With simultaneous use of systemic or inhaled / nasal budesonide, fluticasone or prednisone, and combinations ritonavir, concentrations of these corticosteroids may increase the plasma.Concomitant use can increase the risk of systemic effects of corticosteroids, including Cushing’s syndrome and adrenal suppression. With simultaneous use of prednisone, and combinations ritonavir should be clinical monitoring. Alternative treatment options, particularly for long-term use should be considered.
In a study on the interaction between a combination masteron cycle ritonavir (600/100 mg 2 times a day) and boceprevir (800 mg 3 times daily), darunavir concentrations decreased by 44%, and the concentration of boceprevir was reduced by 32%. Thus, it is not recommended to use a combination ritonavir together with boceprevir.
In studies of the interaction between a combination ritonavir (600 mg / 100 mg twice daily) with telaprevir (750 mg every 8 hours), darunavir concentration decreased by 40%, and telaprevir concentration decreased by 35%. Not recommended simultaneous combination ritonavir with telaprevir.
In an application simeprevira and combinations ritonavir (800/100 mg per day) and the concentration of darunavir simeprevira in plasma were increased due to the inhibition is oenzymes. In clinical studies the interaction of a combination ritonavir and simeprevira simeprevira concentration in plasma was increased by 2.59 times, the concentration of darunavir increased by 1.18 times. Not recommended for use while simeprevir and a combination of ritonavir.
Preparations containing an extract of Hypericum perforatum
Hypericum perforatum extract lowers the concentration of darunavir and ritonavir plasma (induction of hepatic enzymes). The combination ritonavir should not be used in conjunction with preparations containing St. John’s wort extract. If the patient started taking preparations containing St. John’s wort extract, you must stop taking them and, if possible, to check virus titers. The concentration of darunavir (as the concentration of ritonavir) may increase after cessation of preparations containing extracts of Hypericum perforatum. This effect may persist for two weeks after discontinuation of products containing St. John’s wort extract.
HMG-CoA reductase inhibitors (atorvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin)
In the metabolism of statins, such as simvastatin and lovastatin, play an important role isoenzymes , so their concentration in plasma may increase significantly when used concurrently with a combination ritonavir. Elevated levels of statins may cause myopathy, including rhabdomyolysis. The use of a combination ritonavir together with lovastatin or simvastatin is contraindicated.
Investigation of the interaction between atorvastatin (10 mg once a day) and a combination of darunavir / ritonavir (300mg / 100mg twice a day) showed that the concentration of atorvastatin in this situation, the plasma was only 15% lower than with monotherapy with atorvastatin (40 mg once a day). If necessary, the simultaneous use of atorvastatin, and the combination of darunavir / ritonavir is recommended to start with a dose of atorvastatin 10 mg once a day. Then you can gradually increase the dose of atorvastatin, focusing on the clinical effect of therapy.
The combination of darunavir / ritonavir (600 mg / 100 mg twice a day) increased the concentration of pravastatin in plasma after a single dose of the drug (40 mg) to about 80%, but in some patients. If necessary, the joint use of a combination of pravastatin and ritonavir is recommended to start taking a statin with the lowest possible dose and increase the dose until clinical effect, controlling the side effects of the drug.
Investigation of the interaction between a combination ritonavir (600 mg / 100 mg), rosuvastatin (10 mg) showed increasing concentrations of rosuvastatin. If necessary, the simultaneous use of rosuvastatin and a combination of ritonavir is recommended to start with the lowest dose of rosuvastatin and gradually increase the dose to the clinical effect, constantly monitoring the safety of the therapy.
Investigation of the interaction between the combination masteron cycle ritonavir (800/100 mg per day) and pitavastatin (4 mg per day) showed a decrease in plasma concentrations of pitavastatin, which is not considered to be clinically significant. The combination ritonavir and pitavastatin can be used simultaneously without dose adjustment.