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Drug Interactions between boceprevir and Paxlovid

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

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Interactions between your drugs

Moderate

ritonavir boceprevir

Applies to: Paxlovid (nirmatrelvir / ritonavir) and boceprevir

MONITOR: Coadministration of boceprevir and some ritonavir-boosted protease inhibitor regimens has been associated with decreased plasma concentrations of both boceprevir and the protease inhibitors. The mechanism of interaction has not been described. In a pharmacokinetic study of 39 healthy volunteers, boceprevir reduced the mean trough plasma concentrations (Cmin) of ritonavir-boosted atazanavir, darunavir, and lopinavir by 49%, 59%, and 43%, respectively. Mean reductions of 34% to 44% were observed in the systemic exposure (AUC) and 25% to 36% were observed in the peak concentration (Cmax) of atazanavir, lopinavir, and darunavir. Conversely, ritonavir-boosted atazanavir did not alter the AUC of boceprevir, whereas ritonavir-boosted darunavir and lopinavir decreased the AUC of boceprevir by 32% and 45%, respectively. When boceprevir (400 mg three times daily for 15 days) was given in combination with ritonavir alone (100 mg once daily for 12 days), boceprevir Cmax and AUC decreased by 27% and 19%, respectively. Data are currently unavailable regarding a potential interaction between boceprevir and other protease inhibitors, whether alone or ritonavir-boosted.

MANAGEMENT: Given the risk of reduced viral susceptibility and resistance development associated with subtherapeutic antiviral drug levels, caution is advised if boceprevir is used in combination with ritonavir-boosted protease inhibitor regimens. Patients coinfected with chronic HCV and HIV who have been started on one of these combinations should be closely monitored for treatment response and potential HCV and HIV virologic rebound. The safety and efficacy of boceprevir has not been established in the HCV/HIV coinfected population. As such, the manufacturer does not recommend the coadministration of boceprevir and ritonavir-boosted HIV protease inhibitors.

References (2)
  1. (2011) "Product Information. Victrelis (boceprevir)." Schering-Plough Corporation
  2. FDA. U.S. Food and Drug Administration (2012) FDA Drug Safety Communication: Important drug interactions between (boceprevir) and ritonavir-boosted human immunodeficiency virus (HIV) protease inhibitor drugs. http://www.fda.gov/Drugs/DrugSafety/ucm291119.htm

Drug and food interactions

Moderate

ritonavir food

Applies to: Paxlovid (nirmatrelvir / ritonavir)

ADJUST DOSING INTERVAL: Administration with food may modestly affect the bioavailability of ritonavir from the various available formulations. When the oral solution was given under nonfasting conditions, peak ritonavir concentrations decreased 23% and the extent of absorption decreased 7% relative to fasting conditions. Dilution of the oral solution (within one hour of dosing) with 240 mL of chocolate milk or a nutritional supplement (Advera or Ensure) did not significantly affect the extent and rate of ritonavir absorption. When a single 100 mg dose of the tablet was administered with a high-fat meal (907 kcal; 52% fat, 15% protein, 33% carbohydrates), approximately 20% decreases in mean peak concentration (Cmax) and systemic exposure (AUC) were observed relative to administration after fasting. Similar decreases in Cmax and AUC were reported when the tablet was administered with a moderate-fat meal. In contrast, the extent of absorption of ritonavir from the soft gelatin capsule formulation was 13% higher when administered with a meal (615 KCal; 14.5% fat, 9% protein, and 76% carbohydrate) relative to fasting.

MANAGEMENT: Ritonavir should be taken with meals to enhance gastrointestinal tolerability.

References (1)
  1. (2001) "Product Information. Norvir (ritonavir)." Abbott Pharmaceutical
Moderate

boceprevir food

Applies to: boceprevir

ADJUST DOSING INTERVAL: Food significantly enhances the oral bioavailability of boceprevir. When given at 800 mg three times daily with food, boceprevir exposure increased by up to 65% relative to administration in the fasting state. The bioavailability of boceprevir was similar regardless of meal type (e.g., high-fat versus low-fat) or whether taken 5 minutes prior to eating, during a meal, or immediately following completion of the meal. Therefore, boceprevir may be taken without regard to either meal type or timing of the meal.

MANAGEMENT: To ensure maximal oral absorption, boceprevir should be administered with a meal or light snack.

References (1)
  1. (2011) "Product Information. Victrelis (boceprevir)." Schering-Plough Corporation

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:

  • boceprevir
  • Paxlovid (nirmatrelvir/ritonavir)

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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