Concomitant administration of elbasvir/grazoprevir with Kaletra is contraindicated. Kaletra contains lopinavir and ritonavir, both of which are inhibitors of the P450 isoform CYP3A. Kaletra should not be co-administered with medicinal products that are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life threatening events. These medicinal products include elbasvir/grazoprevir due to increased risk of alanine transaminase (ALT) elevations. Coadministration with elbasvir/grazoprevir (50/200 mg once daily) increased elbasvir AUC, Cmax and C24 by 2.71-, 1.87- and 3.58-fold, respectively; grazoprevir AUC, Cmax and C24 increased by 11.86-, 6.31- and 20.70-fold, respectively. There was no change in lopinavir pharmacokinetics.

Kaletra is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening reactions. Coadministration is expected to increase concentrations of elbasvir and grazoprevir and is contraindicated due to increased risk of alanine transaminase (ALT) elevations. Coadministration of elbasvir/grazoprevir (50/200 mg once daily) and lopinavir/ritonavir (400/100 mg twice daily) increased elbasvir Cmax, AUC and Cmin by 2.87-, 3.71- and 4.58-fold, respectively (n=10). Grazoprevir Cmax, AUC and Cmin increased by 7.31-, 12.86- and 21.70-fold, respectively (n=13).