Liverpool HIV Interactions

Potential Interaction

Ritonavir (RTV)

Cocaine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Cocaine is metabolized by several pathways, with metabolism to norcocaine by CYP3A4 being less than 10% of the overall metabolic clearance. Ritonavir could potentially increase concentrations of the parent compound. The clinical relevance is unknown as cocaine is metabolized by other non-CYP mediated pathways. Ensure the patient is aware of signs/symptoms of cocaine toxicity.

Description:

(See Summary)

Potential Interaction

Lopinavir/ritonavir (LPV/r)

Cocaine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Cocaine is metabolized by several pathways, with metabolism to norcocaine by CYP3A4 being less than 10% of the overall metabolic clearance. Lopinavir/ritonavir could potentially increase concentrations of the parent compound. The clinical relevance is unknown as cocaine is metabolized by other non-CYP mediated pathways. Ensure the patient is aware of signs/symptoms of cocaine toxicity. In addition, caution should be exercised as both drugs have risks of QT prolongation and/or TdP on the CredibleMeds.org website (possible risk for lopinavir; known risk for cocaine).

Description:

Particular caution must be used when prescribing Kaletra and medicinal products known to induce QT interval prolongation such as cocaine. Indeed, Kaletra could increase concentrations of the co-administered medicinal product and this may result in an increase of the associated cardiac adverse events. Cardiac events have been reported with Kaletra in preclinical studies; therefore, the potential cardiac effects of Kaletra cannot be currently ruled out.
Kaletra Summary of Product Characteristics, AbbVie Ltd, January 2021.

Potential Weak Interaction

Lopinavir/ritonavir (LPV/r)

Desogestrel (POP)

Quality of Evidence: Very Low

Summary:

Coadministration with a desogestrel-containing progestogen-only pill (POP) has not been studied. Desogestrel is a prodrug that requires activation to etonogestrel. Activation to etonogestrel is by CYP2C9 (and possibly CYP2C19); the metabolism of etonogestrel is mediated by CYP3A4. Coadministration is predicted to increase etonogestrel and, based on studies with norethisterone used as a POP, the contraceptive efficacy of a desogestrel POP is unlikely to be compromised by lopinavir.

Description:

(See Summary)

Potential Weak Interaction

Ritonavir (RTV)

Desogestrel (POP)

Quality of Evidence: Very Low

Summary:

Coadministration with a desogestrel-containing progestogen-only pill (POP) has not been studied. Desogestrel is a prodrug that requires activation to etonogestrel. Activation to etonogestrel is by CYP2C9 (and possibly CYP2C19); the metabolism of etonogestrel is mediated by CYP3A4. Coadministration is predicted to increase etonogestrel and, based on studies with norethisterone used as a POP, the contraceptive efficacy of a desogestrel POP is unlikely to be compromised by ritonavir.

Description:

(See Summary)

No Interaction Expected

Lopinavir/ritonavir (LPV/r)

Valaciclovir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Valaciclovir is converted to aciclovir which is eliminated renally via glomerular filtration and active renal secretion by OAT1.

Description:

(See Summary)

No Interaction Expected

Ritonavir (RTV)

Valaciclovir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Valaciclovir is converted to aciclovir which is eliminated renally via glomerular filtration and active renal secretion by OAT1.

Description:

(See Summary)

No Interaction Expected

Zidovudine (AZT, ZDV)

Aciclovir (Acyclovir)

Quality of Evidence: Low

Summary:

No significant interaction was observed when zidovudine (500 mg/day) and aciclovir were coadministered to 20 HIV-infected subjects.

Description:

Limited data from clinical trials do not indicate a significantly increased risk of adverse reactions to zidovudine with cotrimoxazole, aerosolised pentamidine, pyrimethamine and aciclovir at doses used in prophylaxis.
Retrovir Summary of Product Characteristics, ViiV Healthcare UK, Ltd, December 2018.

Pharmacokinetic analysis showed no drug interaction when zidovudine (500 mg/day) and aciclovir (2 or 4 g/day) were coadministered to 20 HIV-infected subjects.
Phase I study of low-dose zidovudine and acyclovir in asymptomatic human immunodeficiency virus seropositive individuals. Hollander H, et al. Am J Med, 1989, 87: 628-632.

No Interaction Expected

Lamivudine (3TC)

Aciclovir (Acyclovir)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Aciclovir is eliminated renally via glomerular filtration and active renal secretion by OAT1. A drug-drug interaction is unlikely as lamivudine and aciclovir are eliminated by different renal transporters.

Description:

(See Summary)

No Interaction Expected

Lamivudine (3TC)

Valaciclovir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Valaciclovir is converted to aciclovir which is eliminated renally via glomerular filtration and active renal secretion by OAT1.

