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Drug Interactions between AccessPak for HIV PEP Expanded with Viracept and venlafaxine

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Moderate

venlafaxine nelfinavir

Applies to: venlafaxine and AccessPak for HIV PEP Expanded with Viracept (emtricitabine / nelfinavir / tenofovir)

MONITOR: Coadministration with inhibitors of CYP450 3A4 may increase the plasma concentrations of venlafaxine and its metabolite, O-desmethylvenlafaxine (ODV). The possibility of prolonged and/or increased pharmacologic effects of venlafaxine should be considered. Although venlafaxine is primarily metabolized by CYP450 2D6, there is some evidence that CYP450 3A4 may play a minor role, thus any alteration in its activity levels could conceivably affect the metabolism of venlafaxine. The interaction may be of greater concern in patients who are CYP450 2D6-deficient, or so-called poor metabolizers of CYP450 2D6 (approximately 7% of Caucasians and less than 2% of Asians and individuals of African descent). In healthy volunteers, administration of single-dose venlafaxine with the potent CYP450 3A4 inhibitor ketoconazole (100 mg twice daily) increased venlafaxine systemic exposure (AUC) by 21% in extensive metabolizers and 70% (range -2% to 206%) in poor metabolizers of CYP450 2D6; increased AUC of ODV by 23% in extensive metabolizers and 33% (range -38% to 105%) in poor metabolizers; and increased combined AUC of venlafaxine and ODV by 23% in extensive metabolizers and 53% in poor metabolizers (range 4% to 134%). Venlafaxine and ODV peak plasma concentration (Cmax) also increased by 26% and 14%, respectively, in extensive metabolizers and 48% and 29%, respectively, in poor metabolizers.

MANAGEMENT: Caution is recommended when venlafaxine is used with CYP450 3A4 inhibitors.

References

  1. "Product Information. Effexor (venlafaxine)." Wyeth-Ayerst Laboratories PROD (2001):
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  3. Cerner Multum, Inc. "Australian Product Information." O 0

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Drug and food interactions

Moderate

venlafaxine food

Applies to: venlafaxine

GENERALLY AVOID: Alcohol may potentiate some of the pharmacologic effects of CNS-active agents. Use in combination may result in additive central nervous system depression and/or impairment of judgment, thinking, and psychomotor skills.

MANAGEMENT: Patients receiving CNS-active agents should be warned of this interaction and advised to avoid or limit consumption of alcohol. Ambulatory patients should be counseled to avoid hazardous activities requiring complete mental alertness and motor coordination until they know how these agents affect them, and to notify their physician if they experience excessive or prolonged CNS effects that interfere with their normal activities.

References

  1. Warrington SJ, Ankier SI, Turner P "Evaluation of possible interactions between ethanol and trazodone or amitriptyline." Neuropsychobiology 15 (1986): 31-7
  2. Gilman AG, eds., Nies AS, Rall TW, Taylor P "Goodman and Gilman's the Pharmacological Basis of Therapeutics." New York, NY: Pergamon Press Inc. (1990):
  3. "Product Information. Fycompa (perampanel)." Eisai Inc (2012):
  4. "Product Information. Rexulti (brexpiprazole)." Otsuka American Pharmaceuticals Inc (2015):
View all 4 references

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Minor

tenofovir food

Applies to: AccessPak for HIV PEP Expanded with Viracept (emtricitabine / nelfinavir / tenofovir)

Food enhances the oral absorption and bioavailability of tenofovir, the active entity of tenofovir disoproxil fumarate. According to the product labeling, administration of the drug following a high-fat meal increased the mean peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of tenofovir by approximately 14% and 40%, respectively, compared to administration in the fasting state. However, administration with a light meal did not significantly affect the pharmacokinetics of tenofovir compared to administration in the fasting state. Food delays the time to reach tenofovir Cmax by approximately 1 hour. Tenofovir disoproxil fumarate may be administered without regard to meals.

References

  1. "Product Information. Viread (tenofovir)." Gilead Sciences (2001):

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Therapeutic duplication warnings

No warnings were found for your selected drugs.

Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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