▶ Macrolides (erythromycin) are predicted to increase the

exposure to saquinavir. Avoid.rTheoretical → Also see

TABLE 9 p. 1377

▶ Atazanavir is predicted to increase the exposure to macrolides

(clarithromycin). Adjust dose in renal impairment.rStudy

▶ Ritonavir increases the exposure to macrolides (clarithromycin).

Adjust dose in renal impairment.rStudy

▶ Tipranavir (boosted with ritonavir) increases the exposure to

macrolides (clarithromycin) and macrolides (clarithromycin)

increase the exposure to tipranavir (boosted with ritonavir).

Monitor; adjust dose in renal impairment.rStudy

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

(boosted with ritonavir) are predicted to increase the

exposure to macrolides (clarithromycin). Adjust dose in renal

impairment.rStudy

▶ HIV-protease inhibitors (atazanavir, darunavir, fosamprenavir,

lopinavir, ritonavir, tipranavir) are predicted to increase the

exposure to macrolides (erythromycin).rTheoretical

▶ Darunavir (boosted with ritonavir) markedly increases the

exposure to

Study

maraviroc. Refer to specialist literature.r

▶ Maraviroc potentially decreases the exposure to fosamprenavir

and fosamprenavir potentially decreases the exposure to

maraviroc. Avoid.rStudy

▶ HIV-protease inhibitors (atazanavir, saquinavir) moderately to

markedly increase the exposure to maraviroc. Refer to

specialist literature.rStudy

▶ Lopinavir (boosted with ritonavir) moderately increases the

Study

exposure to maraviroc. Refer to specialist literature.r

▶ Ritonavir markedly increases the exposure to maraviroc. Refer

to specialist literature.rStudy

▶ Ritonavir

o

is predicted to decrease the exposure to melatonin.

Theoretical

▶ Ritonavir is predicted to increase the clearance of mexiletine.

Monitor and adjust dose.oStudy

▶ HIV-protease inhibitors are predicted to markedly to very

markedly increase the exposure to midazolam. Avoid or adjust

dose.rStudy

▶ HIV-protease inhibitors are predicted to very markedly increase

the exposure to

r

midostaurin. Avoid or monitor for toxicity.

Study

▶ HIV-protease inhibitors are predicted to increase the exposure

to mirabegron. Adjust mirabegron dose in hepatic and renal

impairment, p. 781.oStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to mirtazapine.oStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to modafinil.nTheoretical

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

predicted to increase the risk of neutropenia when given with

monoclonal antibodies (brentuximab vedotin). Monitor and

adjust dose.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to

r

monoclonal antibodies (trastuzumab emtansine). Avoid.

Theoretical

▶ HIV-protease inhibitors are predicted to markedly increase the

exposure to naloxegol. Avoid.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to netupitant.oStudy

▶ Nevirapine decreases the exposure to HIV-protease inhibitors.

Refer to specialist literature.oStudy

▶ HIV-protease inhibitors are predicted to moderately increase

the exposure to nilotinib. Avoid.rStudy → Also see TABLE 9

p. 1377

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

predicted to increase the exposure to

Study

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

to nitisinone. Adjust dose.oTheoretical

▶ Ritonavir is predicted to decrease the efficacy of

norethisterone. For FSRH guidance, see Contraceptives,

interactions p. 794.rAnecdotal

▶ Ritonavir is predicted to decrease the exposure to olanzapine.

Monitor and adjust dose.oStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to olaparib. Avoid potent inhibitors of CYP3A4 or adjust

olaparib dose, p. 1005.oStudy

▶ Ombitasvir (in fixed-dose combination with dasabuvir)

decreases the concentration of darunavir. Avoid or adjust

dose.oStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to opioids (alfentanil, buprenorphine, fentanyl, oxycodone,

sufentanil). Monitor and adjust dose.rStudy

▶ HIV-protease inhibitors (boosted with ritonavir) are predicted

to decrease the exposure to

Study → Also see TABLE 9 p. 1377

opioids (methadone).o ▶ Ritonavir is predicted to decrease the concentration of opioids

(morphine).oTheoretical

▶ Ritonavir increases the risk of CNS toxicity when given with

opioids (pethidine). Avoid.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to

