Ritonavir alprazolam

Greenblatt DJ, von Moltke LL, Harmatz JS, et al. Alprazolam-ritonavir interaction implications for product labeling. Clin Pharmacol Ther 2000 67 335-341. 

Aprepitant (Emend) [Centrally Acting Antiemetic] Uses Pre-vents N/V assoc w/ emetogenic CA chemo (eg, cisplatin) (use in combo w/ other antiemetics) Action Substance P/neurokinin l(NKi) receptor antagonist Dose 125 mg PO day 1, 1 h before chemo, then 80 mg PO qAM days 2 3 Caution [B, /-] Contra Use w/ pimozide, Disp Caps SE Fatigue, asthenia, hiccups Interactions T Effects W/ clarithromycin, diltiazem, itraconazole, ketoconazole, nefazodone, nelfinavir, ritonavir, troleandomycin T effects OF alprazolam, astem-izole, cisapride, dexamethasone, methylprednisolone, midazolam, pimozide, terfe-nadine, triazolam, chemo agents, eg, docetaxel, etoposide, ifosfamide, imatinib, irinotecan, paclitaxel, vinblastine, vincristine, vinorelbine i effects W/ paroxetine,... 

Greenblatt DJ, von Moltke LL, Daily JP, Harmatz JS, Shader RI. Extensive impairment of triazolam and alprazolam clearance by short-term low dose ritonavir the clinical dilemma of concurrent inhibition and induction. J Clin Psychopharmacol 1999 19 293-296. 

St. John s wort Alprazolam, cyclosporine, digoxin, indinavir, oral contraceptives, ritonavir, simvastatin, tacrolimus, warfarin... 

Itraconazole Alfentanil, alprazolam, astemizole, atorvastatin, buspirone, cisapride, cyclosporine, delavirdine, diazepam, digoxin, felodipine, indinavir, loratadine, lovastatin, midazolam, nisoldipine, phenytoin, quinidine, ritonavir, saquinavir, sildenafil, simvastatin, sirolimus, tacrolimus, triazolam, verapamil, warfarin... 

Duloxetine8 Propofol Paclitaxel0 Flurbiprofen Lansoprazole11 Laurie acid Aripiprazole Alprazolam Docetaxel Ketamine Ritonavir... 

The inhibitory effect of ritonavir (a viral protease inhibitor) on the metabolism of alprazolam, a CYP3A-mediated reaction, has been investigated in a doubleblind study (44). Ten subjects took alprazolam 1.0 mg plus either low-dose ritonavir (four doses of 200 mg) or placebo. Ritonavir reduced alprazolam clearance by 60%, prolonged its half-life, and magnified its benzodiazepine agonist effects, such as sedation and impairment of performance. 

Clinically important, potentially hazardous interactions with alprazolam, astemizole, carbamazepine, cisapride, clarithromycin, dexamethasone, diltiazem, docetaxel, ifosfamide, imatinib, irinotecan, itraconazole, ketoconazole, methylprednisolone, midazolam, nefazodone, oral contraceptives, paroxetine, phenytoin, pimozide, rifampin, ritonavir, terfenadine, tolbutamide, trabectedin, troleandomycin, vinblastine, vincristine, warfarin... 

Clinically important, potentially hazardous interactions with alcohol, alprazolam, carbamazepine, metoprolol, phenelzine, ritonavir, warfarin... 

Ritonavir (RTV) Yes Alprazolam, Ethinyl Estradiol Product Monograph Yes Methadone Bupropion [50]... 

A study and a case report show that saquinavir markedly decreases midazolam metabolism, resulting in a significant increase in sedation. Ritonavir similarly affects triazolam and, to a lesser extent, alprazolam, but appears not to affect zolpidem levels. 

Alprazolam, midazolam and triazolam are metabolised by the cytochrome P450 isoenzyme CYP3A4, which is inhibited, to varying degrees, by the protease inhibitors. Benzodiazepine levels and effects are therefore increased by saquinavir and ritonavir. Zolpidem metabolism depends on several isoenzymes so inhibition of CYP3A4 alone may not produce clinically significant changes in its clearance. 

Class 2 (High PermeabiUty, Low Solrrbility) Azathioprine, Azithromycin, Alprazolam, Warfarin, Haloperidol, Glipizide, Griseofulvinum, Danazol, Dapsone, Diclofenac, Indometacin, Itraconzol, Carbamazepine, Carvedilol, Ketoconazole, Lansoprazol, Mebendazole, Mefloqrrine, Nalidixic acid. Nevirapine, Piroxicam, Praziquantel, Ritonavir, Rifampicinirm, Spironolactone, Tamoxifen, Terfenadine, Trimethoprim, Ibnprofen, lopanoic add, Lovastatin, Naproxen, Oxaprozin, Flubiprofen, Cisapride. ... 

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