Skip to main content

Drug Interactions between nebivolol / valsartan and ritonavir

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

Edit list (add/remove drugs)

Interactions between your drugs

Moderate

ritonavir valsartan

Applies to: ritonavir and nebivolol / valsartan

MONITOR: Coadministration with inhibitors of the hepatic uptake transporter OATP 1B1 (e.g., rifampin, cyclosporine, paritaprevir) or the hepatic efflux transporter MRP2 (e.g., ritonavir) may increase the systemic exposure to valsartan, which is a substrate of both transporters.

MANAGEMENT: Caution is advised if valsartan is used in combination with inhibitors of OATP 1B1 or MRP2. Pharmacologic response and blood pressure should be monitored more closely following the addition, discontinuation, or change of dosage of the transporter inhibitor, and the valsartan dosage adjusted as necessary.

References (7)
  1. (2001) "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals
  2. Cerner Multum, Inc. "UK Summary of Product Characteristics."
  3. (2007) "Product Information. Exforge (amlodipine-valsartan)." Novartis Pharmaceuticals
  4. Cerner Multum, Inc. "Australian Product Information."
  5. (2022) "Product Information. Viekira Pak (dasabuvir/ombitasvir/paritaprev/ritonav)." AbbVie US LLC
  6. (2020) "Product Information. Nexlizet (bempedoic acid-ezetimibe)." Esperion Therapeutics
  7. (2020) "Product Information. Nexletol (bempedoic acid)." Esperion Therapeutics
Moderate

ritonavir nebivolol

Applies to: ritonavir and nebivolol / valsartan

MONITOR: Coadministration with inhibitors of CYP450 2D6 may increase the plasma concentrations of nebivolol, which is primarily metabolized by the isoenzyme The mechanism is decreased clearance due to inhibition of CYP450 2D6 activity. Several studies have shown that coadministration of CYP450 2D6 inhibitors increases the peak plasma concentration (Cmax) and systemic exposure (AUC) of nebivolol. When the potent CYP450 2D6 inhibitor paroxetine (20-40 mg daily) was coadministered with nebivolol (5 mg) in 23 healthy subjects, nebivolol's Cmax and AUC increased by 5.7-fold and 6.1-fold, respectively. Similarly, when bupropion (300 mg), a potent CYP450 2D6 inhibitor, was coadministered with nebivolol in 18 healthy volunteers, the Cmax and AUC increased by 2.3-fold and 7.2-fold, respectively. Fluoxetine (20 mg daily), a potent CYP450 2D6 inhibitor, increased nebivolol's Cmax and AUC by approximately 2.3-fold and 6-fold in 10 patients. Fluvoxamine, a mild CYP450 2D6 inhibitor, increased Cmax and AUC by 1.41-fold and 1.44-fold in 18 healthy volunteers. However, no data resulted in significant changes to heart rate or blood pressure.

MANAGEMENT: Caution is advised when nebivolol is used concomitantly with CYP450 2D6 inhibitors. Additional caution and monitoring are advised if the coadministered CYP450 2D6 inhibitor may potentiate the blood pressure lowering effects of nebivolol (e.g., phenothiazines, tricyclic antidepressants (TCAs), and some antipsychotic (neuroleptic) agents). Patients should be monitored closely for adverse effects such as bradycardia, diarrhea, nausea, fatigue, chest pain, peripheral edema, headache, dizziness, insomnia, dyspnea and rash, and the nebivolol dose should be adjusted according to blood pressure response.

References (7)
  1. Lindamood C, Ortiz S, shaw a, Rackley R, Gorski JC (2011) "Effects of commonly administered agents and genetics on nebivolol pharmacokinetics: drug-drug interaction studies." J Clin Pharmacol, 51, p. 575-85
  2. Gheldiu AM, Vlase L, Popa A, et al. (2017) "Investigation of a potential pharmacokinetic interaction between nebivolol and fluvoxamine in healthy volunteers." J Pharm Pharm Sci, 20, p. 68-80
  3. Briciu C, Neag M, Muntean D, et al. (2014) "A pharmacokinetic drug interaction study between nebivolol and paroxetine in healthy volunteers." J Clin Pharm Ther, 39, p. 535-40
  4. Gheldiu AM, Popa A, Neag M, et al. (2016) "Assessment of a potential pharmacokinetic interaction between nebivolol and bupropion in healthy volunteers." Pharmacology, 98, p. 190-8
  5. (2024) "Product Information. Nebivolol (nebivolol)." Apnar Pharma LLP
  6. (2025) "Product Information. Nebivolol (nebivolol)." Glenmark Pharmaceuticals Europe Ltd
  7. (2024) "Product Information. Nepiten (nebivolol)." Southern Cross Pharma Pty Ltd

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
Moderate

valsartan food

Applies to: nebivolol / valsartan

GENERALLY AVOID: Moderate-to-high dietary intake of potassium, especially salt substitutes, may increase the risk of hyperkalemia in some patients who are using angiotensin II receptor blockers (ARBs). ARBs can promote hyperkalemia through inhibition of angiotensin II-induced aldosterone secretion. Patients with diabetes, heart failure, dehydration, or renal insufficiency have a greater risk of developing hyperkalemia.

MANAGEMENT: Patients should receive dietary counseling and be advised to not use potassium-containing salt substitutes or over-the-counter potassium supplements without consulting their physician. If salt substitutes are used concurrently, regular monitoring of serum potassium levels is recommended. Patients should also be advised to seek medical attention if they experience symptoms of hyperkalemia such as weakness, irregular heartbeat, confusion, tingling of the extremities, or feelings of heaviness in the legs.

References (2)
  1. (2001) "Product Information. Cozaar (losartan)." Merck & Co., Inc
  2. (2001) "Product Information. Diovan (valsartan)." Novartis Pharmaceuticals

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.

See also

Report options

Loading...
QR code containing a link to this page

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.

Medical Disclaimer