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sourceUrl combinationId reference evidence drugClass HIVDrugURL drugName summary warning HIVDrugName description
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=13568 13568 Diefenbach C, Künzer T, Buzello W, Theisohn M. Alcuronium: a pharmacodynamic and pharmacokinetic update. Anesth Analg. 1995 Feb;80(2):373-7 Very Low Anaesthetics and Muscle Relaxants InteractionDetailList.aspx?HIVDrugId=232&Page= Alcuronium This interaction has not been studied. Based on the metabolism/elimination and toxicity profiles of both drugs there is little potential for interaction. Alcuronium is predominantly eliminated unchanged via the kidneys. No clinically significant interaction expected Atazanavir An intravenous (IV) single-bolus injection of alcuronium (0.25 mg/kg = ED95) was administered to 10 patients undergoing maxillofacial surgery during nitrous-oxide opioid anesthesia. Alcuronium neuromuscular block, plasma concentration, and renal elimination (HPLC assay) were measured during the 12-h after its administration. Two hours after the injection of alcuronium, partial recovery from the neuromuscular block had occurred from 100% to 26% +/- 24% depression of twitch tension, although less than 25% of the injected dose was recovered from the urine. The 12-h plasma concentration and urinary recovery were 0.1 +/- 0.08 mg/L and 61% +/- 20%, respectively. Recovery from neuromuscular block was dominated by intercompartmental distribution rather than by renal elimination. Alcuronium does not undergo biodegradation; apart from negligible biliary excretion, the kidney represented the only excretory pathway.
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=57 57 None None Analgesics InteractionDetailList.aspx?HIVDrugId=122&Page= Aspirin None No clinically significant interaction expected ZZAmprenavir# None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=58 58 None None Analgesics InteractionDetailList.aspx?HIVDrugId=123&Page= Aspirin None No clinically significant interaction expected Indinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=59 59 None None Analgesics InteractionDetailList.aspx?HIVDrugId=124&Page= Aspirin None No clinically significant interaction expected Lopinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=60 60 None None Analgesics InteractionDetailList.aspx?HIVDrugId=125&Page= Aspirin None No clinically significant interaction expected Nelfinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=61 61 None None Analgesics InteractionDetailList.aspx?HIVDrugId=126&Page= Aspirin None No clinically significant interaction expected Ritonavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=62 62 None None Analgesics InteractionDetailList.aspx?HIVDrugId=127&Page= Aspirin None No clinically significant interaction expected Saquinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=63 63 None None Analgesics InteractionDetailList.aspx?HIVDrugId=122&Page= Paracetamol (Acetominophen) None No clinically significant interaction expected ZZAmprenavir# None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=64 64 None None Analgesics InteractionDetailList.aspx?HIVDrugId=123&Page= Paracetamol (Acetominophen) None No clinically significant interaction expected Indinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=65 65 None None Analgesics InteractionDetailList.aspx?HIVDrugId=124&Page= Paracetamol (Acetominophen) None No clinically significant interaction expected Lopinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=66 66 None None Analgesics InteractionDetailList.aspx?HIVDrugId=125&Page= Paracetamol (Acetominophen) None No clinically significant interaction expected Nelfinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=67 67 None None Analgesics InteractionDetailList.aspx?HIVDrugId=126&Page= Paracetamol (Acetominophen) None No clinically significant interaction expected Ritonavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=68 68 None None Analgesics InteractionDetailList.aspx?HIVDrugId=127&Page= Paracetamol (Acetominophen) None No clinically significant interaction expected Saquinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=69 69 None None Analgesics InteractionDetailList.aspx?HIVDrugId=122&Page= Dextropropoxyphene None Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration ZZAmprenavir# None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=70 70 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=123&Page= Dextropropoxyphene Coadministration has not been studied. Dextropropoxyphene is mainly metabolized by CYP3A. Indinavir and indinavir/ritonavir could potentially increase dextropropoxyphene exposure. Use with caution due to the risk of abnormal heart rhythm (prolongation of PR and QT intervals) reported for dextropropoxyphene. A decrease in dextropropoxyphene dose may be needed. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Indinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=71 71 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=124&Page= Dextropropoxyphene Coadministration has not been studied. Dextropropoxyphene is mainly metabolized by CYP3A. Lopinavir/ritonavir could potentially increase dextropropoxyphene exposure. Use with caution due to the risk of abnormal heart rhythm (prolongation of PR and QT intervals) reported for dextropropoxyphene. A decrease in dextropropoxyphene dose may be needed. