| Kaletra (lopinavir/ritonavir) plus ... |
| Kaletra is a single pill containing 2 anti-HIV drugs, lopinavir and ritonavir. References below indicate which drug contained in Kaletra is specifically altered in combinations. |
| Amiodarone |
May increase amiodarone level in blood. Checking amiodarone level in blood is recommended. |
| Amprenavir |
Decreases lopinavir level by 15% and increases amprenavir trough level about 2-fold in blood. Amprenavir dose may be reduced to 750 mg twice a day or less. However, optimal dose is unclear. |
| Astemizole |
Should not be used together. Increases risk of side effects. |
| Atorvastatin |
Should be used together with great caution. Increases active atorvastatin level about 6-fold and atorvastatin metabolite by 2.5 times in blood and may increase risk of side effects. |
| Atovaquone |
Decreases atovaquone level in blood. Atovaquone dose may have to be increased. |
| Bepridil |
May increase bepridil level in blood. Checking bepridil level in blood is recommended. |
| Carbamazepine |
Should be used together with great caution. May decrease lopinavir level in blood. |
| Cisapride |
Should not be used together. Increases risk of side effects. |
| Clarithromycin |
Increases clarithromycin level in blood. Clarithromycin dose should be decreased for people with kidney dysfunction. |
| Cyclosporine |
May increase cyclosporine level in blood. Checking cyclosporine level in blood is recommended. |
| ddI or ddI EC |
ddI or ddI EC should be taken 1 hour before or 2 hours after taking Kaletra. ddI and ddI EC should be taken on an empty stomach, and Kaletra should be taken with a meal. |
| Delavirdine |
May increase lopinavir level in blood. Needs further study. |
| Dexamethasone |
Should be used together with great caution. May decrease lopinavir level in blood. |
| Dihydroergotamine |
Should not be used together. Increases risk of side effects. |
| Disulfiram/metronidazole |
Should be used together with Kaletra oral solution with caution. Alcohol in Kaletra oral solution may increase risk of side effects. |
| Efavirenz |
Decreases lopinavir level by about 25% (trough by about 33%). Kaletra dose should be increased to 4 capsules twice a day. |
| Ergonovine |
Should not be used together. Increases risk of side effects. |
| Ergotamine |
Should not be used together. Increases risk of side effects. |
| Ethinyl estradiol |
Should not be used together. Decreases ethinyl estradiol level by 42% in blood. Use another form of contraception. |
| Felodipine |
Should be used together with caution. May increase felodipine level in blood. Check for side effects. |
| Food |
Increases lopinavir level in blood. Kaletra should be taken with food. |
| Fosamprenavir |
Significantly decreases fosamprenavir level in blood. Also increases risk of side effects. Appropriate dose adjustments not yet established. |
| Indinavir |
Increases indinavir trough level by about 4 times in blood. Currently under study; however, indinavir dose should be reduced to no more than 600 mg twice a day if used together. |
| Itraconazole |
Increases itraconazole level in blood. Itraconazole dose should not exceed 200 mg/day. |
| Ketoconazole |
Increases ketoconazole level by 3 times in blood. Ketoconazole dose should not exceed 200 mg/day. |
| Lidocaine (systemic) |
May increase lidocaine level in blood. Checking lidocaine level in blood is recommended. |
| Lovastatin |
Should not be used together. Increases risk of side effects. |
| Methadone |
Decreases methadone level by 53% in blood. Check for methadone withdrawal symptoms and adjust methadone dose accordingly. |
| Methylergonovine |
Should not be used together. Increases risk of side effects. |
| Midazolam |
Should not be used together. Increases risk of side effects. |
| Nelfinavir |
Decreases lopinavir level in blood. Kaletra dose may need to be increased. Optimal dose is under study. |
| Nevirapine |
Decreases lopinavir level in blood. Kaletra dose should be increased to 4 capsules twice a day. |
| Nicardipine |