Study

ospemifene. Avoid in poor CYP2C9 metabolisers.o ▶ HIV-protease inhibitors are predicted to increase the exposure

to oxybutynin.nStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to

Study

palbociclib. Avoid or adjust palbociclib dose, p. 992.r

▶ HIV-protease inhibitors are predicted to increase the exposure

to panobinostat. Adjust panobinostat dose; in hepatic

impairment avoid, p. 936.oStudy → Also see TABLE 9

p. 1377

▶ Atazanavir (boosted with ritonavir) markedly increases the

exposure to

Study

paritaprevir. Avoid or give unboosted.o ▶ Darunavir (boosted with ritonavir) slightly decreases the

exposure to

Study

paritaprevir. Avoid or give unboosted.o ▶ HIV-protease inhibitors (fosamprenavir, tipranavir) (boosted with

ritonavir) are predicted to increase the exposure to

paritaprevir. Avoid.rStudy

▶ Lopinavir (boosted with ritonavir) moderately to markedly

increases the exposure to paritaprevir. Avoid.rStudy

▶ Saquinavir is predicted to increase the exposure to paritaprevir

(in fixed-dose combination). Avoid.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to

Study

pazopanib

→ Also see

. Avoid or adjust

TABLE 9 p. 1377

pazopanib dose, p. 993.o ▶ HIV-protease inhibitors are predicted to increase the exposure

to phosphodiesterase type-5 inhibitors (avanafil, vardenafil).

Avoid.rStudy → Also see TABLE 9 p. 1377

1466 HIV-protease inhibitors — HIV-protease inhibitors BNF 78

Interactions | Appendix 1

A1

▶ HIV-protease inhibitors are predicted to increase the exposure

to phosphodiesterase type-5 inhibitors (sildenafil). Avoid potent

inhibitors of CYP3A4 or adjust

Study → Also see TABLE 9 p. 1377

sildenafil dose, p. 813.r

▶ HIV-protease inhibitors are predicted to increase the exposure

to phosphodiesterase type-5 inhibitors (tadalafil). Use with

caution or avoid.rStudy

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

ritonavir) increase the exposure to

Study

pibrentasvir. Avoid.r

▶ Ritonavir

r

potentially increases the exposure to pibrentasvir.

Theoretical

▶ Saquinavir is predicted to increase the exposure to

pibrentasvir.oTheoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to pimozide. Avoid.rStudy → Also see TABLE 9 p. 1377

▶ Ritonavir

o

is predicted to decrease the exposure to pirfenidone.

Theoretical

▶ HIV-protease inhibitors are predicted to slightly increase the

exposure to ponatinib. Monitor and adjust ponatinib dose,

p. 994.oStudy

▶ HIV-protease inhibitors are predicted to moderately increase

the exposure to praziquantel.nStudy

▶ Proton pump inhibitors decrease the exposure to atazanavir.

Avoid or adjust dose.rStudy

▶ Proton pump inhibitors increase the exposure to saquinavir.

Avoid.rStudy

▶ Tipranavir decreases the exposure to proton pump inhibitors.

Avoid.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to quetiapine. Avoid.rStudy

▶ Atazanavir increases the exposure to raltegravir (high-dose).

Avoid.oStudy

▶ Darunavir increases the risk of rash when given with

raltegravir.oStudy

▶ Fosamprenavir (boosted with ritonavir) decreases the

exposure to raltegravir and raltegravir decreases the exposure

to fosamprenavir (boosted with ritonavir). Avoid.rStudy

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

exposure to raltegravir (high-dose). Avoid.oStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to ranolazine. Avoid.rStudy → Also see TABLE 9 p. 1377

▶ HIV-protease inhibitors are predicted to increase the exposure

to reboxetine. Avoid.oStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to regorafenib. Avoid.oStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to repaglinide.oStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to

o

retinoids (alitretinoin). Adjust alitretinoin dose, p. 1262.

Theoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to

Study

ribociclib

→ Also see

. Avoid or adjust

TABLE 9 p. 1377

ribociclib dose, p. 997.o ▶ HIV-protease inhibitors (atazanavir, darunavir, fosamprenavir,

lopinavir, saquinavir, tipranavir) (boosted with ritonavir)

increase the exposure to

r

rifabutin. Monitor and adjust dose.

Study

▶ Ritonavir markedly increases the exposure to rifabutin. Avoid

or adjust dose.rStudy

▶ Rifampicin is predicted to moderately to markedly decrease

the exposure to HIV-protease inhibitors (atazanavir, darunavir,

fosamprenavir, lopinavir, saquinavir). Avoid.rStudy

▶ Rifampicin

Study

slightly decreases the exposure to ritonavir.r

▶ Rifampicin is predicted to decrease the exposure to tipranavir.

