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Drug Interactions between amprenavir and Olysio

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

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Interactions between your drugs

Major

amprenavir simeprevir

Applies to: amprenavir and Olysio (simeprevir)

GENERALLY AVOID: Coadministration with potent and some moderate inhibitors of CYP450 3A4 may significantly increase the plasma concentrations of simeprevir, which is primarily metabolized by the isoenzyme. In clinical trials, higher simeprevir exposures have been associated with increased frequency of adverse reactions including rash and photosensitivity. In 24 healthy study subjects administered simeprevir (150 mg once daily) in combination with the moderate CYP450 3A4 and P-glycoprotein substrate/inhibitor erythromycin (500 mg three times a day) for 7 days, mean simeprevir peak plasma concentration (Cmax), systemic exposure (AUC) and trough plasma concentration (Cmin) increased by approximately 4.5-, 7.5 and 12.7-fold, respectively. Erythromycin Cmax, AUC and Cmin also increased by about 1.6-, 1.9- and 3.1-fold, respectively, presumably due to inhibition of CYP450 3A4 and P-glycoprotein by simeprevir. In another study, simeprevir (200 mg once daily for 7 days) given with the potent CYP450 3A4 inhibitor ritonavir (100 mg twice daily for 15 days) to 12 healthy subjects resulted in approximately 4.7-, 7.2 and 14.4-fold increases in simeprevir Cmax, AUC and Cmin, respectively. Likewise, when simeprevir (50 mg and 150 mg once daily) was given with darunavir/ritonavir (800 mg/100 mg once daily) to 25 healthy subjects for 7 days, simeprevir Cmax, AUC and Cmin increased by about 1.8-, 2.6 and 4.6-fold, respectively, while ritonavir Cmax, AUC and Cmin increased by 1.2-, 1.3 and 1.4-fold, respectively. Darunavir Cmin increased by 1.3-fold.

MANAGEMENT: The use of simeprevir in combination with potent and some moderate CYP450 3A4 inhibitors such as azole antifungal agents, conivaptan, nefazodone, cobicistat, delavirdine, protease inhibitors, and ketolide and certain macrolide antibiotics should generally be avoided. Some authorities recommend avoiding concomitant use of simeprevir during and for 2 weeks after treatment with itraconazole.

References (3)
  1. (2002) "Product Information. Sporanox (itraconazole)." Janssen Pharmaceuticals
  2. Cerner Multum, Inc. "Australian Product Information."
  3. (2013) "Product Information. Olysio (simeprevir)." Janssen Pharmaceuticals

Drug and food interactions

Moderate

amprenavir food

Applies to: amprenavir

GENERALLY AVOID: Administration with a high-fat meal may decrease the oral bioavailability of amprenavir. The mechanism is unknown. In healthy volunteers, consumption of a standardized high-fat meal decreased the peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of amprenavir (1200 mg single oral dose) by 36% and 21%, respectively, compared to administration in the fasted state. The time to reach Cmax (Tmax) was increased 44% following a high-fat meal.

Grapefruit juice does not appear to significantly affect the pharmacokinetics of amprenavir. In 12 healthy volunteers, administration with grapefruit juice (200 mL) decreased the mean peak plasma concentration (Cmax) of amprenavir (1200 mg single oral dose) by 22% compared to water. The median time to reach Cmax (Tmax) was prolonged from 0.75 to 1.13 hours. These pharmacokinetic changes are not thought to be clinically significant, since antiretroviral response is more closely associated with systemic exposure (AUC) and trough plasma concentration (Cmin), which were not affected in the study.

MANAGEMENT: Amprenavir may be taken with or without food, but should not be taken with a high-fat meal.

References (2)
  1. (2001) "Product Information. Agenerase (amprenavir)." Glaxo Wellcome
  2. Demarles D, Gillotin C, Bonaventure-Paci S, Vincent I, Fosse S, Taburet AM (2002) "Single-dose pharmacokinetics of amprenavir coadministered with grapefruit juice." Antimicrob Agents Chemother, 46, p. 1589-1590
Moderate

simeprevir food

Applies to: Olysio (simeprevir)

ADJUST DOSING INTERVAL: Food significantly enhances the oral bioavailability of simeprevir, although the type of food does not seem to matter. In healthy study subjects, administration of simeprevir after a high-fat, high-caloric (928 kcal) breakfast increased systemic exposure (AUC) by 61% and delayed absorption by 1 hour, while administration after a normal caloric (533 kcal) breakfast increased AUC by 69% and delayed absorption by 1.5 hours.

MANAGEMENT: To ensure maximal oral absorption, simeprevir should be administered with food.

References (1)
  1. (2013) "Product Information. Olysio (simeprevir)." Janssen Pharmaceuticals

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Protease inhibitors

Therapeutic duplication

The recommended maximum number of medicines in the 'protease inhibitors' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'protease inhibitors' category:

  • amprenavir
  • Olysio (simeprevir)

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

See also

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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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