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Drug Interactions between Olysio and tipranavir

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

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Interactions between your drugs

Major

tipranavir simeprevir

Applies to: tipranavir and Olysio (simeprevir)

GENERALLY AVOID: Coadministration with potent and some moderate inducers of CYP450 3A4 may significantly decrease the plasma concentrations of simeprevir, which is primarily metabolized by the isoenzyme. In 18 healthy study subjects administered simeprevir (200 mg once daily) in combination with the potent CYP450 3A4 inducer rifampin (600 mg once daily) for 7 days, mean simeprevir peak plasma concentration (Cmax) increased by 31% but systemic exposure (AUC) and trough plasma concentration (Cmin) decreased by 48% and 92%, respectively. Likewise, when simeprevir (150 mg once daily) was given with the moderate inducer efavirenz (600 mg once daily) to 23 healthy subjects for 14 days, mean simeprevir Cmax, AUC and Cmin decreased by 51%, 71% and 91%, respectively. Simeprevir had no significant effects on the pharmacokinetics of efavirenz or rifampin, but increased the AUC of metabolite 25-desacetyl-rifampin by 24%.

MANAGEMENT: The use of simeprevir in combination with potent and some moderate CYP450 3A4 inducers such as carbamazepine, dexamethasone, efavirenz, enzalutamide, eslicarbazepine, etravirine, nevirapine, oxcarbazepine, phenobarbital, phenytoin, primidone, rifamycins, St. John's wort, and tipranavir should generally be avoided.

References

  1. (2001) "Product Information. Sustiva (efavirenz)." DuPont Pharmaceuticals
  2. (2013) "Product Information. Olysio (simeprevir)." Janssen Pharmaceuticals

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Drug and food interactions

Moderate

tipranavir food

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

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Moderate

simeprevir food

Applies to: Olysio (simeprevir)

ADJUST DOSING INTERVAL: Food significantly enhances the oral bioavailability of simeprevir, although the type of food does not seem to matter. In healthy study subjects, administration of simeprevir after a high-fat, high-caloric (928 kcal) breakfast increased systemic exposure (AUC) by 61% and delayed absorption by 1 hour, while administration after a normal caloric (533 kcal) breakfast increased AUC by 69% and delayed absorption by 1.5 hours.

MANAGEMENT: To ensure maximal oral absorption, simeprevir should be administered with food.

References

  1. (2013) "Product Information. Olysio (simeprevir)." Janssen Pharmaceuticals

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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:

  • Olysio (simeprevir)
  • tipranavir

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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