Nevirapine Fluconazole

Drugs that may affect nevirapine include rifamycins (eg, rifampin, rifabutin), fluconazole, St. John s wort. 

Others Acetaminophen, amiodarone, carbamazepine, delavirdine, efavirenz, nevirapine, quinidine, repaglinide, sildenafil, tadalafil, trazodone, vardenafil Amiodarone, amprenavir, atazanavir, ciprofloxacin, cisapride, clarithromycin, diltiozem, erythromycin, fluconazole, fluvoxamine, grapefruit juice (in high ingestion), indinavir, itraconazole, ketoconazole, nefazodone, nelfinavir, norfloxacin, ritonavir, telithromycin, troleandomycin, verapamil, voriconazole Carbamazepine, efavirenz, glucocorticoids, macrolide antibiotics, nevirapine, phenytoin, phenobarbital, rifabutin, rifapentine, rifampin, St. John s wort... 

Nevirapine is a moderate inducer of CYP3A metabolism, resulting in decreased levels of amprenavir, indinavir, lopinavir, saquinavir, efavirenz, and methadone (Table 49-4). Drugs that induce the CYP3A system, such as tipranavir, rifampin, rifabutin, and St. John s wort, can decrease levels of nevirapine, whereas those that inhibit CYP3A activity, such as fluconazole, ketoconazole, and clarithromycin, can increase nevirapine levels. 

Clinically important, potentially hazardous interactions with amprenavir, aprepitant, atazanavir, carbamazepine, chlorpheniramine, cimetidine, clarithromycin, clorazepate, CNS depressants, darunavir, delavirdine, dexamethasone, efavirenz, erythromycin, esomeprazole, fluconazole, fluoxetine, fosamprenavir, grapefruit juice, griseofulvin, imatinib, indinavir, itraconazole, ivermectin, ketoconazole, lopinavir, nelfinavir, nevirapine, phenobarbital, phenytoin, primidone, rifabutin, rifampin, ritonavir, roxithromycin, saquinavir, St John s wort, telithromycin, tipranavir... 

Fluconazole doubles nevirapine exposure, and the combination should be used with caution. Fluconazole causes a minor rise in efavirenz steady-state levels, and does not alter delavirdine levels. Fluconazole levels are not altered by these NNRTIs. 

The concurrent use of fluconazole and nevirapine doubled the exposure to nevirapine compared with historical control data, although nevirapine did not have any clinically relevant effect on fluconazole pharmacokinetics. The manufacturer suggests that patients should be closely monitored for nevirapine-associated adverse effects if fluconazole and nevirapine are used concurrently. However, in a retrospective study of patients who had received a nevirapine-based HAART regimen, there was no increase in the incidence of clinical hepatitis, elevated aminotransferases or skin rashes, when the outcomes of225 patients not receiving fluconazole, 392 patients treated with fluconazole 400 mg weekly, and 69 patients receiving fluconazole 200 mg daily with nevirapine were compared. ... 

Nevirapine In a substudy within a large double-blind, randomized, placebo-con-trolled study of the use of fluconazole 200 mg three times per week in primary prophylaxis of cryptococcal disease in HIV-infected adults in rural south-western Uganda, fluconazole increased the nevirapine AUCo sh by 29% [42 ]. In the larger cohort from which the participants were drawn, co-administration of fluconazole did not increase the risk of hepatotoxicity, despite increased exposure to nevirapine. 

Wakeham K, Parkes-Ratanshi R, Watson V, Ggayi AB, Khoo S, Lalloo DG. Co-administration of fluconazole increases nevirapine concentrations in HIV-infected Ugandans. J Antimicrob Chemother 2010 65 316-9. 

Simultaneous didanosine, folic acid, ganciclovir, lamivudine, nevirapine, pyrazinamide, ranitidine, rifampin, stavudine, sulfamethoxazole, trimethoprim, zidovudine Noninterfering adefovir, amprenavir, delavirdine, efavirenz, fluconazole, indinavir, itraconazole, methadone, nelfinavir, oxazepam, pyrimethamine, rifampin, ritonavir, saquinavir, zalcitabine... 

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