Quality of Evidence: Very Low
Coadministration with ritonavir alone has not been studied. In an interaction study of single-dose bedaquiline and multiple-dose lopinavir/ritonavir, bedaquiline AUC was increased by 22%. This increase is likely due to ritonavir and increases in bedaquiline exposure would be expected when coadministered with other ritonavir-boosted HIV protease inhibitors. The combination of bedaquiline and ritonavir should be avoided. If the benefit of coadministration outweighs the risk and coadministration is necessary, clinical monitoring including frequent electrocardiogram assessment and monitoring of transaminases is recommended. There are no clinical data on the safety and efficacy of bedaquiline when coadministered with antiretroviral agents.
Strong CYP3A4 inhibitors such as protease inhibitors may increase bedaquiline exposure which could potentially increase the risk of bedaquiline-related adverse reactions. Therefore, combination of bedaquiline with ritonavir should be avoided. However, if the benefit outweighs the risk, co-administration of bedaquiline with ritonavir must be done with caution. More frequent electrocardiogram monitoring and monitoring of transaminases is recommended. No interaction study is available with ritonavir only. In an interaction study of single-dose bedaquiline and multiple dose lopinavir/ritonavir, the AUC of bedaquiline was increased by 22%. This increase is likely due to ritonavir and a more pronounced effect may be observed during prolonged co-administration.
Norvir Summary of Product Characteristics, AbbVie Ltd, September 2016.
Coadministration is expected to increase bedaquiline concentrations. Bedaquiline should only be used with ritonavir if the benefit of co-administration outweighs the risk.
Norvir Prescribing Information, AbbVie Inc, December 2016.