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Drug Interactions between cabotegravir and ritonavir

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

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Interactions between your drugs

Major

ritonavir cabotegravir

Applies to: ritonavir and cabotegravir

CONTRAINDICATED: Coadministration with inducers of uridine diphosphate glucuronosyltransferase (UGT)1A1 or 1A9 may decrease the plasma concentrations of cabotegravir. Cabotegravir is primarily metabolized by UGT1A1 and to a lesser extent by UGT 1A9. In 15 study subjects given a single 30 mg dose of cabotegravir with the UGT 1A1 inducer rifampin (600 mg once daily), mean cabotegravir peak plasma concentration (Cmax) and systemic exposure (AUC) were reduced by 6% and 59%, respectively. Loss of therapeutic efficacy of cabotegravir may occur.

MANAGEMENT: According to the manufacturer of cabotegravir, due to the potential for loss of therapeutic efficacy, its concomitant use with UGT 1A1 inducers including, but not limited to carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, and rifapentine is considered contraindicated.

References (7)
  1. (2021) "Product Information. Cabenuva (cabotegravir-rilpivirine)." ViiV Healthcare ULC
  2. (2021) "Product Information. Vocabria (cabotegravir)." ViiV Healthcare
  3. Lee LSU, Pham PA, Flexner C (2012) "Unexpected drug-drug interactions in human immunodeficiency virus (HIV) therapy: induction of UGT1A1 and bile efflux transporters by Efavirenz" National Library of Medicine, 41, p. 559-562
  4. Miners JO, Polasek TM, Hulin JA, Rowland A, Meech R (2023) "Drug-drug interactions that alter the exposure of glucuronidated drugs: Scope, UDP-glucuronosyltransferase (UGT) enzyme selectivity, mechanisms (inhibition and induction), and clinical significance" Pharmacol Ther, 248, p. 108459
  5. Song I, Borland J, Chen S, Guta P, Lou Y, Wilfret D, Wajima T, Savina P, Peppercorn AF, castellino s, wagner d, Hosking L, Mosteller M, Rubio JP (2014) "Effects of enzyme inducers efavirenz and tipranavir/ritonavir on the pharmacokinetics of the HIV integrase inhibitor dolutegravir" Eur J Clin Pharmacol, 70, p. 1173-1179
  6. Marvanova M (2016) "Pharmacokinetic characteristics of antiepileptic drugs (AEDs)" National Library of Medicine, 6, p. 8-20
  7. Lemaitre F, Grégoire M, Monchaud C, Bouchet S, Saint-Salvi B, Polard E (2022) "Management of drug-drug interactions with nirmatrelvir/ritonavir in patients treated for Covid-19: Guidelines from the French Society of Pharmacology and Therapeutics (SFPT)" National Library of Medicine, 77, p. 509-521

Drug and food interactions

Moderate

ritonavir food

Applies to: 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

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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