Indinavir with itraconazole

The information about the interactions of protease inhibitors with itraconazole is limited. On the basis of the available data, it is possible that itraconazole has greater effects than ketoconazole , (below), on protease inhibitor levels. The manufacturers of indinavir advise modestly reducing the indinavir dose to 600 mg every 8 hours if it is to be given with itraconazole. The UK manufacturer of saquinavir recommends monitoring for saquinavir toxicity if itraconazole is used. Some protease inhibitors, especially ritonavir and possibly indinavir, may increase itraconazole levels and most manufacturers say that doses of itraconazole greater than 200 mg a day are not recommended. The US manufacturers of amprenavir recommend increased monitoring for adverse effects and state that the dose of itraconazole may need to be reduced if it is greater than 400 mg daily. ... 

Sildenafil doses should be decreased when any potent cytochrome P450 3A4 inhibitor is used (e g., cimetidine, erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir, and saquinavir). Vardenafil doses vary accordingto which agent is used (2.5 mg q 72 h for ritonavir, 2.5 mg q 24 h for indinavir, ketoconazole 400 mg daily, and itraconazole 400 mg daily and 5 mg q 24 h for ketoconazole 200 mg daily, itraconazole200 mg daily, and erythromycin). Tadalafil doses are reduced only when it is used with the most potent cytochrome P450 3A4 inhibitors (e g., ketoconazole or ritonavir). 

Pregnancy (ergotamine s powerful uterine stimulant actions may cause fetal harm) hypersensitivity to ergot alkaloids peripheral vascular disease (eg, thromboangiitis obliterans, leutic arteritis, severe arteriosclerosis, thrombophlebitis, Raynaud s disease) hepatic or renal impairment severe pruritus coronary artery disease hypertension sepsis. The use of potent CYP3A4 inhibitors (ritonavir, nelfinavir, indinavir, erythromycin, clarithromycin, troleandomycin, ketoconazole, itraconazole) with dihydroergotamine is contraindicated. 

HIV infection (in combination with other antiretrovirals) PO 800 mg (two 400-mg capsules) q8h. Dosage adjustments when given concomitantly Delavirdine, itraconazole, ketoconazok Reduce dose to 600 mg q8h. Efavirenz-. Increase dose to 1,000 mg q8h. Lopinavir/ritonavir Reduce dose to 600 mg twice a day. Nevirapine-. Increase dose to 1,000 mgqSh. Rifabutin-. Reduce rifabutin by lA and increase indinavir to 1,000 mg q8h. Ritonavir 100-200 mg twice a day and indinavir 800 mg twice a day or ritonavir 400 mg twice a day and indinavir 400 mg twice a day. 

Dosage with concurrent ketoconazole or itraconazole (at 400 mg/day), or indinavir. PO... 

The buffer in didanosine tablets and powder interferes with absorption of indinavir, delavirdine, atazanavir, dapsone, itraconazole, and fluoroquinolone agents therefore, administration should be separated in time. Serum levels of didanosine are increased when -administered with tenofovir or ganciclovir, and are decreased by atazanavir, delavirdine, ritonavir, tipranavir, and methadone (Table 49-4). 

Since indinavir is a substrate as well as an inhibitor of CYP3 A4, numerous and complex drug interactions can occur as described above. Indinavir levels decrease with concurrent use of rifabutin, fluconazole, St. John s wort, and rifampin. Caution is advised with other 3 A4 inducers also, including phenobarbital, phenytoin, carbamezepine, and dexamethasone. Dose reduction of indinavir should be considered if coadministered with delavirdine, ketoconazole, or itraconazole, while an increase in the dose of indinavir is indicated if the drug is coadministered with efavirenz or rifabutin. 

