Page 195 - HIV/AIDS Guidelines

Table 15a. Drug Interactions between Protease Inhibitors* and Other Drugs (Page 7 of 11)

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

Corticosteroids
Dexamethasone All PIs ↓ PI levels possible Use systemic dexamethasone with caution or consider
alternative corticosteroid for long-term use.
Fluticasone All RTV- RTV 100 mg BID ↑ fluticasone AUC 350- Coadministration can result in adrenal insufficiency,
(inhaled or boosted fold and ↑ C max 25-fold including Cushing’s syndrome. Do not coadminister
intranasal) PIs
unless potential benefits of inhaled fluticasone
outweigh the risks of systemic corticosteroid adverse
effects.

Prednisone LPV/r ↑ prednisolone AUC 31% No dosage adjustment necessary.
Hepatitis C NS3/4A Protease Inhibitors

ATV/r ATV AUC ↓ 35%, C min ↓ 49% Coadministration is not recommended.
RTV AUC ↓ 36%
boceprevir AUC ↔

DRV/r DRV AUC ↓ 44%, C min ↓ 59% Coadministration is not recommended.
Boceprevir RTV AUC ↓ 26%
boceprevir AUC ↓ 29%, C min ↓ 35%

LPV/r LPV AUC ↓ 34%, C min ↓ 43% Coadministration is not recommended.
RTV AUC ↓ 23%
boceprevir AUC ↓ 44%, C min ↓ 35%
ATV/r telaprevir AUC ↓ 20% No dose adjustment necessary.

DRV/r telaprevir AUC ↓ 35% Coadministration is not recommended.
DRV AUC ↓ 40%
Telaprevir FPV/r telaprevir AUC ↓ 32% Coadministration is not recommended.
APV AUC ↓ 47%

LPV/r telaprevir AUC ↓ 54% Coadministration is not recommended.
LPV: no significant change

Herbal Products
St. John’s Wort All PIs ↓ PI expected Do not coadminister.

Hormonal Contraceptives
RTV-boosted PIs
ATV/r ethinyl estradiol AUC ↓ 19% and Oral contraceptive should contain at least 35 mcg of
C min ↓ 37% ethinyl estradiol.
Hormonal norgestimate ↑ 85% Oral contraceptives containing progestins other than
Contraceptives a
norethindrone or norgestimate have not been studied.
DRV/r ethinyl estradiol AUC ↓ 44% Use alternative or additional contraceptive method.
norethindrone AUC ↓ 14%

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents K-25

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