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Drug Interactions between alfuzosin and Crixivan

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

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Interactions between your drugs

Major

indinavir alfuzosin

Applies to: Crixivan (indinavir) and alfuzosin

CONTRAINDICATED: Coadministration with potent inhibitors of CYP450 3A4 may significantly increase the plasma concentrations of alfuzosin, which is primarily metabolized by the isoenzyme. Severe hypotension and priapism may occur. In pharmacokinetic studies, repeated oral administration of 400 mg/day of ketoconazole, a potent CYP450 3A4 inhibitor, increased alfuzosin peak plasma concentration (Cmax) and systemic exposure (AUC) by 2.3- and 3.2-fold, respectively, following a single 10 mg dose. Repeated oral administration of ketoconazole 200 mg/day increased alfuzosin Cmax by 2.1-fold and AUC by 2.5-fold following a single 10 mg dose.

MANAGEMENT: Concomitant use of alfuzosin with potent CYP450 3A4 inhibitors such as itraconazole, ketoconazole, posaconazole, voriconazole, conivaptan, nefazodone, cobicistat, delavirdine, protease inhibitors, and ketolide and certain macrolide antibiotics is considered contraindicated. Some authorities recommend avoiding concomitant use of alfuzosin during and for 2 weeks after treatment with itraconazole.

References (5)
  1. (2002) "Product Information. Sporanox (itraconazole)." Janssen Pharmaceuticals
  2. (2003) "Product Information. Uroxatral (alfuzosin)." sanofi-aventis
  3. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  4. EMEA. European Medicines Agency (2007) EPARs. European Union Public Assessment Reports. http://www.ema.europa.eu/ema/index.jsp?curl=pages/includes/medicines/medicines_landingpage.jsp&mid
  5. Cerner Multum, Inc. "Australian Product Information."

Drug and food interactions

Moderate

indinavir food

Applies to: Crixivan (indinavir)

ADJUST DOSING INTERVAL: According to the manufacturer, coadministration with a meal high in calories, fat, and protein reduces the absorption of indinavir. In ten patients given indinavir in this manner, the peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of indinavir decreased by an average of 84% and 77%, respectively. In contrast, grapefruit juice may have only minor effects on the oral bioavailability of indinavir. The manufacturer's package labeling states that administration of a single 400 mg dose of indinavir with 8 oz. of grapefruit juice decreased indinavir AUC by an average of 26%. Likewise, a study consisting of 14 HIV-infected subjects found no uniform nor significant changes in steady-state indinavir AUC during administration with double-strength grapefruit juice compared to water. There was, however, a delay in absorption (Tmax) due to grapefruit juice that is unlikely to be of clinical significance.

MANAGEMENT: To ensure maximal oral absorption, indinavir should be administered without food but with water 1 hour before or 2 hours after a meal. Alternatively, indinavir may be administered with other liquids such as skim milk, juice, coffee, or tea, or with a light meal (e.g., dry toast with jelly, juice, and coffee with skim milk and sugar; corn flakes, skim milk and sugar).

References (3)
  1. (2001) "Product Information. Crixivan (indinavir)." Merck & Co., Inc
  2. Yeh KC, Deutsch PJ, Haddix H, Hesney M, Hoagland V, Ju WD, Justice SJ, Osborne B, Sterrett AT, Stone JA, Woolf E, Waldman S (1998) "Single-dose pharmacokinetics of indinavir and the effect of food." Antimicrob Agents Chemother, 42, p. 332-8
  3. Shelton MJ, Wynn HE, Newitt RG, DiFrancesco R (2001) "Effects of grapefruit juice on pharmacokinetic exposure to indinavir in HIV-positive subjects." J Clin Pharmacol, 41, p. 435-42
Moderate

alfuzosin food

Applies to: alfuzosin

ADJUST DOSING INTERVAL: Administration of alfuzosin with food enhances oral bioavailability. According to the manufacturer, extent of absorption is 50% higher when administered under fed conditions compared to fasting conditions.

MANAGEMENT: To ensure maximal oral absorption, alfuzosin should be administered with or immediately after a meal.

References (1)
  1. (2003) "Product Information. Uroxatral (alfuzosin)." sanofi-aventis

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

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