CIPLADOC - AIDS Update - DRUG INTERACTIONS IN HIV THERAPY - DRUG INTERACTIONS BETWEEN PROTEASE INHIBITORS

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DRUG INTERACTIONS IN HIV THERAPY
A Clinician's Guide

DRUG INTERACTIONS BETWEEN PROTEASE INHIBITORS
AND NON-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS

Effect of Drug on Levels (AUCs)/Dose

Drugs Affected	Nevirapine	Delavirdine	Efavirenz
Indinavir (IDV)	Levels: IDVi 28% NVP no effect Dose: IDV 1000 mg q8h NVP standard	Levels: IDVi >40% DLV no effect Dose: IDV 600 mg q8h DLV: standard	Levels: IDVi 31% Dose: IDV 1000 mg q8h
Ritonavir (RTV)	Levels: RTVi 11% NVP no effect Dose: Standard	Levels: RTVh70% DLV: no effect Dose: DLV: standard RTV: no data	EFV standard Levels: RTVh 18% EFV h21% Dose: RTV 600 mg bid (500 mg bid for intolerance) EFV standard
Saquinavir (SQV)	Levels: SQV i 25% NVP no effect Dose: No data	Levels:h SQV 5X+ DLV no effect Dose: SQV soft gel capsules 800 mg tid DLV standard (monitor transaminase levels)	Levels: SQV i 62%+ EFV i 12% Co-administration not recommended
Nelfinavir (NFV)	Levels: NFV h 10% NVP no effect Dose: Standard	Levels: NFV h 2x DLV i 50% Dose: No data (monitor for neutropenic complications)	Levels: NFV h 20% Dose: Standard

Drugs Affected	Nevirapine	Delavirdine	Efavirenz
Amprenavir	No data	No data	Levels: APV (APV) AUCi 36% Dose: APV 1200 mg tid as single PI, or 1200 mg bid + RTV 200 mg bid EFV standard
Nevirapine (NVP)		No data	Levels: NVP: no effect EFV: AUC i 22%
Delavirdine (DLV)	No data		No data
Lopinavir/ Ritonavir (LPV/ RTV)	Levels: LPV Cmin i 55% Dose: Consider LPV/r 533/133 mg bid in PI- experienced patients NVP standards	Levels: LPV levels expected to increase. Dose: Insufficient data	Levels: LPV AUC i 40% EFV no change Dose: Consider LPV/R 533/133 mg bid in PI-experienced patients EFV standard

+ Conducted with SQV hard gel capsule