OBJECT DRUGS

Antivirals:

• Atazanavir (Reyataz)
• Fosamprenavir (Lexiva)
• Indinavir (Crixivan)
• Nelfinavir (Viracept)
• Rilpivirine (Edurant)
• Tipranavir (Aptivus)

PRECIPITANT DRUGS

Gastric Antisecretory Agents:

• Cimetidine (Tagamet, etc.)
• Dexlansoprazole (Kapidex)
• Esomeprazole (Nexium, etc.)
• Famotidine (Pepcid, etc.)
• Lansoprazole (Prevacid, etc.)
• Nizatidine (Axid, etc.)
• Omeprazole (Prilosec, etc.)
• Pantoprazole (Protonix, etc.)
• Rabeprazole (Aciphex)
• Ranitidine (Zantac, etc.)

Comment:

Clinical reports suggest that the absorption of some protease inhibitors (especially atazanavir and nelfinavir) may to be reduced by gastric antisecretory agents or antacids.

Class 3: Assess Risk & Take Action if Necessary

• Consider Alternative: Consider amprenavir (Agenerase), darunavir (Prezista), lopinavir (Kaletra), ritonavir (Norvir), or saquinavir (Invirase) as alternatives that are minimally affected by elevated gastric pH.
• Circumvent/Minimize: Low doses of the gastric antisecretory agent tend to minimize the reduction of protease inhibitor absorption. Separation of the doses of the protease inhibitor from the antisecretory agent or antacid may reduce the magnitude of the interaction.
• Monitor: Monitor for reduced antiviral effect in patients treated with a gastric alkalinizer or antacid; adjust dose of protease inhibitor as needed.