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

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

Miscellaneous Interactions
All PIs RTV 100 mg BID ↑ colchicine AUC 296%, For treatment of gout flares
C max 184% Colchicine 0.6 mg x 1 dose, followed by 0.3 mg 1
hour later. Do not repeat dose for at least 3 days.
With all PIs: significant ↑ in colchicine With FPV without RTV: 1.2 mg x 1 dose and no
AUC expected
repeat dose for at least 3 days
For prophylaxis of gout flares
Colchicine 0.3 mg once daily or every other day
With FPV without RTV: colchicine 0.3 mg BID or
0.6 mg once daily or 0.3 mg once daily
Colchicine
For treatment of familial Mediterranean fever
Do not exceed colchicine 0.6 mg once daily or 0.3
mg BID.
With FPV without RTV: Do not exceed 1.2 mg
once daily or 0.6 mg BID.
Do not coadminister in patients with hepatic or
renal impairment.

Salmeterol All PIs ↑ salmeterol possible Do not coadminister because of potential
increased risk of salmeterol-associated
cardiovascular events, including QT prolongation,
palpitations, and sinus tachycardia.

Atovaquone/ ATV/r, LPV/r ATV/r ↓ atovaquone AUC 46% and No dosage recommendation. Consider alternative
proguanil ↓ proguanil AUC 41% drug for malaria prophylaxis, if possible.
LPV/r ↓ atovaquone AUC 74% and
↓ proguanil AUC 38%

a
The following products contain at least 35 mcg of ethinyl estradiol combined with norethindrone or norgestimate (generic formulation may
also be available): Ovcon 35, 50; Femcon Fe; Brevicon; Modicon; Ortho-Novum 1/35, 10/11, 7/7/7; Norinyl 1/35; Tri-Norinyl; Ortho-Cyclen;
Ortho Tri-Cyclen.
b
The following products contain no more than 30 mcg of ethinyl estradiol combined with norethindrone or norgestimate (generic formulation
may also be available): Loestrin 1/20, 1.5/30; Loestrin Fe 1/20, 1.5/30; Loestrin 24 Fe; Ortho Tri-Cyclen Lo.
c
Norbuprenorphine is an active metabolite of buprenorphine.
d
R-methadone is the active form of methadone.
Key to Abbreviations: APV = amprenavir, ART = antiretroviral therapy, ARV = antiretroviral, ATV = atazanavir, ATV/r = atazanavir + ritonavir,
AUC = area under the curve, BID = twice daily, CCB = calcium channel blocker, C max = maximum plasma concentration, C min = minimum
plasma concentration, CNS = central nervous system, CrCl = creatinine clearance, CYP = cytochrome P, DRV = darunavir,
DRV/r = darunavir + ritonavir, ECG = electrocardiogram, FDA = Food and Drug Administration, FPV = fosamprenavir (FPV is a prodrug of APV),
FPV/r = fosamprenavir + ritonavir, IDV = indinavir, INR = international normalized ratio, LPV = lopinavir, LPV/r = lopinavir + ritonavir,
NFV = nelfinavir, PAH = pulmonary arterial hypertension, PDE5 = phosphodiesterase type 5, PI = protease inhibitor, PK = pharmacokinetic,
PPI = proton pump inhibitor, RTV = ritonavir, SQV = saquinavir, SQV/r = saquinavir + ritonavir, TCA = tricyclic antidepressant, TDF = tenofovir,
TID = three times a day, TPV = tipranavir, TPV/r = tipranavir + ritonavir, VPA = valproic acid

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents K-29

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