How do antifungals and protease inhibitors (PIs) interact?

Updated: Jan 15, 2019
  • Author: Jason F Okulicz, MD, FACP, FIDSA; Chief Editor: Michelle R Salvaggio, MD, FACP  more...
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Antifungal agents include fluconazole, itraconazole, posaconazole, and voriconazole.

Fluconazole increases tipranavir AUC by 50%; fluconazole >200 mg/day is not recommended; if high-dose fluconazole is indicated, consider an alternative PI or another class of antiretroviral agents.

When itraconazole and RTV-boosted PIs are given in combination, there is a potential for increased itraconazole or PI drug concentrations; high doses of itraconazole are not recommended (>200 mg/day) unless dosing is guided by drug levels.

LPV/RTV with itraconazole can lead to increased itraconazole drug levels; consider not exceeding 200 mg/day.

A bidirectional interaction has been observed between SQV/RTV and itraconazole; decreased itraconazole dosage may be needed; monitor itraconazole levels.

ATV or FPV in combination with itraconazole may increase itraconazole levels or PI levels.

Posaconazole can increase drug concentrations of ATV and ATV/RTV; monitor for ATV adverse effects.

Posaconazole should be avoided with FPV.

Do not coadminister voriconazole with RTV unless the benefits outweigh the risks; interaction applies to RTV-boosted PIs.

ATV or FPV in combination with voriconazole may lead to increased voriconazole or PI levels.

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