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Lopinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=72 72 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=127&Page= Dextropropoxyphene Coadministration has not been studied. Dextropropoxyphene is mainly metabolized by CYP3A. Saquinavir/ritonavir could potentially increase dextropropoxyphene exposure. Use with caution due to the risk of abnormal heart rhythm (prolongation of PR and QT intervals) reported for dextropropoxyphene. A decrease in dextropropoxyphene dose may be needed. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Saquinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=73 73 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=125&Page= Dextropropoxyphene Coadministration has not been studied. Dextropropoxyphene is mainly metabolized by CYP3A. Nelfinavir could potentially increase dextropropoxyphene exposure. Use with caution due to the risk of abnormal heart rhythm (prolongation of PR and QT intervals) reported for dextropropoxyphene. A decrease in dextropropoxyphene dose may be needed. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Nelfinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=74 74 Dextropropoxyphene is contraindicated with ritonavir as coadministration is likely to result in increased plasma concentrations of propoxyphene, thereby increasing the risk of serious respiratory depression or haematologic abnormalities, or other serious adverse effects. Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=126&Page= Dextropropoxyphene Coadministration may increase dextropropoxyphene concentrations. The European SPC contraindicates coadministration due to the risk of serious respiratory depression or haematologic abnormalities; this may be more applicable for full dose ritonavir. The US Prescribing Information suggests dose reduction may be required; this may be more applicable for low dose ritonavir. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Ritonavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=75 75 None None Analgesics InteractionDetailList.aspx?HIVDrugId=122&Page= Diamorphine None Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration ZZAmprenavir# None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=76 76 None None Analgesics InteractionDetailList.aspx?HIVDrugId=123&Page= Diamorphine None Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Indinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=77 77 None None Analgesics InteractionDetailList.aspx?HIVDrugId=124&Page= Diamorphine None Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Lopinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=78 78 None None Analgesics InteractionDetailList.aspx?HIVDrugId=125&Page= Diamorphine None Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Nelfinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=79 79 None None Analgesics InteractionDetailList.aspx?HIVDrugId=126&Page= Diamorphine None Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Ritonavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=80 80 None None Analgesics InteractionDetailList.aspx?HIVDrugId=127&Page= Diamorphine None Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Saquinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=81 81 None None Analgesics InteractionDetailList.aspx?HIVDrugId=122&Page= Fentanyl None Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration ZZAmprenavir# None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=82 82 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=123&Page= Fentanyl The interaction with indinavir/ritonavir has not been studied, but may increase the plasma concentrations of fentanyl. Careful monitoring of therapeutic and adverse effects is recommended. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Indinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=83 83 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=124&Page= Fentanyl Coadministration is expected to increase fentanyl concentrations which may result in increased risk of side effects. Careful monitoring of therapeutic and adverse effects (notably potentially fatal respiratory depression but also sedation) is recommended. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Lopinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=84 84 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=126&Page= Fentanyl Coadministration may increase fentanyl concentrations. Careful monitoring of therapeutic and adverse effects (including potentially fatal respiratory depression) is recommended. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Ritonavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=85 85   Low Analgesics InteractionDetailList.aspx?HIVDrugId=127&Page= Alfentanil Coadministration is contraindicated due to the potential for life threatening cardiac arrhythmia. Although specific studies have not been performed, coadministration may increase plasma concentrations of alfentanil. These drugs should not be coadministered Saquinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=86 86 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=125&Page= Fentanyl Coadministration has not been studied. Fentanyl undergoes extensive CYP3A4 metabolism. Nelfinavir could potentially increase fentanyl exposure and thus may increase the risk of respiratory depression. Use with caution and monitor closely. Start with a lower dose and titrate as required. