In patients who have been receiving APTIVUS/ritonavir for at least 10 days, start bosentan at 62.5 mg once daily or every other day based upon individual tolerability.
Co-administration of APTIVUS/ritonavir in patients on bosentan:
Discontinue use of bosentan at least 36 hours prior to initiation of APTIVUS/ritonavir.
After at least 10 days following the initiation of APTIVUS/ritonavir, resume bosentan at 62.5 mg once daily or every other day based upon individual tolerability. |
HMG-CoA Reductase Inhibitors:
|
|
Atorvastatin
Rosuvastatin |
↑ Atorvastatin
↓ Hydroxy-atorvastatin metabolites
↑ Tipranavir
↑ Rosuvastatin |
Use the lowest possible dose of atorvastatin or rosuvastatin with careful monitoring, or consider other HMG-CoA reductase inhibitors such as pravastatin or fluvastatin when in concomitant use of APTIVUS, co-administered with 200 mg of ritonavir. |
Hypoglycemics:
|
|
|
|
Combination with APTIVUS/ritonavir not studied |
Careful glucose monitoring is warranted. |
|
|
Glimepiride
Glipizide
Glyburide
Pioglitazone |
↔ Glimepiride (CYP 2C9)
↔ Glipizide (CYP 2C9)
↔ Glyburide (CYP 2C9)
↕ Pioglitazone (CYP 2C8 and CYP 3A4) |
|
|
|
|
Repaglinide |
↕ Repaglinide (CYP 2C8 and CYP 3A4) |
|
|
|
|
Tolbutamide |
↔ Tolbutamide (CYP 2C9)
The effect of TPV/ritonavir on CYP 2C8 substrate is not known. |
|
Immunosuppressants:
|
|
|
|
Combination with APTIVUS/ritonavir not studied. Cannot predict effect of TPV/ritonavir on immunosuppressants due to conflicting effect of TPV/ritonavir on CYP 3A and P-gp. |
Increased frequency of monitoring of plasma levels of immunosuppressant drugs is recommended. |
Cyclosporine
Sirolimus
Tacrolimus |
↕ Cyclosporine
↕ Sirolimus
↕ Tacrolimus |
|
Inhaled beta agonist:
Salmeterol |
↑ Salmeterol |
Concurrent administration of APTIVUS/ritonavir is not recommended. The combination may result in increased risk of cardiovascular adverse events associated with salmeterol, including QT prolongation, palpitations, and sinus tachycardia. |
Inhaled/Nasal Steroids:
|
|
|
Fluticasone |
↑ Fluticasone |
Concomitant use of fluticasone propionate and APTIVUS/ritonavir may increase plasma concentrations of fluticasone propionate, resulting in significantly reduced serum cortisol concentrations. Co-administration of fluticasone propionate and APTIVUS/ritonavir is not recommended unless the potential benefit to the patient outweighs the risk of systemic corticosteroid side effects. |
Narcotic Analgesics:
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