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Interaction Checker
Potential Interaction
Lopinavir/ritonavir (LPV/r)
Atovaquone
Quality of Evidence: Low
Summary:
The AUCs of single dose atovaquone/proguanil (250/100 mg) were 74% and 38% lower, respectively, in HIV-infected individuals on stable antiretroviral treatment containing lopinavir/ritonavir (400/100 mg twice daily or 800/200 mg once daily) than in healthy volunteers. The clinical relevance of this interaction is unknown due to the lack of data on the minimal effective atovaquone plasma concentration in the setting of malaria prophylaxis. Consider taking atovaquone/proguanil with a high fat meal to increase its bioavailability and increase the dosage if required.
Description:
Coadministration of lopinavir and atovaquone may result in decreased concentrations of atovaquone. The clinical significance is unknown, however, an increase in atovaquone dose may be needed.
Kaletra Prescribing Information, AbbVie Ltd, October 2020.
The pharmacokinetics of atovaquone and proguanil were determined following administration of single doses of atovaquone/proguanil (250/100 mg) to HIV-negative subjects (n=18) and HIV-infected subjects stable on antiretroviral regimens containing lopinavir/ritonavir (400/100 mg twice daily or 800/200 mg once daily, n=19). Atovaquone AUC and Cmax decreased by 74% and 44%, respectively, in the presence of lopinavir/ritonavir; proguanil AUC decreased by 38% and there was no effect on Cmax.
Lower atovaquone/proguanil concentrations in patients taking efavirenz, lopinavir/ritonavir or atazanavir/ritonavir. van Luin M et al. AIDS, 2010, 24(8): 1223-6.
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