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Nelfinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=87 87 Coadministration of methadone with amprenavir resulted in a decrease in the Cmax and AUC of the active methadone enantiomer (R-enantiomer) of 25% and 13% respectively, whilst the Cmax, AUC and Cmin of the inactive methadone enantiomer (S-enantiomer) were decreased by 48%, 40% and 23% respectively. When methadone is co-administered with amprenavir, patients should be monitored for opiate abstinence syndrome, in particular if low-dose ritonavir is also given. As compared to a non-matched historical control group, co-administration of methadone and amprenavir resulted in a 30%, 27% and 25% decrease in serum amprenavir AUC, Cmax and Cmin respectively. No recommendations can currently be made regarding adjustment of amprenavir dose when amprenavir is co-administered with methadone due to the inherent low reliability of non-matched historical controls. None Analgesics InteractionDetailList.aspx?HIVDrugId=122&Page= Methadone In HIV- subjects stable on methadone therapy given fosamprenavir/ritonavir(700/100 mg twice daily), the active (R-) methadone decreased by 18% (AUC) and 21% (Cmax); inactive (S-) methadone decreased by 42% (AUC) and 43% (Cmax). Pharmacokinetics of amprenavir were similar to historical controls. In this study no subject required a change in methadone dose and there was no evidence of opiate withdrawal 14 days after the addition of fosamprenavir/ritonavir. Patients should be monitored for opiate withdrawal symptoms and the dosage of methadone may need to be increased. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration ZZAmprenavir# None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=88 88 Administration of indinavir (800 mg every 8 hours) with methadone (20 mg to 60 mg daily) for one week in 10 subjects on methadone maintenance resulted in decreases of 7% and 4% for methadone Cmax and AUC, and a 6% increase in methadone Cmin. Based on a comparison to historical data, there was little or no change in indinavir AUC. Moderate Analgesics InteractionDetailList.aspx?HIVDrugId=123&Page= Methadone Indinavir and methadone can be co-administered without dose adjustment. Methadone AUC and Cmin were not affected by indinavir. The interaction with indinavir/ritonavir has not been studied but decreases in methadone AUC have been observed with other ritonavir-boosted protease inhibitors. Dose adjustment when given with indinavir/ritonavir should be considered based on the patient's clinical response to methadone therapy. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Indinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=89 89 Coadministration of methadone (5 mg single dose) and lopinavir/ritonavir (400/100 mg twice daily for 10 days) to 11 HIV- subjects resulted in a 45% decrease in methadone Cmax and a 53% decrease in AUC. Dosage of methadone may need to be increased when coadministered with Kaletra. Moderate Analgesics InteractionDetailList.aspx?HIVDrugId=124&Page= Methadone Methadone AUC decreased by 53%. Increase dose of methadone according to patients' withdrawal symptoms. Caution should be exercised when administering both drugs due to the risk of QT prolongation. ECG monitoring is recommended. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Lopinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=90 90 Concentrations of methadone were decreased when coadministered with nelfinavir. Coadministration of nelfinavir (1250 mg twice daily for 8 days) with methadone (59-101 mg once daily for longer than 1 month) was investigated in 13 subjects. Total methadone AUC, Cmax and Cmin were decreased by 47%, 46% and 53%, respectively. Similar changes in the individual R and S-enantiomers were observed. The dosage of methadone may need to be increased when coadministered with nelfinavir. Moderate Analgesics InteractionDetailList.aspx?HIVDrugId=125&Page= Methadone Coadministration of methadone with nelfinavir (1250 mg twice daily) to 13 HIV- subjects decreased methadone exposure by ~50%. No subjects experience withdrawal symptoms in this study, but the dose of methadone may need to be increased in some patients. Another study in HIV- subjects showed no significant effect of methadone on nelfinavir pharmacokinetics. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Nelfinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=91 91 The coadministration of ritonavir (500 mg every 12 hours for 15 days) with methadone (5 mg single dose) was investigated in 11 subjects. Effects were assessed on a dose-normalised comparison to a methadone 20 mg single dose. Methadone AUC and Cmax were reduced by 36% and 38%, respectively. Dosage increase in methadone may be considered. Low Analgesics InteractionDetailList.aspx?HIVDrugId=126&Page= Methadone Based on parallel group comparison, coadministration of methadone (5 mg single dose) and ritonavir (500 mg twice daily) decreased methadone AUC (36%) and Cmin (38%). Dose increase should be considered based on the patient's clinical response to methadone therapy. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Ritonavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=92 92 Coadministration of saquinavir/ritonavir (1000/100 mg twice daily) and methadone (60-120 mg once daily) decreased methadone AUC by 19%. None of the 12 patients experienced withdrawal symptoms. Contraindicated in combination with Invirase/ritonavir due to the potential for life threatening cardiac arrhythmia. Moderate Analgesics InteractionDetailList.aspx?HIVDrugId=127&Page= Methadone Coadministration with saquinavir/ritonavir decreased R-methadone AUC by 19%. Coadministration is contraindicated in the European SPC due to potentially life threatening cardiac arrhythmia (QT prolongation), but the US Prescribing Information advises caution and warns that the dosage of methadone may need to be increased. The charts reflect the more cautious option. If coadministered, ECG monitoring is recommended. These drugs should not be coadministered Saquinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=93 93 None None Analgesics InteractionDetailList.aspx?HIVDrugId=122&Page= Morphine None Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration ZZAmprenavir# None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=94 94 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=123&Page= Morphine The interaction with indinavir/ritonavir has not been studied, but morphine levels may be decreased by ritonavir. Careful monitoring of therapeutic and adverse effects is recommended. