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Ketoconazole |
↑ Itraconazole (not studied)
↑ Ketoconazole (not studied) |
Based on theoretical considerations itraconazole and ketoconazole should be used with caution. High doses (>200 mg/day) are not recommended. |
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Voriconazole |
↕ Voriconazole (not studied) |
Due to multiple enzymes involved with voriconazole metabolism, it is difficult to predict the interaction. |
Antimycobacterials:
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Clarithromycin |
↑ Tipranavir, ↑ Clarithromycin,
↓ 14-hydroxy-clarithromycin metabolite |
No dose adjustment of APTIVUS or clarithromycin for patients with normal renal function is necessary.
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For patients with renal impairment the following dosage adjustments should be considered:
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For patients with CLCR 30 to 60 mL/min the dose of clarithromycin should be reduced by 50%.
-
For patients with CLCR <30 mL/min the dose of clarithromycin should be decreased by 75%.
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Rifabutin |
Tipranavir not changed, ↑ Rifabutin
↑ Desacetyl-rifabutin |
Single dose study. Dosage reductions of rifabutin by 75% are recommended (e.g., 150 mg every other day). Increased monitoring for adverse events in patients receiving the combination is warranted. Further dosage reduction may be necessary. |
Other Agents Commonly Used |
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Anticonvulsants:
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Carbamazepine
Phenobarbital
Phenytoin |
↓ Tipranavir |
Caution should be used when prescribing carbamazepine, phenobarbital and/or phenytoin. APTIVUS may be less effective due to decreased tipranavir plasma concentration in patients taking these agents concomitantly. |
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Valproic Acid |
↓ Valproic Acid |
Caution should be used when prescribing valproic acid. Valproic acid may be less effective due to decreased valproic acid plasma concentration in patients taking APTIVUS concomitantly. |
Antidepressants:
Trazodone |
↑ Trazodone |
Concomitant use of trazodone and APTIVUS/ritonavir may increase plasma concentrations of trazodone. Adverse events of nausea, dizziness, hypotension, and syncope have been observed following co-administration of trazodone and ritonavir. If trazodone is used with a CYP 3A4 inhibitor such as APTIVUS/ritonavir, the combination should be used with caution and a lower dose of trazodone should be considered. |
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Desipramine |
Combination with APTIVUS/ritonavir not studied
↑ Desipramine |
Dosage reduction and concentration monitoring of desipramine is recommended. |
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Selective Serotonin-Reuptake Inhibitors: |
Combination with APTIVUS/ritonavir not studied |
Antidepressants have a wide therapeutic index, but doses may need to be adjusted upon initiation of APTIVUS/ritonavir therapy. |
