Interaction Checker
Potential Interaction
Lopinavir/ritonavir (LPV/r)
Cabotegravir/rilpivirine [long acting] (CAB/RPV LA)
Quality of Evidence: Very Low
Summary:
Cabenuva (cabotegravir LA, rilpivirine LA) is indicated for use as a complete regimen for the treatment of HIV-1 infection. However, in specific clinical situations where an intensification of HIV treatment is needed, coadministration with lopinavir/ritonavir would be possible from a pharmacokinetic standpoint. Cabotegravir is mainly metabolized by UGT1A1 and to a lesser extent by UGT1A9. Induction of UGTs by ritonavir used to boost lopinavir is unlikely to cause a clinically relevant decrease of cabotegravir exposure based on drug-drug interaction studies with rifabutin, another moderate inducer. Coadministration of oral rilpivirine (150 mg once daily) and lopinavir/ritonavir (400/100 mg twice daily) increased rilpivirine Cmax, AUC and Cmin by 29%, 52% and 74%, respectively. Lopinavir Cmax, AUC and Cmin decreased by 4%, 1% and 11%, respectively. [Note: this interaction study has been performed with a dose higher than the licensed dose for rilpivirine assessing the maximal effect on the co-administered drug]. No dose adjustment of rilpivirine is required. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses, but equivalent rilpivirine concentrations are unlikely to occur with lopinavir/ritonavir. However, the product label for rilpivirine indicates that rilpivirine should be used with caution in combination with drugs with a risk of QT interval prolongation. Lopinavir has a possible risk of QTc prolongation and/or TdP on the CredibleMeds.org website. Residual concentrations of cabotegravir and rilpivirine may remain in the systemic circulation of patients for a prolonged period after discontinuation of intramuscular cabotegravir/rilpivirine but are not expected to affect exposure of antiretroviral drugs.
Description:
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