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Indinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=95 95 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=124&Page= Morphine Coadministration has not been studied. Morphine is mainly glucuronidated to morphine-3-glucuronide (UGT2B7>UGT1A1) and, to a lesser extent, to the pharmacologically active morphine-6-glucuronide (UGT2B7>UGT1A1). As ritonavir induces glucuronidation, lopinavir/ritonavir could potentially decrease the analgesic effect although to a moderate extent as induction of glucuronidation may increase the formation of the active metabolite. No a priori dosage adjustment is recommended but monitor the analgesic effect and signs of opiate withdrawal. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Lopinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=96 96 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=125&Page= Morphine Coadministration has not been studied. Morphine is mainly glucuronidated to morphine-3-glucuronide (UGT2B7>UGT1A1) and, to a lesser extent, to the pharmacologically active morphine-6-glucuronide (UGT2B7>UGT1A1). As nelfinavir induces glucuronidation, coadministration could potentially decrease the analgesic effect although to a moderate extent as induction of glucuronidation may increase the formation of the active metabolite. No a priori dosage adjustment is recommended but monitor the analgesic effect and signs of opiate withdrawal. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Nelfinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=97 97 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=126&Page= Morphine Coadministration may decrease morphine concentrations. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Ritonavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=98 98 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=127&Page= Morphine Coadministration has not been studied. Morphine is mainly glucuronidated to morphine-3-glucuronide (UGT2B7>UGT1A1) and, to a lesser extent, to the pharmacologically active morphine-6-glucuronide (UGT2B7>UGT1A1). As ritonavir induces glucuronidation, saquinavir/ritonavir could potentially decrease the analgesic effect although to a moderate extent as induction of glucuronidation may increase the formation of the active metabolite. No a priori dosage adjustment is recommended but monitor the analgesic effect and signs of opiate withdrawal. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Saquinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=99 99 None None Analgesics InteractionDetailList.aspx?HIVDrugId=122&Page= Pethidine (Meperidine) None Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration ZZAmprenavir# None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=100 100 None Low Analgesics InteractionDetailList.aspx?HIVDrugId=123&Page= Pethidine (Meperidine) Indinavir/ritonavir should not be administered with meperidine. These drugs should not be coadministered Indinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=101 101 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=124&Page= Pethidine (Meperidine) Coadministration has not been studied. Pethidine is metabolized mainly by CYP2B6 and to a lesser extent by CYP3A4. Coadministration of ritonavir (500 mg twice daily) and pethidine in healthy volunteers decreased pethidine AUC but increased the AUC of norpethidine (a neurotoxic metabolite), possibly due to induction of CYP2B6 by ritonavir. Long term use of pethidine and lopinavir/ritonavir is not recommended due to the increased concentration of norpethidine which may increase the risk of seizures. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Lopinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=102 102 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=125&Page= Pethidine (Meperidine) Coadministration has not been studied. Pethidine is metabolized mainly by CYP2B6 and to a lesser extent by CYP3A4. Coadministration of ritonavir (500 mg twice daily) and pethidine in healthy volunteers decreased pethidine AUC but increased the AUC of norpethidine (a neurotoxic metabolite), possibly due to induction of CYP2B6 by ritonavir. Long term use of pethidine and lopinavir/ritonavir is not recommended due to the increased concentration of norpethidine which may increase the risk of seizures. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Nelfinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=103 103 The use of meperidine and ritonavir is contraindicated due to the increased concentrations of the metabolite, normeperidine, which has both analgesic and CNS stimulant activity. Elevated normeperidine concentrations may increase the risk of CNS effects (e.g., seizures). Coadministration of pethidine (50 mg single oral dose) and ritonavir (500 mg twice daily) decrease pethidine AUC and Cmin by 62% and 59%, respectively, but increased normeperidine AUC and Cmin by 47% and 87%, respectively. Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=126&Page= Pethidine (Meperidine) Coadministration of pethidine (50 mg single oral dose) and ritonavir (500 mg twice daily) decreased pethidine AUC (62%) and Cmin (59%), but increased normeperidine AUC (47%) and Cmin (87%). The European SPC contraindicates coadministration due the increased concentrations of normeperidine, which has both analgesic and CNS stimulant activity and which may increase the risk of CNS effects (e.g., seizures); this may be more applicable for full dose ritonavir. The US Prescribing Information states that long term use and dose increase are not recommended; this may be more applicable for low dose ritonavir. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Ritonavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=104 104 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=127&Page= Pethidine (Meperidine) Coadministration has not been studied. Pethidine is metabolized mainly by CYP2B6 and to a lesser extent by CYP3A4. Coadministration of ritonavir (500 mg twice daily) and pethidine in healthy volunteers decreased pethidine AUC but increased the AUC of norpethidine (a neurotoxic metabolite), possibly due to induction of CYP2B6 by ritonavir. Long term use of pethidine and saquinavir/ritonavir is not recommended due to the increased concentration of norpethidine which may increase the risk of seizures. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Saquinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=105 105 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=123&Page= Tramadol Coadministration has not been studied. Tramadol is metabolized by CYPs 3A4, 2B6, and 2D6. Metabolism by CYP2D6 is to a metabolite more potent than the parent compound. Indinavir/ritonavir may increase tramadol exposure but also reduce the conversion to the more potent active metabolite. Monitor tramadol related side effects and the analgesic effect. Adjust tramadol dosage if needed. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Indinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=106 106 None None Analgesics InteractionDetailList.aspx?HIVDrugId=122&Page= Tramadol None Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration ZZAmprenavir# None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=107 107 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=124&Page= Tramadol Coadministration has not been studied. Tramadol is metabolized by CYPs 3A4, 2B6, and 2D6. Metabolism by CYP2D6 is to a metabolite more potent than the parent compound. Lopinavir/ritonavir may increase tramadol exposure but also reduce the conversion to the more potent active metabolite. Monitor tramadol related side effects and the analgesic effect. Adjust tramadol dosage if needed. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Lopinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=108 108 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=125&Page= Tramadol Coadministration has not been studied. Tramadol is metabolized by CYPs 3A4, 2B6, and 2D6. Metabolism by CYP2D6 is to a metabolite more potent than the parent compound. Nelfinavir may increase tramadol exposure. Monitor tramadol related side effects and the analgesic effect. Adjust tramadol dosage if needed. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Nelfinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=109 109 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=126&Page= Tramadol Coadministration may increase tramadol concentrations and a dose reduction may be needed. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Ritonavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=110 110 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=127&Page= Tramadol Coadministration has not been studied. Tramadol is metabolized by CYPs 3A4, 2B6, and 2D6. Metabolism by CYP2D6 is to a metabolite more potent than the parent compound. Saquinavir/ritonavir may increase tramadol exposure but also reduce the conversion to the more potent active metabolite. Monitor tramadol related side effects and the analgesic effect. Adjust tramadol dosage if needed. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Saquinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=111 111 None None Analgesics InteractionDetailList.aspx?HIVDrugId=122&Page= Ibuprofen None No clinically significant interaction expected ZZAmprenavir# None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=112 112 None None Analgesics InteractionDetailList.aspx?HIVDrugId=123&Page= Ibuprofen None No clinically significant interaction expected Indinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=113 113 None None Analgesics InteractionDetailList.aspx?HIVDrugId=124&Page= Ibuprofen None No clinically significant interaction expected Lopinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=114 114 None None Analgesics InteractionDetailList.aspx?HIVDrugId=125&Page= Ibuprofen None No clinically significant interaction expected Nelfinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=115 115 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=126&Page= Ibuprofen Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Ibuprofen is metabolized mainly by CYP2C9 and to a lesser extent by CYP2C8 and direct glucuronidation. In vitro and in vivo data indicate that ritonavir is a modest inducer of CYP2C9, but a dose adjustment is unlikely to be required for ibuprofen when coadministered