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Medications That Should Not Be Used With: Saquinavir (Invirase), Indinavir (Crixivan), Ritonavir (Norvir)

December 1997

**Saquinavir (Invirase, Fortovase)**
Drug Category	Potential Alternatives
Antimycobacterial (anti-TB or anti-MAC): rifampin (Rifadin, others), rifabutin	azithromycin (Zithromax), ethambutol (Myambutol)
Sedative/hypnotic: midazolam (Versed), triazolam (Halcion)	very limited clinical experience
Ergot derivatives (anti-migraine):	very limited clinical experience
Cold and allergy antihistamines: astemizole (Hismanal), terfenadine (Seldane)	loratadine (Claritin)
Advertisement Gastrointestinal: cisapride (Propulsid)	very limited clinical experience

**Indinavir (Crixivan), Nelfinavir (Viracept)**
Drug Category	Potential Alternatives
Antimycobacterial (Anti-TB or anti-MAC): rifampin (Rifadin, others)	clarithromycin (Biaxin) azithromycin (Zithromax) ethambutol (Myambutol)
Cold and allergy antihistamines: astemizole (Hismanal), terfenadine (Seldane)	loratadine (Claritin)
Gastrointestinal: cisapride (Propulsid)	very limited clinical experience
Sedative/hypnotic	midazolam (Versed) triazolam (Halcion)

**Ritonavir (Norvir)**
Drug Category	Potential Alternatives
Analgesic (pain reliever): meperidine (Demerol) piroxicam (Feldene) propoxyphene (Darvon, others)	acetaminophen (Tylenol, others) aspirin (Bayer, others) oxycodone (Percocet, others)
Cardiovascular (for the heart): amiodarone (Cordarone) flecainide (Tambocor) propafenone (Rythmol) quinidine (various)	very limited clinical experience
Antimycobacterial (Anti-TB or anti-MAC): rifabutin (Mycobutin)	clarithromycin (Biaxin) azithromycin (Zithromax) ethambutol (Myambutol)
Calcium Channel Blocker (for the heart): bepridil (Vascor)	very limited clinical experience
Ergot Alkaloid (vasoconstrictor): dihydroergotamine (D.H.E. 45) Ergotamine (various)
Cold and allergy antihistamines: astemizole (Hismanal), terfenadine (Seldane)	loratadine (Claritin)
Gastrointestinal: cisapride (Propulsid)	very limited clinical experience
Psychotropic (antidepressant): bupropion (Wellbutrin)	fluoxetine (Prozac) desipramine (Norpramin)
Psychotropic (neuroleptic): clozapine (Clozaril) pimozide (Orap)	very limited clinical experience
Sedative/hypnotic: alprazolam (Xanax) clorazepate (Tranxene) diazepam (Valium) estazolam (ProSom) flurazepam (Dalmane) midazolam (Versed) triazolam (Halcion) zolpidem (Ambien)	Temazepam (Restoril) Lorazepam (Ativan)

* Please note that alternatives may not be therapeutically equivalent

References: Product Labeling
Invirase™ (December 6, 1995)
Norvir™ (March 1, 1996)
Drug Interactions: Physician Guide
Crixivan™ (March 13, 1996)
Fortovase™ (November 7, 1997)

Drugs That May Interact With Ritonavir

The following is a list of medications that may potentially interact with ritonavir therapy.

Drug Category	Drugs that may interact with ritonavir (Norvir)
Analgesics, Narcotics (pain relievers)	alfentanil (Alfenta) fentanyl (Sublimaze)
Antiarrhythmics (for the heart)	disopyramide (Norpace) lidocaine (Xylocaine, others)
Anticoagulants (for the blood)	R-warfarin (Coumadin)
Anticonvulsants	carbamazepine (Tegretol) clonazepam (Klonopin) ethosuximide (Zarontin)
Antihistamine	loratadine (Claritin)
Antidepressants, other	nefazodone (Serzone) sertraline (Zoloft) trazodone (Desyrel)
Antiemetics	dronabinol (Marinol) ondansetron (Zofran)
Antimycobacterial (anti-TB or anti-MAC)	rifampin (Rifadin, others)
Antiparasitics	quinidine (various)
Calcium Channel Blockers	amlodipine (Norvasc) diltiazem (Cardizem, Diltiazem) felodipine (Plendil) isradipine (DynaCirc) nicardipine (Cardene) nifedipine (Adalat, Procardia) nimodipine (Nimotop) nisoldipine (Sular) verapamil (Calan, Isoptin)
Cancer chemotherapeutic agents	etoposide (VePesid) paclitaxel (Taxol) tamoxifen (Nolvadex, others) vinblastine (Velban) vincristine (Oncovin)
Corticosteriods	dexamethasone (Decadron, others) prednisone (various)
Hypolipidemics	lovastatin (Mevacor) pravastatin (Pravachol)
Immunosuppressants	cyclosporine (Sandimmune, Neoral) tacrolimus (Prograf)

Drugs That May Interact With Nelfinavir

The following is a list of medications that may potentially interact with nelfinavir therapy.

Drug Category	Drugs that may interact
Anticonvulsants	carbamazepine (Tegretol) phenobarbital phenytoin (Dilantin)
Anti-HIV protease inhibitors	indinavir (Crixivan) ritonavir (Norvir)
Oral contraceptives (birth control pills)	ethinyl estradiol norethindrone

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This article was provided by AIDSinfo. It is a part of the publication HIV Protease Inhibitors and You.

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