Avoid.rStudy

▶ Ritonavir is predicted to increase the exposure to riociguat.

Avoid.oTheoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to risperidone. Adjust dose.oStudy → Also see TABLE 9

p. 1377

▶ Ritonavir moderately increases the exposure to rivaroxaban.

Avoid.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

Study

to ruxolitinib. Adjust dose and monitor side effects.o ▶ HIV-protease inhibitors are predicted to increase the exposure

to saxagliptin.oStudy

▶ HIV-protease inhibitors are predicted to increase the

concentration of sirolimus. Avoid.rStudy

▶ Tipranavir is predicted to decrease the exposure to sofosbuvir.

Avoid.rTheoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to solifenacin. Adjust solifenacin p. 779 or tamsulosin with

solifenacin

r

p. 786 dose; avoid in hepatic and renal impairment.

Study

▶ HIV-protease inhibitors are predicted to moderately increase

the exposure to SSRIs (dapoxetine). Avoid potent inhibitors of

CYP3A4 or adjust dapoxetine dose, p. 821.rStudy

▶ St John’s Wort is predicted to decrease the exposure to HIVprotease inhibitors. Avoid.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to statins (atorvastatin). Avoid or adjust dose and monitor

rhabdomyolysis.rStudy

▶ HIV-protease inhibitors slightly to moderately increase the

Study

exposure to statins (rosuvastatin). Avoid or adjust dose.r

▶ HIV-protease inhibitors are predicted to increase the exposure

to statins (simvastatin). Avoid.rStudy

▶ HIV-protease inhibitors are predicted to slightly increase the

o

exposure to sunitinib. Avoid or adjust sunitinib dose, p. 999.

Study → Also see TABLE 9 p. 1377

▶ HIV-protease inhibitors are predicted to increase the

Study

concentration of tacrolimus. Monitor and adjust dose.r

▶ HIV-protease inhibitors are predicted to increase the exposure

to taxanes (cabazitaxel). Avoid.rStudy

▶ HIV-protease inhibitors are predicted to moderately increase

r

the exposure to taxanes (docetaxel). Avoid or adjust dose.

Study

▶ HIV-protease inhibitors are predicted to increase the exposure

to taxanes (paclitaxel).rTheoretical

▶ HIV-protease inhibitors are predicted to increase the

concentration of temsirolimus. Avoid.rTheoretical

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

the exposure to

o

tenofovir alafenamide. Avoid or adjust dose.

Study

▶ Tipranavir is predicted to decrease the exposure to tenofovir

alafenamide. Avoid.oTheoretical

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

predicted to increase the risk of renal impairment when given

with tenofovir disoproxil.rAnecdotal

▶ HIV-protease inhibitors are predicted to increase the exposure

to tezacaftor. Adjust tezacaftor with ivacaftor p. 295 dose with

potent inhibitors of CYP3A4.rStudy

▶ Ritonavir is predicted to decrease the exposure to theophylline.

Adjust dose.oStudy

▶ Ritonavir decreases the concentration of thyroid hormones

(levothyroxine). MHRA advises monitor TSH for at least one

month after starting or stopping ritonavir.oAnecdotal

▶ HIV-protease inhibitors are predicted to markedly increase the

exposure to ticagrelor. Avoid.rStudy

▶ Ritonavir moderately decreases the exposure to tizanidine.

nStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to tofacitinib. Adjust tofacitinib dose, p. 1105.oStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to tolterodine. Avoid.rStudy → Also see TABLE 9 p. 1377

▶ HIV-protease inhibitors are predicted to increase the exposure

to tolvaptan. Manufacturer advises caution or adjust tolvaptan

dose with potent inhibitors of CYP3A4, p. 669.rStudy

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

predicted to increase the exposure to topotecan.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to toremifene.oTheoretical → Also see TABLE 9 p. 1377

▶ HIV-protease inhibitors are predicted to increase the exposure

to trabectedin. Avoid or adjust dose.rTheoretical

BNF 78 HIV-protease inhibitors — HIV-protease inhibitors 1467

Interactions | Appendix 1

A1

HIV-protease inhibitors (continued)

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

predicted to increase the concentration of

o

trametinib.