with ritonavir. No clinically significant interaction expected Ritonavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=116 116 None None Analgesics InteractionDetailList.aspx?HIVDrugId=127&Page= Ibuprofen None No clinically significant interaction expected Saquinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=117 117 None None Analgesics InteractionDetailList.aspx?HIVDrugId=122&Page= Piroxicam None Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration ZZAmprenavir# None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=118 118 None Low Analgesics InteractionDetailList.aspx?HIVDrugId=123&Page= Piroxicam Indinavir/ritonavir should not be administered with piroxicam. These drugs should not be coadministered Indinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=119 119 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=124&Page= Piroxicam Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Piroxicam is primarily metabolized by CYP2C9 and in vivo data indicate that ritonavir is a modest inducer of CYP2C9. A dose adjustment is unlikely to be required for piroxicam when coadministered with lopinavir/ritonavir. No clinically significant interaction expected Lopinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=120 120 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=125&Page= Piroxicam Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Piroxicam is primarily metabolized by CYP2C9 and in vivo data indicate that nelfinavir is a modest inducer of CYP2C9. A dose adjustment is unlikely to be required for piroxicam when coadministered with nelfinavir. No clinically significant interaction expected Nelfinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=121 121 None Low Analgesics InteractionDetailList.aspx?HIVDrugId=126&Page= Piroxicam Coadministration is contraindicated as it is likely to increase piroxicam concentrations and the risk of serious respiratory depression or haematologic abnormalities. These drugs should not be coadministered Ritonavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=122 122 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=127&Page= Piroxicam Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Piroxicam is primarily metabolized by CYP2C9 and in vivo data indicate that ritonavir is a modest inducer of CYP2C9. A dose adjustment is unlikely to be required for piroxicam when coadministered with saquinavir/ritonavir. No clinically significant interaction expected Saquinavir None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=123 123 None None Analgesics InteractionDetailList.aspx?HIVDrugId=113&Page= Aspirin None No clinically significant interaction expected Delavirdine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=124 124 None None Analgesics InteractionDetailList.aspx?HIVDrugId=114&Page= Aspirin None No clinically significant interaction expected Efavirenz None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=125 125 None None Analgesics InteractionDetailList.aspx?HIVDrugId=115&Page= Aspirin None No clinically significant interaction expected Nevirapine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=126 126 None None Analgesics InteractionDetailList.aspx?HIVDrugId=113&Page= Paracetamol (Acetominophen) None No clinically significant interaction expected Delavirdine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=127 127 None None Analgesics InteractionDetailList.aspx?HIVDrugId=114&Page= Paracetamol (Acetominophen) None No clinically significant interaction expected Efavirenz None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=128 128 None None Analgesics InteractionDetailList.aspx?HIVDrugId=115&Page= Paracetamol (Acetominophen) None No clinically significant interaction expected Nevirapine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=129 129 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=113&Page= Dextropropoxyphene Coadministration has not been studied but could potentially increase dextropropoxyphene exposure. Dextropropoxyphene is metabolized mainly by CYP3A4 and delavirdine is an inhibitor of this enzyme. Use with caution due to the risk of abnormal heart rhythm (prolongation of PR and QT intervals) reported for dextropropoxyphene. A decrease in dextropropoxyphene dose may be needed. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Delavirdine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=130 130 None None Analgesics InteractionDetailList.aspx?HIVDrugId=114&Page= Dextropropoxyphene None No clinically significant interaction expected Efavirenz None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=131 131 None None Analgesics InteractionDetailList.aspx?HIVDrugId=115&Page= Dextropropoxyphene None No clinically significant interaction expected Nevirapine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=132 132 None None Analgesics InteractionDetailList.aspx?HIVDrugId=113&Page= Diamorphine None No clinically significant interaction expected Delavirdine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=133 133 None None Analgesics InteractionDetailList.aspx?HIVDrugId=114&Page= Diamorphine None No clinically significant interaction expected Efavirenz None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=134 134 None None Analgesics InteractionDetailList.aspx?HIVDrugId=115&Page= Diamorphine None No clinically significant interaction expected Nevirapine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=135 135 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=113&Page= Fentanyl Coadministration has not been studied but could potentially increase fentanyl exposure and thus may increase the risk of respiratory depression. Fentanyl undergoes extensive CYP3A4 metabolism and delavirdine is an inhibitor of this enzyme. It is recommended to start with a lower dose of fentanyl and titrate as required with close monitoring. