(Crixivan®, IDV) (Norvir®, RTV) (Fortovase®, SQV) (Viracept®, NFV) (Agenerase®, APV) (Kaletra®, LPV/RTV) Antifungal Ketoconazole IDV ↑ 68% Keto. ↑ 3X SQV ↑ 3X No dose adjustment APV ↑ 31%, Keto ↑ 44% LPV AUC ↓ 13% Dose: IDV 600mg tid Dose: NTE keto dose No dose adjustment Dose: Combo. Use under Keto ↑ 3-fold 200mg/day investigation Anti-mycobacterials Rifampin IDV ↓ 89% RTV ↓ 35% SQV ↓ 84% NFV ↓ 82% APV AUC ↓ 82% LPV ↓ 75% Contraindicated Dose: no data, possible ↑ Contraindicated unless using Contraindicated No change in rifampin AUC Avoid concomitant use liver toxicity with RTV+SQV→use Avoid concomitant use rifampin dose 600mg qd or 2- 3X/wk Rifabutin IDV ↓ 32% Rifabutin ↑ 4X SQV ↓ 40% NFV ↓ 32% APV AUC ↓ 15% Rifabutin AUC ↑ 3-fold rifabutin ↑ 2X Dose: ↓ rifabutin dose to No dose adjustment unless Rifabutin ↑ 2X Rifabutin ↑ 193% Dose: Rifabutin ↓ 150mg Dose: ↓ rifabutin 150mg qd or 150mg qod or 3x/wk use with SQV+RTV→ Dose: rifabutin ↓ 150mg qd Dose: Rifabutin ↓ 150mg qd or qod & LPV/RTV std dose 300mg 2-3x/wk RTV std dose rifabutin 150mg 2-3x/wk or 300mg 2-3x/wk 300mg 2-3x/wk IDV 1000mg tid NFV ↑ 1000mg tid APV std dose
Clarithromycin Clarithro ↑ 53% Clarithro ↑ 77% Clarithro ↑ 45% No data APV AUC ↑ 18% No data No dose adjustment Dose adjust for renal SQV ↑ 177% No dose adjustment impairment No dose adjustment Oral Contraceptives Norethindrone ↑ 26% Ethinyl estradiol ↓ 40% No data Norethindrone ↓ 18% Potential for interaction Ethinyl estradiol ↓ 42% Ethinyl estradiol ↑ 24% Use alternative/additional Ethinyl estradiol ↓ 47% Use alternative/additional Use alternative/additional No dsoe adjustment methods Use alternative/additional methods methods methods Lipid Lowering Agents Simvastatin Potential for large increase in Potential for large increase Potential for large increase in Potential for large increase in Potential for large increase in Potential for large increase in Lovastatin statin level in statin level statin level statin level statin level statin level Avoid concomitant use Avoid concomitant use Avoid concomitant use Avoid concomitant use Avoid concomitant use Avoid concomitant use Atorvastatin Atorvastatin AUC ↑ 5.88- Pravastatin _____ _____ _____ _____ ______ fold→ use w/caution Pravastatin AUC ↑ 33%→ no dose adjustment Anticonvulsants Phenobarbitol Carbamazepine ↓ IDV AUC Unknown Unknown, may ↓ SQV levels Unknown, may ↓ NFV levels Unknown, may ↓ APV levels Unknown, may ↓ LPV levels Phenytoin Consider alternative agent Use w/caution, monitor Monitor anticonvulsant level Monitor anticonvulsant levels substantially substantially Carbamazepine anticonvulsant levels Monitor anticonvulsant level Monitor anticonvulsant levels Methadone No change in methadone levels Methadone ↓ 37% No data NFV may ↓ methadone levels No data Methadone AUC ↓ 53% May need to ↑ methadone May need to ↑ methadone May need to ↑ methadone dose dose dose Miscellaneous GJ§ ↓ IDV by 26% Sildenafil AUC ↑ 2-11 GJ§ ↑ SQV levels Sildenafil AUC ↑ 2-11 fold Sildenafil AUC ↑ 2-11 fold Possible substantial ↑ in Sildenafil AUC ↑ 2-11 fold. fold. NTE 25mg in 48 hr Sildenafil AUC ↑ 2-11 fold. NTE 25mg in 48 hr NTE 25mg in 48 hr sildenafil AUC. NTE 25mg in 48 hr Desipramine ↑ 145%, ↓ Use 25mg starting dose of NTE 25mg in 48 hr dose sildenafil Theophylline ↓ 47%, monitor level
