aripiprazole. Adjust aripiprazole dose, p. 395.

Study

▶ HIV-protease inhibitors are predicted to increase the exposure

to axitinib. Avoid or adjust dose.oStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to bedaquiline. Avoid prolonged use.nStudy → Also see

TABLE 9 p. 1377

▶ HIV-protease inhibitors (lopinavir, ritonavir, saquinavir) are

predicted to increase the exposure to beta blockers, nonselective (nadolol).oStudy

▶ Ritonavir is predicted to increase the exposure to beta blockers,

selective (metoprolol).oStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to beta2 agonists (salmeterol). Avoid.rStudy

▶ Atazanavir moderately increases the exposure to bictegravir.

Avoid.rStudy

▶ HIV-protease inhibitors (lopinavir, ritonavir, saquinavir) are

predicted to increase the exposure to bictegravir. Use with

caution or avoid.oTheoretical

▶ HIV-protease inhibitors slightly increase the exposure to

bortezomib.oStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to bosentan.rStudy

▶ HIV-protease inhibitors are predicted to markedly increase the

exposure to bosutinib. Avoid or adjust dose.rStudy →

Also see TABLE 9 p. 1377

▶ HIV-protease inhibitors are predicted to increase the exposure

to brigatinib. Adjust brigatinib dose, p. 971.rStudy

▶ Ritonavir

o

is predicted to decrease the exposure to bupropion.

Study

▶ HIV-protease inhibitors are predicted to increase the exposure

to buspirone. Adjust buspirone dose, p. 342.rStudy

▶ HIV-protease inhibitors slightly increase the exposure to

cabozantinib.oStudy → Also see TABLE 9 p. 1377

▶ Ritonavir is predicted to moderately increase the clearance of

caffeine citrate. Monitor and adjust dose.oStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to calcium channel blockers (amlodipine, felodipine, lacidipine,

nicardipine, nifedipine, nimodipine)

o

. Monitor and adjust dose.

Study

▶ HIV-protease inhibitors are predicted to increase the exposure

to calcium channel blockers (diltiazem, verapamil).rStudy

▶ HIV-protease inhibitors are predicted to markedly increase the

exposure to

r

calcium channel blockers (lercanidipine). Avoid.

Study

▶ HIV-protease inhibitors are predicted to increase the exposure

to

o

cannabis extract. Use with caution and adjust dose.

Theoretical

▶ HIV-protease inhibitors are predicted to moderately increase

the exposure to cariprazine. Avoid.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to ceritinib. Avoid or adjust ceritinib dose, p. 973.rStudy →

Also see TABLE 9 p. 1377

▶ HIV-protease inhibitors increase the concentration of

ciclosporin.rStudy

▶ HIV-protease inhibitors are predicted to moderately increase

the exposure to

o

cilostazol. Adjust cilostazol dose, p. 232.

Study

▶ HIV-protease inhibitors are predicted to moderately increase

the exposure to cinacalcet. Adjust dose.oStudy

▶ Ritonavir is predicted to affect the exposure to clozapine.

Avoid.rTheoretical

▶ HIV-protease inhibitors are predicted to markedly increase the

exposure to

Study

cobimetinib. Avoid or monitor for toxicity.r

1464 HIV-protease inhibitors — HIV-protease inhibitors BNF 78

Interactions | Appendix 1

A1

▶ HIV-protease inhibitors are predicted to increase the exposure

to colchicine. Avoid potent inhibitors of CYP3A4 or adjust

colchicine dose, p. 1120.rStudy

▶ Atazanavir (unboosted) increases the exposure to combined

hormonal contraceptives. Adjust dose.rStudy

▶ Ritonavir is predicted to decrease the efficacy of combined

hormonal contraceptives. For FSRH guidance, see

Contraceptives, interactions p. 794.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to corticosteroids (beclometasone) (risk with beclometasone is

likely to be lower than with other corticosteroids).