Theoretical

▶ HIV-protease inhibitors are predicted to moderately increase

the exposure to

Study

trazodone. Avoid or adjust dose.o ▶ HIV-protease inhibitors (ritonavir, tipranavir) are predicted to

increase the exposure to

Theoretical

tricyclic antidepressants.o ▶ HIV-protease inhibitors (atazanavir, darunavir, fosamprenavir,

lopinavir, saquinavir, tipranavir) are predicted to increase the

exposure to

Study

ulipristal. Avoid if used for uterine fibroids.r

▶ Ritonavir decreases the efficacy of ulipristal. For FSRH

guidance, see

Anecdotal

Contraceptives, interactions p. 794.r

▶ Tipranavir

r

is predicted to increase the exposure to velpatasvir.

Theoretical

▶ HIV-protease inhibitors are predicted to increase the exposure

to vemurafenib.rTheoretical → Also see TABLE 9 p. 1377

▶ HIV-protease inhibitors are predicted to increase the exposure

to venetoclax. Avoid or adjust dose—consult product

literature.rStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to venlafaxine.oStudy → Also see TABLE 9 p. 1377

▶ HIV-protease inhibitors are predicted to increase the exposure

to vinca alkaloids.rTheoretical → Also see TABLE 9 p. 1377

▶ HIV-protease inhibitors are predicted to increase the exposure

to vitamin D substances (paricalcitol).oStudy

▶ Atazanavir (boosted with ritonavir) increases the

concentration of voxilaprevir. Avoid.rStudy

▶ Lopinavir (boosted with ritonavir) is predicted to increase the

concentration of voxilaprevir. Avoid.rTheoretical

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

concentration of voxilaprevir.rTheoretical

▶ Tipranavir slightly decreases the exposure to zidovudine.

Avoid.oStudy

▶ HIV-protease inhibitors are predicted to increase the exposure

to zopiclone. Adjust dose.oTheoretical

Homatropine → see TABLE 10 p. 1377 (antimuscarinics)

Hormone replacement therapy

▶ Antiepileptics (carbamazepine, eslicarbazepine, fosphenytoin,

oxcarbazepine, perampanel, phenobarbital, phenytoin,

primidone, rufinamide, topiramate) are predicted to decrease

the effects of hormone replacement therapy.oAnecdotal

▶ Hormone replacement therapy is predicted to alter the

exposure to antiepileptics (lamotrigine).oTheoretical

▶ Aprepitant is predicted to decrease the effects of hormone

replacement therapy.oAnecdotal

▶ Bosentan is predicted to decrease the effects of hormone

replacement therapy.oAnecdotal

▶ Hormone replacement therapy decreases the clearance of

dopamine receptor agonists (ropinirole). Monitor and adjust

dose.oStudy

▶ Efavirenz is predicted to decrease the effects of hormone

replacement therapy.oAnecdotal

▶ Fosaprepitant is predicted to decrease the effects of hormone

replacement therapy.oAnecdotal

▶ HIV-protease inhibitors (ritonavir) are predicted to decrease the

effects of hormone replacement therapy.oAnecdotal

▶ Hormone replacement therapy is predicted to increase the risk

of venous thromboembolism when given with

r

lenalidomide.

Theoretical

▶ Modafinil is predicted to decrease the effects of hormone

replacement therapy.oAnecdotal

▶ Hormone replacement therapy is predicted to increase the

exposure to

o

monoamine-oxidase B inhibitors (selegiline). Avoid.

Study

▶ Nevirapine is predicted to decrease the effects of hormone

replacement therapy.oAnecdotal

▶ NSAIDs (etoricoxib) slightly increase the exposure to hormone

replacement therapy.oStudy

▶ Hormone replacement therapy potentially opposes the effects

of ospemifene. Avoid.rTheoretical

▶ Hormone replacement therapy is predicted to increase the risk

of venous thromboembolism when given with

r

pomalidomide.

Theoretical

▶ Hormone replacement therapy potentially opposes the effects

of raloxifene. Avoid.rTheoretical

▶ Rifabutin is predicted to decrease the effects of hormone

replacement therapy.oAnecdotal

▶ Rifampicin is predicted to decrease the effects of hormone

replacement therapy.oAnecdotal

▶ St John’s Wort is predicted to decrease the efficacy of hormone

replacement therapy.oTheoretical

▶ Hormone replacement therapy is predicted to increase the risk

of venous thromboembolism when given with

r

thalidomide.