Interaction Checker
Potential Interaction
Ritonavir (RTV)
Quinine
Quality of Evidence: Low
Summary:
Coadministration may increase quinine concentrations and a decrease in quinine dose may be necessary. Coadministration of ritonavir (200 mg twice daily) and quinine (600 mg single dose) increased both the AUC and Cmax of quinine by~4-fold and increased half life by 20%. The metabolism of quinine to its major metabolite, 3-hydroxyquinine, was markedly inhibited. Quinine had no significant effect on ritonavir pharmacokinetics.
Description:
When ritonavir is coadministered with quinine, plasma concentrations of quinine may be increased and a decrease in dose may be needed.
Norvir Prescribing Information, AbbVie Inc, December 2016.
The pharmacokinetic interaction between ritonavir (200 mg twice daily for 9 days) and single doses of quinine (600 mg) was studied in healthy volunteers during a three-period pharmacokinetic non-randomized sequential design study. Pharmacokinetics of ritonavir, quinine and its major metabolite, 3-hydroxyquinine, were determined. Ritonavir increased quinine Cmax and AUC by 2.8-fold and 3.4-fold, respectively, with a 77% decrease in clearance. This, together with a decrease in the Cmax (50%) and AUC (60%) of the metabolite, resulted in a pronounced reduction in the ratio of metabolite:unchanged drug AUC. Quinine caused modest but significant increases in the Cmax (15%), AUC (21%) and elimination half life (32%) of ritonavir. Downward dosage adjustment of quinine appears necessary when concurrently administered with ritonavir.
Pharmacokinetic interactions between ritonavir and quinine in healthy volunteers following concurrent administration. Soyinka JO, Onyeji CO, Omoruyi SI, et al. Br J Clin Pharmacol, 2010, 69(3): 262-270.
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