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Meperidine |
Combinations with APTIVUS/ritonavir not studied
↓ Meperidine, ↑ Normeperidine |
Dosage increase and long-term use of meperidine are not recommended due to increased concentrations of the metabolite normeperidine which has both analgesic activity and CNS stimulant activity (e.g., seizures). |
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Methadone |
↓ Methadone
↓ S-Methadone, >↓ R-Methadone |
Dosage of methadone may need to be increased when co-administered with APTIVUS and 200 mg of ritonavir. |
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Oral Contraceptives/Estrogens:
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Ethinyl estradiol |
↓ Ethinyl estradiol concentrations by 50% |
Alternative methods of nonhormonal contraception should be used when estrogen based oral contraceptives are co-administered with APTIVUS and 200 mg of ritonavir. Patients using estrogens as hormone replacement therapy should be clinically monitored for signs of estrogen deficiency. Women using estrogens may have an increased risk of non-serious rash. |
Proton Pump Inhibitors:
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Omeprazole |
↓ Omeprazole, ↔ Tipranavir |
Dosage of omeprazole may need to be increased when co-administered with APTIVUS and ritonavir. |
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PDE-5 Inhibitors: |
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Only the combination of tadalafil with APTIVUS/ritonavir has been studied (at doses used for treatment of erectile dysfunction).
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Co-administration with APTIVUS/ritonavir may result in an increase in PDE-5 inhibitor-associated adverse events, including hypotension, syncope, visual disturbances, and priapism.
Use of PDE-5 inhibitors for pulmonary arterial hypertension (PAH):
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Use of sildenafil (Revatio) is contraindicated when used for the treatment of pulmonary arterial hypertension (PAH) [see Contraindications (4.2)].
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The following dose adjustments are recommended for use of tadalafil (Adcirca) with APTIVUS/ritonavir:
Co-administration of tadalafil (Adcirca) in patients on APTIVUS/ritonavir:
In patients receiving APTIVUS/ritonavir for at least one week, start Adcirca at 20 mg once daily. Increase to 40 mg once daily based upon individual tolerability.
Co-administration of APTIVUS/ritonavir in patients on tadalafil (Adcirca):
Avoid use of tadalafil (Adcirca) during the initiation of APTIVUS/ritonavir. Stop Adcirca at least 24 hours prior to starting APTIVUS/ritonavir. After at least one week following the initiation of APTIVUS/ritonavir, resume Adcirca at 20 mg once daily. Increase to 40 mg once daily based upon individual tolerability.
Use of PDE-5 inhibitors for erectile dysfunction:
Concomitant use of PDE-5 inhibitors with APTIVUS/ritonavir should be used with caution and in no case should the starting dose of:
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sildenafil exceed 25 mg within 48 hours
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tadalafil exceed 10 mg every 72 hours
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vardenafil exceed 2.5 mg every 72 hours
Use with increased monitoring for adverse events. |
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