Theoretical

o ▶ HIV-protease inhibitors are predicted to increase the exposure

to corticosteroids (betamethasone, budesonide, ciclesonide,

deflazacort, dexamethasone, fludrocortisone, fluticasone,

hydrocortisone, methylprednisolone, mometasone,

prednisolone, triamcinolone)

r

. Avoid or monitor side effects.

Study

▶ HIV-protease inhibitors are predicted to affect the

anticoagulant effect of coumarins.oStudy

▶ HIV-protease inhibitors are predicted to moderately increase

the exposure to crizotinib. Avoid.oStudy → Also see

TABLE 9 p. 1377

▶ HIV-protease inhibitors (lopinavir, ritonavir, saquinavir) are

predicted to increase the exposure to

r

dabigatran. Avoid.

Theoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to dabrafenib. Use with caution or avoid.oStudy

▶ HIV-protease inhibitors are predicted to markedly to very

markedly increase the exposure to

Study

darifenacin. Avoid.r

▶ Dasabuvir (with ombitasvir, paritaprevir, and ritonavir)

decreases the concentration of darunavir. Avoid or adjust

dose.oStudy

▶ HIV-protease inhibitors are predicted to markedly increase the

exposure to dasatinib. Avoid or adjust dose—consult product

literature.rStudy → Also see TABLE 9 p. 1377

▶ HIV-protease inhibitors very slightly increase the exposure to

delamanid.rStudy → Also see TABLE 9 p. 1377

▶ Ritonavir is predicted to decrease the efficacy of desogestrel.

For FSRH guidance, see

r

Contraceptives, interactions p. 794.

Theoretical

▶ Ritonavir is predicted to increase the exposure to diazepam.

Avoid.oTheoretical

▶ Didanosine (buffered) decreases the exposure to atazanavir.

Didanosine should be taken 2 hours after atazanavir, p. 648,

p. 656.rStudy

▶ Didanosine (buffered) is predicted to decrease the exposure to

darunavir (boosted with ritonavir). Didanosine should be taken

1 hour before or 2 hours after darunavir.oTheoretical

▶ Tipranavir decreases the exposure to didanosine. Separate

administration by 2 hours.oStudy

▶ Ritonavir increases the concentration of digoxin. Adjust dose

and monitor concentration.rStudy

▶ Fosamprenavir (boosted with ritonavir) slightly decreases the

exposure to dolutegravir. Avoid if resistant to HIV-integrase

inhibitors.rStudy

▶ Tipranavir moderately decreases the exposure to dolutegravir.

Refer to specialist literature.rStudy

▶ HIV-protease inhibitors increase the risk of QT-prolongation

when given with domperidone. Avoid.rStudy

▶ HIV-protease inhibitors increase the exposure to dopamine

receptor agonists (bromocriptine).rStudy

▶ HIV-protease inhibitors are predicted to increase the

concentration of

o

dopamine receptor agonists (cabergoline).

Anecdotal

▶ HIV-protease inhibitors are predicted to increase the exposure

to doravirine.nStudy

▶ Ritonavir

o

is predicted to decrease the exposure to duloxetine.

Theoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to

Theoretical

dutasteride. Monitor side effects and adjust dose.o

▶ HIV-protease inhibitors (lopinavir, ritonavir, saquinavir) are

predicted to slightly increase the exposure to

r

edoxaban.

Theoretical

▶ Efavirenz decreases the exposure to HIV-protease inhibitors.

Refer to specialist literature.rStudy → Also see TABLE 9

p. 1377

▶ HIV-protease inhibitors are predicted to markedly increase the

exposure to eletriptan. Avoid.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

rto eliglustat. Avoid or adjust dose—consult product literature.

Study

▶ HIV-protease inhibitors (atazanavir, lopinavir) (boosted with

ritonavir) increase the concentration of elvitegravir. Refer to

specialist literature.oStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to encorafenib. Avoid or monitor.rStudy → Also see

TABLE 9 p. 1377

▶ HIV-protease inhibitors are predicted to increase the risk of

Theoretical

ergotism when given with ergometrine. Avoid.r

▶ HIV-protease inhibitors are predicted to increase the risk of

ergotism when given with ergotamine. Avoid.rTheoretical

▶ HIV-protease inhibitors are predicted to slightly increase the

o

exposure to erlotinib. Use with caution and adjust dose.