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Delavirdine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=136 136 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=114&Page= Fentanyl Coadministration has not been studied but could potentially decrease fentanyl exposure. Fentanyl undergoes extensive CYP3A4 metabolism and efavirenz is an inducer of this enzyme. It is recommended to monitor the therapeutic effect and adjust the dose of fentanyl if required. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Efavirenz None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=137 137 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=115&Page= Fentanyl Coadministration may decrease fentanyl concentrations. Dose adjustment may be needed due to possible decrease in clinical effect. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Nevirapine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=138 138 Coadministration of delavirdine (600 mg twice daily for 7 days) and methadone (mean maintenance dose 71 mg) was studied in 15 HIV-negative subjects stable on methadone maintenance; a further 15 subjects acted as delavirdine control subjects (non-opioid maintained). Delavirdine significantly decreased methadone clearance and increased half life, resulting in increases in AUC (19%), Cmax (8%) and Cmin (29%). When compared to values obtained in the control subjects, methadone had no effect on delavirdine concentrations (AUC24h 385.1 µM.h vs 395.8 µM.h, control vs methadone). Delavirdine should be used with caution in opioid-maintained patients; the coadministration will require close clinical monitoring for signs or symptoms opioid toxicity. Moderate Analgesics InteractionDetailList.aspx?HIVDrugId=113&Page= Methadone Coadministration of delavirdine (600 mg twice daily) and methadone (mean maintenance dose 71 mg) significantly increased methadone AUC (19%), Cmax (8%) and Cmin (29%). When compared to control subjects, methadone had no effect on delavirdine AUC. Use with caution and close clinical monitoring for signs or symptoms opioid toxicity. Dosage of methadone may need to be decreased. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Delavirdine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=139 139 Coadministration of efavirenz (600 mg daily for 14-21 days) to 11 subjects stable on methadone maintenance (35-100 mg daily) resulted in a 45% decrease in methadone Cmax, a 52% decrease in AUC and signs of opiate withdrawal. Methadone dose was increased by a mean of 22% to alleviate withdrawal symptoms. Patients should be monitored for signs of withdrawal and their methadone dose increased as required to alleviate withdrawal symptoms. High Analgesics InteractionDetailList.aspx?HIVDrugId=114&Page= Methadone Coadministration of efavirenz (600 mg daily) to 11 subjects stable on methadone maintenance (35-100 mg daily) decreased methadone Cmax (45%) and AUC (52%). The methadone dose was increased by~22% to alleviate withdrawal symptoms. Patients should be monitored for signs of withdrawal and their methadone dose increased as required. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Efavirenz None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=140 140 In a controlled pharmacokinetic study with 9 patients receiving chronic methadone to whom steady state nevirapine therapy was added, the clearance of methadone was increased by 3-fold resulting in symptoms of withdrawal, requiring dose adjustments in 10 mg segments, in 7 of the 9 patients. Methadone did not have any effect on nevirapine clearance. Increased dosages may be required to prevent symptoms of opiate withdrawal. Methadone maintained patients beginning nevirapine therapy should be monitored for evidence of withdrawal and methadone dose should be adjusted accordingly. High Analgesics InteractionDetailList.aspx?HIVDrugId=115&Page= Methadone Coadministration decreases methadone AUC by ~40-65%; narcotic withdrawal syndrome has been reported in patients treated with nevirapine and methadone concomitantly. Methadone-maintained patients beginning nevirapine therapy should be monitored for evidence of withdrawal and methadone dose should be adjusted accordingly. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Nevirapine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=141 141 None None Analgesics InteractionDetailList.aspx?HIVDrugId=113&Page= Morphine None No clinically significant interaction expected Delavirdine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=142 142 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=114&Page= Morphine Coadministration has not been studied. Morphine is mainly glucuronidated to morphine-3-glucuronide (UGT2B7>UGT1A1) and, to a lesser extent, to the pharmacologically active morphine-6-glucuronide (UGT2B7>UGT1A1). In vitro data indicate that efavirenz is a substrate and inhibitor of UGT2B7 and could potentially increase morphine concentrations via competition or inhibition of UGT2B7. Monitor for signs of opiate toxicity. