonavir) moderately increases the
exposure tomaraviroc. Refer to specialist literature.r
Study
▶Ritonavirmarkedly increases the exposure tomaraviroc. Refer
to specialist literature.rStudy
▶Ritonaviris predicted to decrease the exposure tomelatonin.
oTheoretical
▶HIV-protease inhibitorsare predicted to markedly to very
markedly increase the exposure tomidazolam. Avoid or adjust
dose.rStudy
▶HIV-protease inhibitorsare predicted to very markedly increase
the exposure tomidostaurin. Avoid or monitor for toxicity.
rStudy
▶HIV-protease inhibitorsare predicted to increase the exposure
tomirabegron. Adjustmirabegrondose in hepatic and renal
impairment.oStudy
▶HIV-protease inhibitorsare predicted to increase the exposure
tomirtazapine.oStudy
▶HIV-protease inhibitorsare predicted to increase the exposure
tomodafinil.nTheoretical
▶HIV-protease inhibitors(lopinavir, ritonavir, saquinavir)are
predicted to increase the risk of neutropenia when given with
monoclonal antibodies(brentuximab vedotin). Monitor and
adjust dose.rStudy
▶HIV-protease inhibitorsare predicted to increase the exposure
tomonoclonal antibodies(trastuzumab emtansine). Avoid.
rTheoretical
▶HIV-protease inhibitorsare predicted to markedly increase the
exposure tonaloxegol. Avoid.rStudy
▶HIV-protease inhibitorsare predicted to increase the exposure
tonetupitant.oStudy
▶Nevirapinedecreases the exposure toHIV-protease inhibitors.
Refer to specialist literature.oStudy

▶HIV-protease inhibitorsare predicted to moderately increase

the exposure tonilotinib. Avoid.rStudy→Also seeTABLE 9

p. 849

▶HIV-protease inhibitors(lopinavir, ritonavir, saquinavir)are

predicted to increase the exposure tonintedanib.o

Study

▶HIV-protease inhibitorsare predicted to increase the exposure

tonitisinone. Adjust dose.oTheoretical

▶Ritonaviris predicted to decrease the efficacy of

norethisterone. For FSRH guidance, seeContraceptives,

interactionsp. 497.rAnecdotal

▶Ritonaviris predicted to decrease the exposure toolanzapine.

Monitor and adjust dose.oStudy

▶HIV-protease inhibitorsare predicted to increase the exposure

toolaparib. Avoid potent inhibitors of CYP3A4 or adjust

olaparibdose.oStudy

▶HIV-protease inhibitorsare predicted to increase the exposure

toopioids(alfentanil, buprenorphine, fentanyl, oxycodone,

sufentanil). Monitor and adjust dose.rStudy

▶HIV-protease inhibitors(boosted with ritonavir) are predicted

to decrease the exposure toopioids(methadone).o

Study→Also seeTABLE 9p. 849

▶Ritonaviris predicted to decrease the concentration ofopioids

(morphine).oTheoretical

▶Ritonavirincreases the risk of CNS toxicity when given with

opioids(pethidine). Avoid.rStudy

▶HIV-protease inhibitorsare predicted to increase the exposure

tooxybutynin.nStudy

▶HIV-protease inhibitorsare predicted to increase the exposure

topalbociclib. Avoid or adjustpalbociclibdose.rStudy

▶HIV-protease inhibitorsare predicted to increase the exposure

topanobinostat. Adjustpanobinostatdose; in hepatic

impairment avoid.oStudy→Also seeTABLE 9p. 849

▶HIV-protease inhibitorsare predicted to increase the exposure

toparitaprevir(with ritonavir and ombitasvir). Avoid.r

Theoretical

▶HIV-protease inhibitorsare predicted to increase the exposure

topazopanib. Avoid or adjustpazopanibdose.o

Study→Also seeTABLE 9p. 849

▶HIV-protease inhibitorsare predicted to increase the exposure

tophosphodiesterase type-5 inhibitors(avanafil, vardenafil).

Avoid.rStudy→Also seeTABLE 9p. 849

▶HIV-protease inhibitorsare predicted to increase the exposure

tophosphodiesterase type-5 inhibitors(sildenafil). Avoid potent

inhibitors of CYP3A4 or adjustsildenafildose,p. 120.r

Study→Also seeTABLE 9p. 849

▶HIV-protease inhibitorsare predicted to increase the exposure

tophosphodiesterase type-5 inhibitors(tadalafil). Use with

caution or avoid.rStudy

▶HIV-protease inhibitors(atazanavir, lopinavir)(boosted with

ritonavir) increase the exposure topibrentasvir. Avoid.r

Study

▶Ritonavirpotentially increases the exposure topibrentasvir.

rTheoretical

▶HIV-protease inhibitorsare predicted to increase the exposure

topimozide. Avoid.rStudy→Also seeTABLE 9p. 849

▶Ritonaviris predicted to decrease the exposure topirfenidone.

oTheoretical

▶Ritonaviris predicted to increase the exposure topitolisant.

Use with caution and adjust dose.oStudy

▶HIV-protease inhibitorsare predicted to slightly increase the

exposure toponatinib. Monitor and adjustponatinibdose.

oStudy

▶HIV-protease inhibitorsare predicted to moderately increase

the exposure topraziquantel.nStudy

▶Proton pump inhibitorsdecrease the exposure toatazanavir.

Avoid or adjust dose.rStudy

▶Proton pump inhibitorsincrease the exposure tosaquinavir.

Avoid.rStudy

▶Tipranavirdecreases the exposure toproton pump inhibitors.

Avoid.rStudy

▶HIV-protease inhibitorsare predicted to increase the exposure

toquetiapine. Avoid.rStudy

▶Atazanavirincreases the exposure toraltegravir(high-dose).

Avoid.oStudy

BNFC 2018 – 2019 HIV-protease inhibitors—HIV-protease inhibitors 931

Interactions

|Appendix 1

A1