Page 192 - HIV/AIDS Guidelines

Table 15a. Drug Interactions between Protease Inhibitors* and Other Drugs (Page 4 of 11)

Effect on PI or Concomitant Dosing Recommendations and Clinical
Concomitant Drug PI
Drug Concentrations Comments

Antifungals

RTV-boosted PIs
ATV/r No significant effect No dosage adjustment necessary.

SQV/r No data with RTV boosting No dosage adjustment necessary.
Fluconazole SQV (1200 mg TID) AUC ↑ 50%

TPV/r TPV AUC ↑ 50% Fluconazole >200 mg daily is not recommended. If
high-dose fluconazole is indicated, consider
alternative PI or another class of ARV drug.

RTV-boosted PIs
ATV/r, DRV/r, ↑ itraconazole possible Consider monitoring itraconazole level to guide
FPV/r, TPV/r ↑ PI possible dosage adjustments. High doses (>200 mg/day)
are not recommended unless dose is guided by
itraconazole levels.

LPV/r ↑ itraconazole Consider not exceeding 200 mg itraconazole daily
or monitor itraconazole level.
Itraconazole
SQV/r Bidirectional interaction has been Dose not established, but decreased
observed itraconazole dosage may be warranted.
Consider monitoring itraconazole level.

PIs without RTV

ATV, FPV ↑ itraconazole possible Consider monitoring itraconazole level to guide
↑ PI possible dosage adjustments.

ATV/r ATV AUC ↑ 146% Monitor for adverse effects of ATV.
Posaconazole
ATV ATV AUC ↑ 268% Monitor for adverse effects of ATV.

RTV-boosted PIs
ATV/r, DRV/r, RTV 400 mg BID ↓ voriconazole Do not coadminister voriconazole and RTV
FPV/r, LPV/r, AUC 82% unless benefit outweighs risk. If administered,
SQV/r, TPV/r RTV 100 mg BID ↓ voriconazole consider monitoring voriconazole level and
Voriconazole AUC 39% adjust dose accordingly.
PIs without RTV
ATV, FPV ↑ voriconazole possible Monitor for toxicities.
↑ PI possible

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents K-22

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