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Drug Interactions between Aptivus and Neo-Diaral

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

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Interactions between your drugs

Moderate

loperamide tipranavir

Applies to: Neo-Diaral (loperamide) and Aptivus (tipranavir)

MONITOR: Coadministration with tipranavir in combination with low-dose ritonavir may decrease the plasma concentrations of loperamide. The mechanism probably involves reduced absorption and increased first-pass clearance of loperamide due to induction of the intestinal P-glycoprotein drug efflux pump by tipranavir. In 24 study subjects, tipranavir/ritonavir (750 mg/200 mg twice a day for 10 days) decreased the mean peak plasma concentration (Cmax) and area under the plasma concentration-time curve (AUC) of loperamide (16 mg single dose) by 61% and 51%, respectively, compared to administration of loperamide without tipranavir/ritonavir. Tipranavir/ritonavir also reduced the Cmax and AUC of the metabolite N-demethyl-loperamide by 79% and 77%, respectively. Tipranavir trough plasma concentration (Cmin) was reduced 26%.

MANAGEMENT: Clinicians and patients should be aware that pharmacologic effects of loperamide may be reduced during coadministration with tipranavir/ritonavir.

References

  1. "Product Information. Aptivus (tipranavir)." Boehringer-Ingelheim (2005):

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Drug and food interactions

Moderate

loperamide food

Applies to: Neo-Diaral (loperamide)

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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Moderate

tipranavir food

Applies to: Aptivus (tipranavir)

ADJUST DOSING INTERVAL: Food does not appear to substantially alter the pharmacokinetics of tipranavir. When tipranavir capsules or oral solution was coadministered with ritonavir capsules at steady-state, no clinically significant changes in tipranavir peak plasma concentration (Cmax) and systemic exposure (AUC) were observed under fed conditions (500 to 682 kcal, 23% to 25% calories from fat) relative to fasted conditions. The effect of food on tipranavir exposure during coadministration with ritonavir tablets has not been evaluated. High-fat foods may enhance the gastrointestinal absorption of tipranavir. In a multiple-dose study, administration of tipranavir capsules with a high-fat meal (868 kcal, 53% from fat, 31% from carbohydrates) increased the oral bioavailability of tipranavir by 31% compared to administration with toast and skimmed milk, but did not significantly affect tipranavir Cmax. Thus, tipranavir may be safely taken with standard or high-fat meals.

MANAGEMENT: Tipranavir coadministered with low-dose ritonavir should be taken with food to improve the gastrointestinal tolerability of ritonavir. According to the product labeling, tipranavir coadministered with ritonavir capsules or solution can be taken with or without meals, whereas tipranavir coadministered with ritonavir tablets must be taken with meals.

References

  1. "Product Information. Aptivus (tipranavir)." Boehringer-Ingelheim (2005):
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  3. Canadian Pharmacists Association "e-CPS. http://www.pharmacists.ca/function/Subscriptions/ecps.cfm?link=eCPS_quikLink" (2006):
  4. Cerner Multum, Inc. "Australian Product Information." O 0
View all 4 references

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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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