Lopinavir/ritonavir adverse effects

POTASSIUM-SPARING DIURETICS ANTIVIRALS-PROTEASE INHIBITORS Possibly t adverse effects of eplerenone with nelfinavir, ritonavir (with or without lopinavir) and saquinavir Inhibition of CYP3A4-mediated metabolism of eplerenone Avoid concomitant use... 

ALFENTANIL, BUPRENORPHINE, FENTANYL, TRAMADOL PROTEASE INHIBITORS Possibly t adverse effects when buprenorphine is co administered with indinavir, ritonavir (with or without lopinavir) or saquinavir Inhibition of CYP3A4 (CYP2D6 in the case of tramadol) Halve the starting dose and titrate to effect. For single injection of fentanyl, monitor sedation and respiratoiy function closely. If continued use of fentanyl, i dose may be required. Concomitant use of ritonavir and transdermal fentanyl is not recommended... 

ANAESTHETICS - LOCAL ANTIVIRALS-PROTEASE INHIBITORS t adverse effects of lidocaine with lopinavir and ritonavir Uncertain t bioavailability Caution consider using an alternative local anaesthetic... 

CLARITHROMYCIN, ERYTHROMYCIN PROTEASE INHIBITORS Possibly t adverse effects of macrolide with atazanavir, ritonavir (with or without lopinavir) and saquinavir Inhibition of CYP3A4- and possibly CYP1 A2-mediated metabolism. Altered transport via P-gp may be involved. Amprenavir and indinavir are also possibly t by erythromycin Consider alternatives unless there is Mycobacterium avium intracellulare infection if combined, 1 dose by 50% (75% in the presence of renal failure with a creatinine clearance of <30mL/min)... 

METRONIDAZOLE PROTEASE INHIBITORS t adverse effects, e.g. disulfiram-like reaction, flushing, with ritonavir (with or without lopinavir) Ritonavir and lopinavir oral solutions contain alcohol Warn patient and give alternative preparation if possible... 

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... 

PROTEASE INHIBITORS SSRIs t adverse effects of fluoxetine, paroxetine and sertraline when co-administered with ritonavir (with or without lopinavir). Cardiac and neurological events have been reported, including serotonin syndrome Ritonavir is associated with the most significant interaction of the protease inhibitors due to potent inhibition of CYP3A, CYP2D6, CYP2C9 and CYP2C19 isoenzymes Warn patients to watch for t side-effects of SSRIs and consider 1 dose ofSSRI... 

PROTEASE INHIBITORS AMITRIPTYLINE t adverse effects when amitriptyline is co-administered with ritonavir (with or without lopinavir), and possibly atazanavir Inhibition of CYP3A4-mediated metabolism. Note that SSRIs are metabolized by a number of enzymes, including CYP2C9, CYP2C19, CYP2D6 and CYP3A4 therefore, the effect of protease inhibitors is variable Monitor closely... 

PROTEASE INHIBITORS BUPROPION t adverse effects of bupropion with nelfinavir and ritonavir (with or without lopinavir) Possibly inhibition of CYP2B6-mediated metabolism of bupropion Avoid co-administration... 

PROTEASE INHIBITORS PROGESTOGENS -NORETHISTERONE t adverse effects with amprenavir and atazanavir. Possibly 1 efficacy and risk of contraceptive failure with nelfinavir and ritonavir (with or without lopinavir) Uncertain Advise patients to use additional contraception for the period of intake and for 1 month after stopping coadministration with these drugs. Barrier methods are necessary to prevent transmission of infection from patients with HIV. Watch for early features of toxicity of amprenavir and atazanavir, and adjust the dose accordingly... 

The pharmacology, clinical pharmacology, uses, adverse effects, and interactions of lopinavir + ritonavir... 

In a prospective, randomized trial in 100 patients, the most common adverse effects of lopinavir + ritonavir included abnormal stools, diarrhea, and nausea (14). 

The most conunon adverse events reported with the lopinavir-ritonavir coformulation have been gastrointestinal including loose stools, diarrhea, nausea, and vomiting. These are less frequent and less severe than those reported with the 600-mg twice-daily standard dose of ritonavir. The most common abnormalities include elevated total cholesterol and triglycerides. Because the same adverse effects occur with ritonavir, it is unclear whether the side effects are due to ritonavir, lopinavir, or both. 

---