Drug interactions between Kaletra and Viramune
| Results for the following 2 drugs: |
|---|
| Kaletra (lopinavir/ritonavir) |
| Viramune (nevirapine) |
Interactions between your selected drugs
nevirapine ↔ lopinavir
Applies to:Viramune (nevirapine) and Kaletra (lopinavir/ritonavir)
ADJUST DOSE: Coadministration with nevirapine may decrease the plasma concentrations of lopinavir, even in the presence of low-dose ritonavir as a pharmacokinetic booster. The proposed mechanism is nevirapine induction of lopinavir metabolism via CYP450 3A4. In a parallel group study consisting of HIV-1 positive adult subjects, coadministration of lopinavir-ritonavir (400 mg-100 mg capsule twice a day) with nevirapine (200 mg twice a day) to steady-state resulted in a 19% relative decrease in lopinavir peak plasma concentration (Cmax), a 27% relative decrease in systemic exposure (AUC), and a 51% relative decrease in trough plasma concentration (Cmin) in 22 subjects compared to administration of lopinavir-ritonavir alone in 19 subjects. Similar results were reported when the interaction was studied in a pediatric population of HIV-infected subjects ranging in age from 6 months to 12 years. In addition, the pharmacokinetics of lopinavir-ritonavir oral solution 300 mg-75 mg/m2 twice daily with nevirapine (7 mg/kg twice daily in patients 6 months to 8 years and 4 mg/kg twice daily in patients older than 8 years) and 230 mg-57.5 mg/m2 twice daily without nevirapine have been studied in a total of 53 pediatric patients ranging in age from 6 months to 12 years. Both regimens provided lopinavir plasma concentrations similar to those obtained in adult patients receiving the 400 mg-100 mg twice daily regimen without nevirapine. In healthy volunteers, lopinavir-ritonavir did not significantly affect the plasma concentrations of nevirapine. However, due to study discontinuations, there was limited power to detect changes in nevirapine pharmacokinetics in the presence of lopinavir-ritonavir.
MANAGEMENT: A dosage increase is recommended for lopinavir-ritonavir when used in combination with nevirapine. For adults, the dosage should be increased to 500 mg-125 mg (two 200 mg-50 mg tablets and one 100 mg-25 mg tablet) twice daily for the tablets and 533 mg-133 mg (6.5 mL) twice daily for the oral solution. Lopinavir-ritonavir should not be administered as a once daily regimen in combination with nevirapine. For pediatric patients 6 months to 18 years of age, the dosage should be increased to 300 mg-75 mg/m2 twice daily for the oral solution in both treatment-naive and treatment-experienced patients, not to exceed the recommended adult dosage of 533 mg-133 mg (6.5 mL) twice daily. If weight-based dosing is preferred, the recommended dosage is 13 mg-3.25 mg/kg given twice daily for patients under 15 kg and 11 mg-2.75 mg/kg given twice daily for patients 15 kg to 45 kg. Pediatric patients weighing more than 45 kg should receive the adult dosage of lopinavir-ritonavir. Please consult the manufacturer's product labeling for pediatric dosing of the tablet formulation. Lopinavir-ritonavir should not be administered in combination with nevirapine in patients under 6 months of age due to the lack of clinical data.
See also...
Drug Interaction Classification
The classifications below are a guideline only. The relevance of a particular drug interaction to a specific patient is difficult to determine using this tool alone given the large number of variables that may apply.
| Major | Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. |
| Moderate | Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. |
| Minor | Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. |
Do not stop taking any medications without consulting your healthcare provider.
Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date, and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. Multum's drug information does not endorse drugs, diagnose patients, or recommend therapy. Multum's drug information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill , knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug of drug combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2012 Multum Information Services, Inc. The information in contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.