MODAFINIL 1. ANTIBIOTICS-clarithromycin, telithromycin 2. ANTIFUNGALS-itraconazole, ketoconazole 3. ANTIVIRALS-indinavir, nelfinavir, ritonavir, saquinavir t plasma concentrations of modafinil, with risk of adverse effects Due to inhibition of CYP3A4, which has a partial role in the metabolism of modafinil Be aware. Warn patients to report dose-related adverse effects, e.g. headache, anxiety... 

ITRACONAZOLE, KETOCONAZOLE PROTEASE INHIBITORS Possibly t levels of ketoconazole by amprenavir, indinavir and ritonavir (with or without lopinavir). Conversely, indinavir, ritonavir and saquinavir levels t by itraconazole and ketoconazole Inhibition of, or competition for, CYP3A4-mediated metabolism Use itraconazole with caution and monitor for adverse effects. No dose adjustment is recommended for doses <400 mg/day of ketoconazole... 

Clinically important, potentially hazardous interactions with alcohol, aprepitant, clarithromycin, CNS depressants, delavirdine, digoxin, efavirenz, fluconazole, fluoxetine, fluvoxamine, grapefruit juice, indinavir, itraconazole, ivermectin, kava, ketoconazole, propoxyphene, ritonavir, saquinavir, St John s wort... 

Clinically important, potentially hazardous interactions with aminophylline, amprenavir, antacids, carbamazepine, carmustine, chlorpheniramine, clarithromycin, efavirenz, esomeprazole, imatinib, indinavir, itraconazole, ketoconazole, MAO inhibitors, midazolam, modobemide, nelfinavir, phenytoin, sucralfate, warfarin... 

Clinically important, potentially hazardous interactions with clarithromycin, digoxin, indinavir, itraconazole, ketoconazole, ritonavir... 

Clinically important, potentially hazardous interactions with amantadine, anticholinergics, antidepressants, antimuscarinics, atazanavir, carbamazepine, clarithromycin, CYP2D6 inhibitors, CYP3A4 inducers, CYP3AF inhibitors, indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, phenobarbital, phenytoin, rifampicin, ritonavir, saquinivir, St John s wort, telithromycin... 

Clinically important, potentially hazardous interactions with amprenavir, aprepitant, bedomethasone, buprenorphine, calcium, chloramphenicol, cimetidine, dobazam, clorazepate, cyclosporine, cyproterone, darunavir, dasatinib, delavirdine, dexamethasone, diazoxide, disulfiram, dopamine, fesoterodine, fluconazole, flunisolide, fluoxetine, fosamprenavir, ginkgo biloba, hydrocortisone, imatinib, indinavir, influenza vaccines, isoniazid, isradipine, itraconazole, lacosamide, lapatinib, lopinavir, meperidine, methylprednisolone, midazolam, mivacurium, nelfinavir, nilotinib, nilutamide, phenylbutazone, piracetam, posaconazole, prednisolone, prednisone, primrose, ritonavir, rivaroxaban, sage, saquinavir, solifenacin, St John s wort, sucralfate, telithromycin, temsirolimus, teniposide, ticlopidine, tizanidine, tolvaptan, triamcinolone, uracil/tegafur, vigabatrin... 

Clinically important, potentially hazardous interactions with amprenavir, amyl nitrite, atazanavir, delavirdine, erythromycin, fosamprenavir, indinavir, isosorbide dinitrate, isosorbide mononitrate, itraconazole, ketoconazole, nelfinavir, nitrates, nitroglycerin, ritonavir, saquinavir... 

The AUC of erlotinib has been found to be increased by 66% when given with ketoconazole 200 mg twice daily for 5 days. The manufacturers advise caution with concurrent use, and recommend that the dose of erlotinib should be reduced if severe adverse reactions occur when given with strong CYP3A4 inhibitors. They specifically name atazanavir, clarithromycin, erythromycin, grapefruit and grapefruit juice, indinavir, itraconazole, ketoconazole, nefazodone, neltinavir, ritonavir, saquinavir, telithromycin, troleandomycin and voriconazole. ... 

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