Voriconazole Ritonavir

VORICONAZOLE RITONAVIR 1 efficacy of voriconazole 1 plasma levels Avoid co-administration if the dose of ritonavir is 400 mg twice a day or greater. Avoid combining low-dose ritonavir (100 mg twice a day) unless benefits outweigh risks... 

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 atazanavir include the following antacids and buffered medications, clarithromycin, didanosine (buffered formulation only), efavirenz, H2-receptor antagonists, indinavir, itraconazole, ketoconazole, nevirapine, proton pump inhibitors, rifampin, ritonavir, St. John s wort, tenofovir, voriconazole. 

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... 

Drugs that may inhibit cytochrome P450 metabolism of other drugs include amiodarone, androgens, atazanavir, chloramphenicol, cimetidine, ciprofloxacin, clarithromycin, cyclosporine, delavirdine, diltiazem, diphenhydramine, disulfiram, enoxacin, erythromycin, fluconazole, fluoxetine, fluvoxamine, furanocoumarins (substances in grapefruit juice), indinavir, isoniazid, itraconazole, ketoconazole, metronidazole, mexile-tine, miconazole, nefazodone, omeprazole, paroxetine, propoxyphene, quinidine, ritonavir, sulfamethizole, verapamil, voriconazole, zafirlukast, and zileuton. 

IFOSFAMIDE 1. ANTIBIOTICS -clarithromycin, erythromycin 2. ANTIFUNGALS -fluconazole, itraconazole, ketoconazole voriconazole 3. ANTIVIRALS-efavirenz, ritonavir 4. GRAPEFRUIT JUICE 5. H2 RECEPTOR BLOCKERS - cimetidine 1 plasma concentrations of 4-hydroxyifbsfamide, the active metabolite of ifosfamide, and risk of inadequate therapeutic response Due to inhibition of the isoenzymatic conversion to active metabolites Monitor the efficacy of ifosfamide clinically and t dose accordingly... 

Lopinavir/ritonavir (LPV/r) Kaletra 33.3 mg and 133.3 mg capsules 20 mg/ml and 80 mg/ml solutions Acetaminophen/propoxyphene or tramadol, codeines, aspirin/caffeine/propoxyphene, erythromycins, itraconazole, ketoconazole, fluconazole, voriconazole... 

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... 

Clinically important, potentially hazardous interactions with acetylcysteine, adenosine, aprepitant, aripiprazole, buprenorphine, caffeine, charcoal, clarithromycin, clobazam, dorazepate, clozapine, darunavir, dasatinib, delavirdine, dexamethasone, diltiazem, doxacurium, erythromycin, felodipine, fesoterodine, fosamprenavir, imatinib, influenza vaccines, lacosamide, lapatinib, levetiracetam, lopinavir, methylprednisolone, midazolam, nelfinavir, nilotinib, piracetam, prednisolone, propoxyphene, ritonavir, rivaroxaban, rufinamide, solifenacin, St John s wort, telithromycin, temsirolimus, terbinafine, tolvaptan, troleandomycin, verapamil, voriconazole... 

Clinically important, potentially hazardous interactions with amprenavir, atazanavir, clarithromycin, delavirdine, grapefruit juice, indinavir, itraconazole, ketoconazole, nefazodone, ritonavir, saquinavir, telithromycin, voriconazole... 

Clinically important, potentially hazardous interactions with amiodarone, astemizole, bepridil, carbamazepine, chloroquine, cisapride, clarithromycin, dihydroergotamine, disopyramide, ergotamine, grapefruit juice, halofantrine, haloperidol, itraconazole, ketoconazole, methadone, moxifloxacin, phenobarbital, phenytoin, pimozide, procainamide, quinidine, rifampicin, ritonavir, sotalol, St John s wort, telithromycin, terfenadine, voriconazole... 

Clinically important, potentially hazardous interactions with amiodarone, anisindione, anticoagulants, azithromycin, corticosteroids, cyclosporine, dapsone, delavirdine, dicumarol, fosamprenavir, lapatinib, lopinavir, midazolam, oral contraceptives, ritonavir, solifenacin, tacrolimus, temsirolimus, tolvaptan, voriconazole... 

