Page 191 - HIV/AIDS Guidelines

Table 15a. Drug Interactions between Protease Inhibitors* and Other Drugs (Page 3 of 11)

Effect on PI or Dosing Recommendations and Clinical
Concomitant Drug PI Concomitant Drug Comments
Concentrations
RTV-boosted PIs
ATV/r, DRV/r, ↓ phenytoin possible Consider alternative anticonvulsant or monitor
SQV/r, TPV/r ↓ PI possible levels of both drugs and assess virologic
response.

FPV/r phenytoin AUC ↓ 22% Monitor phenytoin level and adjust dose
APV AUC ↑ 20% accordingly. No change in FPV/r dose
recommended.
LPV/r phenytoin AUC ↓ 31% Consider alternative anticonvulsant or monitor
Phenytoin LPV/r AUC ↓ 33% levels of both drugs and assess virologic
response. Do not coadminister with LPV/r once
daily.

PIs without RTV
ATV, FPV May ↓ PI levels substantially Consider alternative anticonvulsant, RTV
boosting for ATV and FPV, and/or monitoring PI
level.
Monitor anticonvulsant level and virologic
response.

Valproic Acid (VPA) LPV/r ↓VPA possible Monitor VPA levels and virologic response.
LPV AUC ↑ 75% Monitor for LPV-related toxicities.
Antidepressants

LPV/r bupropion AUC ↓ 57%
Bupropion Titrate bupropion dose based on clinical
TPV/r bupropion AUC ↓ 46% response.

DRV/r paroxetine AUC ↓ 39% Titrate paroxetine dose based on clinical
Paroxetine
FPV/r paroxetine AUC ↓ 55% response.
Sertraline DRV/r sertraline AUC ↓ 49% Titrate sertraline dose based on clinical
response.
ATV +/- RTV, DRV/r, RTV 200 mg BID (for 2 days) Use lowest dose of trazodone and monitor for
FPV +/- RTV, LPV/r, ↑ trazodone AUC 240% CNS and cardiovascular adverse effects.
Trazodone TPV/r

SQV/r ↑ trazodone expected Contraindicated. Do not coadminister.
Tricyclic All RTV-boosted PIs ↑ TCA expected Use lowest possible TCA dose and titrate based on
Antidepressants (TCAs) clinical assessment and/or drug levels.
(Amitriptyline,
Desipramine,
Imipramine,
Nortriptyline)

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents K-21

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