Description:

(See Summary)

No Interaction Expected

Zidovudine (AZT, ZDV)

Valaciclovir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Valaciclovir is converted to aciclovir which is eliminated renally via glomerular filtration and active renal secretion by OAT1.

Description:

(See Summary)

No Interaction Expected

Lamivudine (3TC)

Alcohol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as alcohol is metabolized by alcohol dehydrogenase and aldehyde dehydrogenase.

Description:

(See Summary)

No Interaction Expected

Zidovudine (AZT, ZDV)

Alcohol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as alcohol is metabolized by alcohol dehydrogenase and aldehyde dehydrogenase.

Description:

(See Summary)

No Interaction Expected

Lamivudine (3TC)

Cocaine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cocaine is metabolized by several pathways (non CYP and CYP mediated), with metabolism to norcocaine by CYP3A4 being less than 10% of the overall metabolic clearance.

Description:

(See Summary)

No Interaction Expected

Raltegravir (RAL)

Cocaine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cocaine is metabolized by several pathways (non CYP and CYP mediated), with metabolism to norcocaine by CYP3A4 being less than 10% of the overall metabolic clearance.

Description:

(See Summary)

No Interaction Expected

Zidovudine (AZT, ZDV)

Cocaine

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Cocaine is metabolized by several pathways (non CYP and CYP mediated), with metabolism to norcocaine by CYP3A4 being less than 10% of the overall metabolic clearance.

Description:

(See Summary)

No Interaction Expected

Raltegravir (RAL)

Aciclovir (Acyclovir)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as aciclovir is eliminated renally via glomerular filtration and active renal secretion by OAT1.

Description:

(See Summary)

No Interaction Expected

Raltegravir (RAL)

Valaciclovir

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Valaciclovir is converted to aciclovir which is eliminated renally via glomerular filtration and active renal secretion by OAT1.

Description:

(See Summary)

No Interaction Expected

Raltegravir (RAL)

Alcohol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Alcohol is metabolized by alcohol dehydrogenase and aldehyde dehydrogenase. The chronic use of alcohol may induce CYP2E1 and to a lesser extent CYP3A4. No a priori clinically relevant drug-drug interaction is anticipated.

Description:

(See Summary)

No Interaction Expected

Lamivudine (3TC)

Desogestrel (POP)

Quality of Evidence: Very Low

Summary:

Coadministration with a desogestrel-containing progestogen-only pill (POP) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Desogestrel is a prodrug which is activated to etonogestrel by CYP2C9 (and possible CYP2C19); the metabolism of etonogestrel is mediated by CYP3A4.

Description:

(See Summary)

No Interaction Expected

Raltegravir (RAL)

Desogestrel (POP)

Quality of Evidence: Very Low

Summary:

Coadministration with a desogestrel-containing progestogen-only pill (POP) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Desogestrel is a prodrug which is activated to etonogestrel by CYP2C9 (and possible CYP2C19); the metabolism of etonogestrel is mediated by CYP3A4.

Description:

(See Summary)

No Interaction Expected

Zidovudine (AZT, ZDV)

Desogestrel (POP)

Quality of Evidence: Very Low

Summary:

Coadministration with a desogestrel-containing progestogen-only pill (POP) has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely. Desogestrel is a prodrug which is activated to etonogestrel by CYP2C9 (and possible CYP2C19); the metabolism of etonogestrel is mediated by CYP3A4.

Description:

(See Summary)

No Interaction Expected

Lopinavir/ritonavir (LPV/r)

Aciclovir (Acyclovir)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as aciclovir is eliminated renally via glomerular filtration and active renal secretion by OAT1.

Description:

(See Summary)

No Interaction Expected

Ritonavir (RTV)

Aciclovir (Acyclovir)

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied but based on metabolism and clearance a clinically significant interaction is unlikely as aciclovir is eliminated renally via glomerular filtration and active renal secretion by OAT1.

Description:

(See Summary)

No Interaction Expected

Lopinavir/ritonavir (LPV/r)

Alcohol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Alcohol is metabolized by alcohol dehydrogenase and aldehyde dehydrogenase. The chronic use of alcohol may induce CYP2E1 and to a lesser extent CYP3A4. No a priori clinically relevant drug-drug interaction is anticipated with lopinavir/ritonavir TABLETS. However, coadministration with lopinavir/ritonavir ORAL SOLUTION is not recommended as the large amount of propylene glycol in the oral solution may compete with alcohol for the same elimination pathway.

Description:

(See Summary)

No Interaction Expected

Ritonavir (RTV)

Alcohol

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. Alcohol is metabolized by alcohol dehydrogenase and aldehyde dehydrogenase. The chronic use of alcohol may induce CYP2E1 and to a lesser extent CYP3A4. No a priori clinically relevant drug-drug interaction is anticipated.

Description:

(See Summary)

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