Slide 49 of 76
Notes:
Indinavir/ritonavir + efavirenz: When efavirenz was added to indinavir 800 mg/ritonavir 100 mg BID regimen, indinavir exposure was significantly reduced (19% ? AUC, 48% ? Cmin). Cmin were still ɬ.1 mg/L but caution should still be used with this combination, especially in advanced patients. May wish to consider increasing to indinavir 800 mg/ritonavir 200 mg BID with efavirenz.
With indinavir/ritonavir QD regimens, co-administration of efavirenz significantly lowers indinavir and ritonavir concentrations. Avoid using efavirenz with once-daily indinavir/ritonavir regimens until further data available.
Indinavir/ritonavir + nevirapine: In observational series, nevirapine 400 mg/day combined with indinavir 800 mg/ritonavir 100 mg BID resulted in 75% ? indinavir Cmin, 75% ? ritonavir Cmin; in all cases, indinavir Cmin remained ɬ.1 mg/L, but caution is still warranted with combination, especially in advanced patients.
Lopinavir/ritonavir + efavirenz: Efavirenz 600 mg daily + lopinavir 400 mg/ritonavir 100 mg BID resulted in 25% ? AUC and 44% ? Cmin of lopinavir. Using lopinavir 533 mg/ritonavir 133 mg BID plus EFV resulted in similar lopinavir concentrations to those achieved in the absence of EFV.
Lopinavir/ritonavir + nevirapine: Potential for reduced lopinavir concentrations; suggest using increased dose (lopinavir 533 mg/ritonavir 133 mg BID) with concomitant nevirapine.
Bertz et al. 40th ICAAC, abstract 424; Aarnoutse et al. 40th ICAAC, abstract 423; Saah et al. 5th Int Congress Drug Ther HIV Infection, Glasgow 2000, P284; Burger et al. 7th ECCAT, abstract 824; 2000.
