Indinavir Azithromycin

Azithromycin, fluoroquinolones, ketoconazole, isoniazid, penicillin, rifampin, and tetracycline ° Didanosine, indinavir, stavudine, and zidovudine ° Aledronate, risedronate, and levodopa... 

Azalides azithromycin Azoles fluconazole, itraconazole, ketoconazole, and voriconazole Macrolides erythromycin, clarithromycin Protease inhibitors amprenavir, indinavir, lopinavir/ritonavir, nelfinavir, ritonavir, and saquinavir Quinolones ciprofloxacin, gatifloxacin, levofloxacin, moxifloxacin. 

Drugs that may affect nelfinavir include anticonvulsants, azithromycin, azole antifungals, efavirenz, delavirdine, HMG-CoA reductase inhibitors, indinavir, interleukins, nevirapine, rifabutin, rifampin, ritonavir, saquinavir, St. John s wort. Drugs that may be affected by nelfinavir include amiodarone, antiarrhythmics (amiodarone, quinidine), azithromycin, benzodiazepines, efavirenz, ergot alkaloids, delavirdine, didanosine, fentanyl, indinavir, lamivudine methadone, nonsedating antihistamines, oral contraceptives, phenytoin, pimozide, quinidine, rifabutin, saquinavir, sildenafil, sirolimus, tacrolimus, zidovudine. 

A 35-year old Caucasian man with AIDS and multiple opportunistic infections, including Mycobacterium kansasii and Mycobacterium avium complex (MAC) disease developed moderate to severe primary sensorineural hearing loss after 4—5 months of therapy with oral azithromycin 500 mg/day. Other medications included ethambutol, isoniazid, rifabutin, ciprofloxacin, co-trimoxazole, fluconazole, zidovudine (later switched to stavudine), lamivudine, indinavir, methadone, mod-ified-release oral morphine, pseudoephedrine, diphenhydramine, megestrol acetate, trazodone, sorbitol, salbutamol by metered-dose inhaler and nebulizer, ipratropium, and oral morphine solution as needed. Significant improvement of the hearing impairment was documented 3 weeks after drug withdrawal. 

Clinically important, potentially hazardous interactions with amiodarone, azithromycin, bepredil, bosentan, bretylium, cisapride, clarithromycin, disopyramide, erythromycin, erythromycin fluconazole, fluoxetine, fluvoxamine, grapefruit juice, indinavir, itraconazole, ketoconazole, metronidazole, miconazole, nefazodone, nilotinib, paroxetine, pimozide, probucol, procainamide, quinidine, quinine, ritonavir, saquinavir, sertraline, sotalol, SSRIs, terfenadine, troleandomycin, voriconazole, zileuton, ziprasidone... 

HIV protease inhibitors Indinavir Nelfinavir Ritonavir Saquinavir Amiodarone not Azithromycin Cimetidme Clarithromycin . Diltiazem Erythromycin Fluoxetine Fluvoxamine Grapefruit Juice Itraconazole Ketoconazole Mibefradil Nefezodone Troleandomydn Verapamil... 

Transporter efflux transporter effects predominant Examples Amiodarone Atorvastatin Azithromycin Carbamazepine Carvediioi Chlorpromazine Ciprofloxacin Cisapride Cyciosporine Danazoi Dapsone Diclofenac Diflunisal Digoxin Erythromycin Flurbiprofen Glipizide Glyburide Griseofulvin Ibuprofen Indinavir Indomethacin Itraconazole Ketoconazole Lansoprazole Lovastatin Mebendazole Naproxen Nelfinavir Ofloxacin Oxaprozin Phenazopyridine Phenytoin Piroxicam Raloxifene Ritonavir Saquinavir Saquinavir Sirolimus Sirolimus Spironolactone Spironolactone Tacrolimus Tacrolimus ... 

Azalides azithromycin azoies fiuconazoie, itraconazoie, ketoconazoie, and voriconazoie macroiides erythromycin, ciarithromycin protease inhibitors aprenavir, indinavir, iopinavir/ritonavir, neifinavir, ritonavir, and saquinavir quinoiones ciprofioxacin, gatifioxacin, ievofioxacin, moxifioxacin. 

Rifabutin is effective for the prevention of MAC infection in HIV-infected individuals. At a dose of 3(X) mg per day, rifabutin decreased the frequency of MAC bacteremia (2%). However, azithromycin or clarithromycin are more effective and less likely to interact with highly active antiretroviral therapy (HAART) drugs. Rifabutin also is commonly substituted for rifampin in the treatment of tuberculosis in HIV-infected patients, as it has a less profound CYP-dependent interaction with indinavir and nelfinavir. Rifabutin also is used in combination with clarithromycin and ethambutol for the therapy of MAC disease. 

Nelfinavir approximately doubles the sierum levels of azithromycin, but the ciinical significance of this is uncertain. Single doses of azithromycin have no effect on the levels of indinavir and nelfinavir. Ritonavir and atazanavir increase clarithromycin leveis. Amprenavir, indinavir and saquinavir do not have a clinically significant effect on clarithromycin pharmacokinetics. Clarithromycin has no important effect on the pharmacokinetics of amprenavir, atazanavir, darunavir, indinavir or ritonavir, but it increases tipranavir levels. Although both clarithromycin and erythromycin markedly raise saquinavir levels, this is not considered clinically important for short courses of these antibacteriais. 

Indinavir. A single 1.2-g dose of azithromycin had no effect on the pharmacokinetics of indinavir in healthy subjects who had taken indinavir 800 mg three times daily for 5 days. ... 

The increase in azithromycin levels with nelfinavir is likely to be of clinical significance, and, although the outcome is presumed to be positive, this has yet to be assessed in practice. If concurrent use is necessary, monitor for azithromycin adverse effects. Single doses of azithromycin did not affect the pharmacokinetics of nelfinavir or indinavir, and the manufacturers of a combination product of lopinavir/ritonavir do not expect a clinically significant interaction with azithromycin. ... 

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