Clinically important, potentially hazardous interactions with amiodarone, amprenavir, anisindione, antacids, anticoagulants, aprepitant, atazanavir, atovaquone, beclomethasone, buprenorphine, corticosteroids, cortisone, cyclosporine, cyproterone, dabigatran, dapsone, darunavir, delavirdine, dexamethasone, dicumarol, digoxin, eszopiclone, flunisolide, fosamprenavir, gadoxetate, gestrinone, halothane, imatinib, isoniazid, itraconazole, ketoconazole, lapatinib, lorcainide, methylprednisolone, midazolam, nelfinavir, nifedipine, oral contraceptives, phenylbutazone, prednisone, protease inhibitors, pyrazinamide, ramelteon, ritonavir, saquinavir, solifenacin, sunitinib, tacrolimus, telithromycin, temsirolimus, tipranavir, tolvaptan, trabectedin, triamcinolone, triazolam, voriconazole, warfarin, zaleplon... 

Coadministration with rifampin, rifabutin, or ritonavir is contraindicated because of accelerated voriconazole metabolism. Efavirenz and perhaps other normucleoside reverse transcriptase inhibitors (NNRTIs) significantly increase voriconazole metabolism and slow the metabolism of the NNRTI. When given with phenytoin, the voriconazole dose should be doubled. Drugs that significantly accumulate in patients receiving voriconazole include cyclosporine,... 

IRINOTECAN 1. ANTIBIOTICS-clarithromycin, erythromycin 2. ANTICANCER AND IMMUNOMODULATING DRUGS - imatinib 3. ANTIFUNGALS -fluconazole, itraconazole, ketoconazole, voriconazole 4. ANTIVIRALS-efavirenz, ritonavir 5. GRAPEFRUIT JUICE 6. H2 RECEPTOR BLOCKERS - cimetidine t plasma concentrations of SN-38 (t AUC by 100%) and t toxicity of irinotecan, e.g. diarrhoea, acute cholinergic syndrome, interstitial pulmonary disease Due to inhibition of the metabolism of irinotecan by CYP3A4 isoenzymes by ketoconazole Peripheral blood counts should be checked before each course of treatment. Monitor lung function. Recommendation is to -L dose of irinotecan by 25%... 

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. ... 

The current use of protease inhibitors and voriconazole is predicted to interfere with the metabolism of both drugs. Studies suggest that ritonavir decreases voriconazole levels, but no interaction was seen between indinavir and voriconazole in one study. 

In healthy subjects ritonavir 400 mg twice daily for 9 days decreased the steady-state maximum levels and AUC of oral voriconazole (400 mg twice daily for 1 day, then 200 mg twice daily for 8 days) by 66% and 82%, respectively. The pharmacokinetics of the ritonavir remained unchanged. Low-dose ritonavir (100 mg daily) decreased the AUC of voriconazole by 39% and the AUC of the ritonavir was decreased by 14%. ... 

The manufacturers of voriconazole say that the concurrent use of ritonavir (at doses of400 mg and above twice daily) is contraindicated, presumably because the efficacy of the voriconazole is expected to be markedly reduced. The manufacturer of ritonavir also recommends that when it is used as a pharmacokinetic enhancer (usually 100 mg twice daily) voriconazole should only be given if the benefits outweigh the risks. Most protease inhibitors are given with ritonavir as a pharmacokinetic enhancer however, caution is also warranted if they are given alone, as all the protease inhibitors can inhibit CYP3A4 to some extent and may therefore also increase voriconazole levels. Voriconazole may also affect protease inhibitor levels, but other than ritonavir and indinavir, which are not affected this does not appear to have been studied. Be aware that some increase in their levels is theoretically possible if voriconazole is given. 

Drug-drug interactions The lack of voriconazole-mediated effect on the plasma concentrations of arunavir/ritonavir and etravirine has been reported [35 ]. 

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