Interaction Checker
Potential Interaction
Lopinavir/ritonavir (LPV/r)
Rilpivirine/ Emtricitabine/Tenofovir-DF (RPV/FTC/TDF)
Quality of Evidence: Very Low
Summary:
Eviplera/Complera (rilpivirine, emtricitabine, tenofovir-DF) 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. No dose adjustment is required when rilpivirine is co-administered with lopinavir/ritonavir. Coadministration of 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. Rilpivirine has been associated with prolongation of the QTc interval at supra-therapeutic doses but equivalent rilpivirine concentrations are unlikely to occur during coadministration with lopinavir/ritonavir. However, the product labels for Eviplera/Complera indicate that rilpivirine should be used with caution in combination with drugs with a known risk of Torsade de Pointes. Lopinavir has a possible risk of QTc prolongation and/or TdP on the CredibleMeds.org website. Based on metabolism and clearance a pharmacokinetic interaction with emtricitabine is unlikely. Coadministration of tenofovir-DF (300 mg once daily) and lopinavir/ritonavir (400/100 mg twice daily) had no significant effect on lopinavir/ritonavir pharmacokinetic parameters; tenofovir AUC increased by 32%, Cmin increased by 51%, and there was no change in Cmax. A higher risk of renal impairment has been reported in patients receiving emtricitabine/tenofovir-DF and a ritonavir or cobicistat boosted protease inhibitor. No dose adjustment is recommended, but close monitoring of renal function and for tenofovir-associated adverse reactions is required.
Description:
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