How do PPIs 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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PPIs include omeprazole, pantoprazole, rabeprazole, esomeprazole, dexlansoprazole, and lansoprazole.

PPIs can potentially decrease the drug concentration of PIs; PPIs are not recommended in patients taking unboosted ATV.

When using ATV with RTV boosting, the PPIs should not exceed a dose equivalent of omeprazole 20 mg/day in PI-naive patients; PPIs should be given at least 12 hours prior to ATV/RTV.

PPIs are not recommended in patients who are PI experienced.

When DRV/RTV, TPV/RTV, FPV +/- RTV, and LPV/RTV are administered with PPIs, there is not a significant effect on the PI concentration.

When TPV/RTV is given, there may be a slight decrease in omeprazole concentration; consider adjusting omeprazole dose.

SQV/RTV in combination with PPIs may lead to an 82% increase in the AUC; it is important to monitor for SQV toxicities. [1]

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