Study

▶ HIV-protease inhibitors are predicted to increase the exposure

to esketamine. Adjust dose.oStudy

▶ Ritonavir is predicted to decrease the efficacy of etonogestrel.

For FSRH guidance, see

r

Contraceptives, interactions p. 794.

Theoretical

▶ Etravirine increases the exposure to fosamprenavir (boosted

with ritonavir). Refer to specialist literature.oStudy

▶ Tipranavir

Study

decreases the exposure to etravirine. Avoid.r

▶ HIV-protease inhibitors are predicted to increase the

concentration of everolimus. Avoid.rStudy

▶ HIV-protease inhibitors are predicted to moderately increase

the exposure to fesoterodine. Adjust fesoterodine dose with

potent inhibitors of CYP3A4; avoid in hepatic and renal

impairment, p. 777.rStudy

▶ HIV-protease inhibitors (lopinavir, ritonavir, saquinavir) are

predicted to increase the exposure to

o

fidaxomicin. Avoid.

Study

▶ Ritonavir is predicted to increase the exposure to flurazepam.

Avoid.oTheoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to fosaprepitant.oTheoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to gefitinib.oStudy

▶ HIV-protease inhibitors (atazanavir, darunavir, lopinavir)

(boosted with ritonavir) increase the exposure to glecaprevir.

Avoid.rStudy

▶ Ritonavir

Study

increases the exposure to glecaprevir. Avoid.r

▶ HIV-protease inhibitors are predicted to moderately to

Study

markedly increase the exposure to grazoprevir. Avoid.r

▶ HIV-protease inhibitors are predicted to increase the exposure

to guanfacine. Adjust guanfacine dose, p. 352.oStudy

▶ H2 receptor antagonists decrease the exposure to atazanavir.

Monitor and adjust dose.oStudy

▶ Ritonavir

r

is predicted to increase the exposure to haloperidol.

Theoretical

▶ Ritonavir is predicted to decrease the effects of hormone

replacement therapy.oAnecdotal

▶ HIV-protease inhibitors are predicted to very markedly increase

the exposure to ibrutinib. Avoid potent inhibitors of CYP3A4

or adjust ibrutinib dose, p. 983.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to imatinib.oStudy

▶ HIV-protease inhibitors are predicted to increase the risk of

toxicity when given with irinotecan. Avoid.oStudy

▶ Ritonavir is predicted to decrease the exposure to iron chelators

(deferasirox)

o

. Monitor serum ferritin and adjust dose.

Theoretical

BNF 78 HIV-protease inhibitors — HIV-protease inhibitors 1465

Interactions | Appendix 1

A1

HIV-protease inhibitors (continued)

▶ HIV-protease inhibitors are predicted to increase the exposure

to ivabradine. Avoid.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to ivacaftor. Adjust ivacaftor, p. 293 or lumacaftor with ivacaftor

p. 294 or tezacaftor with ivacaftor p. 295 dose with potent inhibitors

of CYP3A4.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to lapatinib. Avoid.oStudy → Also see TABLE 9 p. 1377

▶ Tipranavir (boosted with ritonavir) is predicted to decrease the

exposure to ledipasvir. Avoid.rTheoretical

▶ HIV-protease inhibitors (atazanavir, lopinavir) (boosted with

ritonavir) are predicted to increase the concentration of

letermovir.oStudy

▶ Ritonavir is predicted to decrease the concentration of

letermovir.oTheoretical

▶ Ritonavir is predicted to decrease the efficacy of

levonorgestrel. For FSRH guidance, see Contraceptives,

interactions p. 794.rTheoretical

▶ HIV-protease inhibitors are predicted to markedly increase the

exposure to lomitapide. Avoid.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to lurasidone. Avoid.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to macitentan.oStudy

▶ Macrolides (clarithromycin) increase the exposure to saquinavir

and saquinavir increases the exposure to macrolides

(clarithromycin). Avoid.rStudy → Also see TABLE 9 p. 1377