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Fluoxetine
Paroxetine
Sertraline |
↑ Fluoxetine
↑ Paroxetine
↑ Sertraline |
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Anti-gout
Colchicine |
↑ Colchicine |
Patients with renal or hepatic impairment should not be given colchicine with APTIVUS/ritonavir.
Treatment of gout flares: Co-administration of colchicines in patients on APTIVUS/ritonavir:
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0.6 mg (1 tablet) x 1 dose, followed by 0.3 mg (half tablet) 1 hour later. Dose to be repeated no earlier than 3 days.
Prophylaxis of gout flares: Co-administration of colchicine in patients on APTIVUS/ritonavir:
-
If the original colchicine regimen was 0.6 mg twice a day, the regimen should be adjusted to 0.3 mg once a day.
-
If the original colchicine regimen was 0.6 mg once a day, the regimen should be adjusted to 0.3 mg once every other day.
Treatment of familial Mediterranean fever (FMF): Co-administration of colchicine in patients on APTIVUS/ritonavir:
-
Maximum daily dose of 0.6 mg (may be given as 0.3 mg twice a day).
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Benzodiazepines:
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|
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Parenterally administered midazolam |
↑ Midazolam |
Midazolam is extensively metabolized by CYP 3A4. Increases in the concentration of midazolam are expected to be significantly higher with oral than parenteral administration. Therefore, APTIVUS should not be given with orally administered midazolam [see Contraindications (4)]. If APTIVUS is co-administered with parenteral midazolam, close clinical monitoring for respiratory depression and/or prolonged sedation should be exercised and dosage adjustments should be considered. |
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Buprenorphine/naloxone |
↔ Buprenorphine
↓ Tipranavir |
APTIVUS/ritonavir did not result in changes in the clinical efficacy of buprenorphine/naloxone. Compared to historical controls tipranavir Cmin was decreased approximately 40% with this combination. Dose adjustments cannot be recommended. |
Calcium Channel Blockers:
Diltiazem
Felodipine
Nicardipine
Nisoldipine
Verapamil |
Combination with APTIVUS/ritonavir not studied. Cannot predict effect of TPV/ritonavir on calcium channel blockers that are dual substrates of CYP3A and P-gp due to conflicting effect of TPV/ritonavir on CYP3A and P-gp.
↕ Diltiazem
↑ Felodipine (CYP3A substrate but not P-gp substrate)
↕ Nicardipine
↕ Nisoldipine (CYP3A substrate but not clear whether it is a P-gp substrate)
↕ Verapamil |
Caution is warranted and clinical monitoring of patients is recommended. |
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Disulfiram/Metronidazole |
Combination with TPV/ritonavir not studied |
APTIVUS capsules contain alcohol that can produce disulfiram-like reactions when co-administered with disulfiram or other drugs which produce this reaction (e.g., metronidazole). |
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Endothelin receptor antagonists |
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Co-administration of bosentan in patients on APTIVUS/ritonavir: |
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Bosentan |
↑ Bosentan |
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