How do cardiovascular agents 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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For patients receiving RTV for at least 10 days, start bosentan at 62.5 mg/day or every other day based on tolerability; for patients receiving bosentan, stop bosentan ≥36 hours before starting RTV; at least 10 days after starting RTV, resume bosentan at 62.5 mg/day or every other day; do not coadminister bosentan and ATV without RTV.

SQV/RTV or RTV can increase digoxin drug concentrations; monitor digoxin levels and use with caution.

All PIs may increase drug concentrations of dihydropyridine calcium channel blockers; electrocardiographic (ECG) monitoring is recommended with ATV.

When diltiazem is administered with ATV +/- RTV, decrease the diltiazem dose by 50%; ECG monitoring is recommended; use caution when diltiazem is coadministered with other PIs.

For antiarrhythmic drugs, amiodarone or dronedarone should not be coadministered with ATV +/- RTV, DRV/RTV, FPV +/- RTV, LPV/RTV, SQV/RTV, or TPV/RTV; flecainide or propafenone should not be used with FPV +/- RTV, SQV/RTV, or TPV/RTV; lidocaine and dofetilide should not be coadministered with SQV/RTV; quinidine should be avoided with SQV/RTV or TPR/RTV.

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