Ritonavir drug interactions: Difference between revisions

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{{Ritonavir }}
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==DRUG INTERACTIONS==
See also Contraindications , Warnings and Precautions , and Clinical Pharmacology
When co-administering NORVIR with other protease inhibitors ([[atazanavir]], [[darunavir]], [[fosamprenavir]], [[saquinavir]], and [[tipranavir]]), see the full prescribing information for that protease inhibitor including important information for drug interactions.
===Potential for NORVIR to Affect Other Drugs===
Ritonavir has been found to be an inhibitor of cytochrome P450 3A (CYP3A) and may increase plasma concentrations of agents that are primarily metabolized by CYP3A. Agents that are extensively metabolized by CYP3A and have high first pass metabolism appear to be the most susceptible to large increases in AUC (greater than 3-fold) when co-administered with ritonavir. Thus, co-administration of NORVIR with drugs highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events is contraindicated. Co-administration with other CYP3A substrates may require a dose adjustment or additional monitoring as shown in Table 4.
Ritonavir also inhibits CYP2D6 to a lesser extent. Co-administration of substrates of CYP2D6 with ritonavir could result in increases (up to 2-fold) in the AUC of the other agent, possibly requiring a proportional dosage reduction. Ritonavir also appears to induce CYP3A, CYP1A2, CYP2C9, CYP2C19, and CYP2B6 as well as other enzymes, including [[glucuronosyl transferase]].
===Established and Other Potentially Significant Drug Interactions===
Table 4 provides a list of established or potentially clinically significant drug interactions. Alteration in dose or regimen may be recommended based on drug interaction studies or predicted interaction [see Clinical Pharmacology (12.3) for magnitude of interaction].<ref name="dailymed.nlm.nih.gov">{{Cite web  | last =  | first =  | title = NORVIR (RITONAVIR) CAPSULE [ABBVIE INC.] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=13b059c6-0c6c-49a5-b985-a4b05caf9ac9 | publisher =  | date =  | accessdate =  }}</ref>
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<ref name="dailymed.nlm.nih.gov">{{Cite web  | last =  | first =  | title = NORVIR (RITONAVIR) CAPSULE [ABBVIE INC.] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=13b059c6-0c6c-49a5-b985-a4b05caf9ac9 | publisher =  | date =  | accessdate =  }}</ref>





Latest revision as of 17:50, 9 January 2014

Ritonavir
NORVIR® FDA Package Insert
Description
Clinical Pharmacology
Microbiology
Indications and Usage
Contraindications
Warnings and Precautions
Adverse Reactions
Drug Interactions
Overdosage
Dosage and Administration
How Supplied
Labels and Packages

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chetan Lokhande, M.B.B.S [2]

DRUG INTERACTIONS

See also Contraindications , Warnings and Precautions , and Clinical Pharmacology

When co-administering NORVIR with other protease inhibitors (atazanavir, darunavir, fosamprenavir, saquinavir, and tipranavir), see the full prescribing information for that protease inhibitor including important information for drug interactions.

Potential for NORVIR to Affect Other Drugs

Ritonavir has been found to be an inhibitor of cytochrome P450 3A (CYP3A) and may increase plasma concentrations of agents that are primarily metabolized by CYP3A. Agents that are extensively metabolized by CYP3A and have high first pass metabolism appear to be the most susceptible to large increases in AUC (greater than 3-fold) when co-administered with ritonavir. Thus, co-administration of NORVIR with drugs highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events is contraindicated. Co-administration with other CYP3A substrates may require a dose adjustment or additional monitoring as shown in Table 4.

Ritonavir also inhibits CYP2D6 to a lesser extent. Co-administration of substrates of CYP2D6 with ritonavir could result in increases (up to 2-fold) in the AUC of the other agent, possibly requiring a proportional dosage reduction. Ritonavir also appears to induce CYP3A, CYP1A2, CYP2C9, CYP2C19, and CYP2B6 as well as other enzymes, including glucuronosyl transferase.

Established and Other Potentially Significant Drug Interactions

Table 4 provides a list of established or potentially clinically significant drug interactions. Alteration in dose or regimen may be recommended based on drug interaction studies or predicted interaction [see Clinical Pharmacology (12.3) for magnitude of interaction].[1]


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References

  1. "NORVIR (RITONAVIR) CAPSULE [ABBVIE INC.]".

Adapted from the FDA Package Insert.