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Efavirenz None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=143 143 None None Analgesics InteractionDetailList.aspx?HIVDrugId=115&Page= Morphine None No clinically significant interaction expected Nevirapine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=144 144 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=113&Page= Pethidine (Meperidine) Coadministration has not been studied but could potentially increase pethidine exposure. Delavirdine is an inhibitor of CYP3A4 and pethidine is metabolised mainly by CYP2B6 and to a lesser extent by CYP3A4. Coadminister with caution due to the risk of narcotic related adverse effects. No a priori dose adjustment is recommended, but monitor and adjust the pethidine dosage if needed. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Delavirdine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=145 145 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=114&Page= Pethidine (Meperidine) Coadministration has not been studied. Pethidine undergoes CYP2B6 and CYP3A4 mediated demethylation to form norpethidine. Norpethidine has analgesic and CNS stimulant activity which may increase the risk of CNS effect (e.g. seizures). Efavirenz induces CYP2B6 and CYP3A4 and could potentially increase concentrations of norpethidine. There is a risk of toxicity with long term therapy. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Efavirenz None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=146 146 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=115&Page= Pethidine (Meperidine) Coadministration has not been studied. Pethidine undergoes CYP2B6 and CYP3A4 mediated demethylation to form norpethidine. Norpethidine has analgesic and CNS stimulant activity which may increase the risk of CNS effect (e.g. seizures). Nevirapine induces CYP2B6 and CYP3A4 and could potentially increase concentrations of norpethidine. There is a risk of toxicity with long term therapy. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Nevirapine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=147 147 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=113&Page= Tramadol Coadministration has not been studied. Tramadol is metabolized by N-demethylation (CYP3A4 and CYP2B6) and to an active metabolite which is more potent than the parent compound by O-demethylation (CYP2D6). In vitro data suggest that delavirdine inhibits CYP3A4 and CYP2D6 and may increase tramadol exposure but also reduce the conversion to the more potent active metabolite. It is recommended to monitor tramadol related side effects and the analgesic effect. Adjust tramadol dosage if needed. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Delavirdine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=148 148 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=114&Page= Tramadol Coadministration has not been studied. Tramadol is metabolized by N-demethylation (CYP3A4 and CYP2B6) and to an active metabolite which is more potent than the parent compound by O-demethylation (CYP2D6). Efavirenz could potentially reduce tramadol exposure but may not affect the metabolic pathway leading to the more potent active metabolite. No a priori dosage adjustment is recommended, but the analgesic effect should be monitored. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Efavirenz None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=149 149 None None Analgesics InteractionDetailList.aspx?HIVDrugId=115&Page= Tramadol None No clinically significant interaction expected Nevirapine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=150 150 None None Analgesics InteractionDetailList.aspx?HIVDrugId=113&Page= Ibuprofen None No clinically significant interaction expected Delavirdine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=151 151 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=114&Page= Ibuprofen Coadministration has not been studied. Ibuprofen is metabolized mainly by CYP2C9 and in vitro data suggest that efavirenz is an inhibitor of CYP2C9, but the clinical significance of this in vitro finding is unknown. Use the lowest recommended dose of ibuprofen particularly in patients with risk factors for cardiovascular disease, those patients at risk of developing gastrointestinal complications, patients with hepatic or renal impairment, and in elderly patients. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Efavirenz None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=152 152 None None Analgesics InteractionDetailList.aspx?HIVDrugId=115&Page= Ibuprofen None No clinically significant interaction expected Nevirapine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=153 153 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=113&Page= Piroxicam Coadministration has not been studied but may increase piroxicam concentrations. Piroxicam is metabolized mainly by CYP2C9 and in vitro data suggest that delavirdine is an inhibitor of CYP2C9. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Delavirdine None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=154 154 None Very Low Analgesics InteractionDetailList.aspx?HIVDrugId=114&Page= Piroxicam Coadministration has not been studied, but may increase piroxicam exposure. Piroxicam is metabolized mainly by CYP2C9 and in vitro data suggest that efavirenz is an inhibitor of CYP2C9, but the clinical significance of this in vitro finding is unknown. Potential interaction that may require close monitoring, alteration of drug dosage or timing of administration Efavirenz None
http://www.hiv-druginteractions.org/InteractionDetail.aspx?CombinationId=155 155 None None Analgesics InteractionDetailList.aspx?HIVDrugId=115&Page= Piroxicam None No clinically significant interaction expected Nevirapine None
April 2013
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