Interactions between nuvigil(armodafinil) and Amprenavir (amprenavir)
amprenavir and armodafinil (Moderate Drug-Drug)
MONITOR: Coadministration with modafinil (the racemate) or armodafinil (the R-enantiomer) may decrease the plasma concentrations of protease inhibitors (PIs). The mechanism involves induction of intestinal CYP450 3A4-mediated first-pass metabolism by modafinil and armodafinil, with possible secondary induction of hepatic 3A4 metabolism. Significant intestinal metabolism appears to occur with indinavir and saquinavir but has not been studied with other PIs. Conversely, PIs may increase the plasma concentrations of modafinil via inhibition of hepatic CYP450 3A4 metabolism. The clinical significance is unknown. However, the possibility of prolonged and/or increased pharmacologic effects of modafinil should be considered.
MANAGEMENT: Given the risk of reduced viral susceptibility and resistance development associated with decreased or subtherapeutic antiretroviral drug levels, caution is advised if modafinil or armodafinil must be used in patients treated with PIs, particularly if they are using only one PI in their antiretroviral regimen. Clinical monitoring for altered effects of both modafinil and the PI may be appropriate following addition or withdrawal of one or the other drug.
