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Drug Interactions between Diflucan and Viekira XR

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

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Interactions between your drugs

Minor

fluconazole ritonavir

Applies to: Diflucan (fluconazole) and Viekira XR (dasabuvir / ombitasvir / paritaprevir / ritonavir)

The coadministration with fluconazole may slightly increase the plasma concentrations of ritonavir. The proposed mechanism is fluconazole inhibition of CYP450 3A4, the isoenzyme responsible for the metabolic clearance of ritonavir. In an open-label, randomized, crossover study consisting of eight healthy subjects, fluconazole (400 mg on day 1, 200 mg on days 2 to 5) increased the peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of ritonavir (200 mg every 6 hours for 4 days) by approximately 15% and 12%, respectively, compared to when ritonavir was administered alone. In a study of 3 HIV-infected patients treated with ritonavir 600 mg orally twice a day, there were no detectable changes in the pharmacokinetics of ritonavir following addition of fluconazole. Other azole antifungal agents are expected to affect ritonavir in a similar fashion but possibly to a greater extent, since fluconazole is a relatively weak inhibitor of CYP450 3A4. No special precautions are necessary when fluconazole is given with ritonavir.

References

  1. Cato A 3rd, Cao G, Hsu A, Cavanaugh J, Leonard J, Granneman R (1997) "Evaluation of the effect of fluconazole on the pharmacokinetics of ritonavir." Drug Metab Dispos, 25, p. 1104-6
  2. Koks CH, Crommentuyn KM, Hoetelmans RM, et al. (2001) "The effect of fluconazole on ritonavir and saquinavir pharmacokinetics in HIV-1-infected individuals." Br J Clin Pharmacol, 51, p. 631-5

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Drug and food interactions

Moderate

ritonavir food

Applies to: Viekira XR (dasabuvir / ombitasvir / paritaprevir / 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. (2001) "Product Information. Norvir (ritonavir)." Abbott Pharmaceutical

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Moderate

paritaprevir food

Applies to: Viekira XR (dasabuvir / ombitasvir / paritaprevir / ritonavir)

ADJUST DOSING INTERVAL: Food enhances the oral bioavailability of ombitasvir, paritaprevir, ritonavir, and dasabuvir. Relative to fasting conditions, administration of ombitasvir, paritaprevir, ritonavir, and dasabuvir with a moderate-fat meal (approximately 600 Kcal; 20% to 30% calories from fat) increased the mean systemic exposure (AUC) by 82%, 211%, 49%, and 30%, respectively. Relative to fasting conditions, administration of ombitasvir, paritaprevir, ritonavir, and dasabuvir with a high-fat meal (approximately 900 Kcal; with 60% calories from fat) increased the mean AUC by 76%, 180%, 44%, and 22%, respectively.

MANAGEMENT: Ombitasvir/paritaprevir/ritonavir plus dasabuvir should always be administered with a meal. The fat or calorie content does not matter.

References

  1. (2022) "Product Information. Viekira Pak (dasabuvir/ombitasvir/paritaprev/ritonav)." AbbVie US LLC

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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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