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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)

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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