Should be used together with caution. May increase nicardipine level in blood. Check for side effects. |
| Nifedipine |
Should be used together with caution. May increase nifedipine level in blood. Check for side effects. |
| Phenobarbital |
Should be used together with great caution. May decrease lopinavir level in blood. |
| Phenytoin |
Should be used together with great caution. May decrease lopinavir level in blood. |
| Pimozide |
Should not be used together. Increases risk of side effects. |
| Pravastatin |
Increases pravastatin level in blood. No dose adjustment recommended. |
| Quinidine |
May increase quinidine level in blood. Checking for quinidine level in blood is recommended. |
| Rapamycin |
May increase rapamycin level in blood. Checking for rapamycin level in blood is recommended. |
| Rifabutin |
Increases rifabutin level by 5.7-fold. Rifabutin dose should be changed to 150 mg every other day or 3 times a week. Check for side rifabutin effects. |
| Rifampin |
Should not be used together. Decreases lopinavir level by 75% in blood. |
| Saquinavir (Fortovase) |
Increases saquinavir trough level by about 3-fold. Saquinavir dose may be reduced to 800 mg twice a day. Optimal dose is under study. |
| Sildenafil |
Should be used together with caution. Increases sildenafil level in blood. Sildenafil dose should be reduced to no more than 25 mg every 48 hours. |
| Simvastatin |
Should not be used together. Increases risk of side effects. |
| St. John's Wort |
Should not be used together. May decrease lopinavir level in blood. |
| Tacrolimus |
May increase tacrolimus level in blood. Checking for tacrolimus level in blood is recommended. |
| Tedalafil |
Should be used together with caution. May increase tedalafil level in blood. |
| Tenofovir |
Increases tenofovir level by about 30% and decreases lopinavir level 15% in blood. No dose adjustment currently recommended. |
| Triazolam |
Should not be used together. Increases risk of side effects. |
| Vardenafil |
Should be used together with caution. May increase vardenafil level in blood. |
| Warfarin |
May affect warfarin level in blood. Check INR. |
| Ketoconazole (Nizoral) plus ... |
| Alcohol |
May increase risk of nausea, vomiting and low blood pressure. |
| Alprazolam |
Should be used together with caution. May increase level of alprazolam in blood. |
| Amphotericin B |
May interfere with the activity of amphotericin B. |
| Amprenavir |
Increases amprenavir level by 31% and increases ketoconazole level by 44% in blood. Impact of interaction is uncertain. |
| Antacids |
Should be taken 2 hours apart, otherwise may decrease ketoconazole level in blood. |
| Astemizole |
Should not be used together*. Increases risk of side effects. |
| Cimetidine |
Should be taken 2 hours apart, otherwise may decrease ketoconazole level in blood. |
| Cisapride |
Should not be used together*. Increases risk of side effects. |
| Clonazepam |
Should be used with caution. May increase clonazepam level in blood. |
| Corticosteroids |
May decrease corticosteroid level in blood. |
| Cyclosporine |
Should be used together with caution. May increase cyclosporine level in blood. Check cyclosporine level and adjust dose accordingly. |
| ddI |
Should be taken 2 hours apart, otherwise ddI buffering agents may significantly decrease ketoconazole level in blood. |
| Delavirdine |
Increases delavirdine level by 50% in blood. |
| Diazepam |
Should be used together with caution. May increase diazepam level in blood. |
| Digoxin |
May increase digoxin level in blood. Digoxin level should be carefully checked. |
| Famotidine |
Should be taken 2 hours apart, otherwise may decrease ketoconazole level in blood. |
| Fosamprenavir |
Should be used together with great caution. Increases risk of serious side effects. Do not exceed 400 mg of ketoconazole if fosamprenavir used alone, or 200 mg if boosted with ritonavir. |
| Glipizide |
May increase risk of low blood sugar level. |
| Glyburide |
May increase risk of low blood sugar level. |
| Indinavir |
Increases indinavir level by 68% in blood. Decrease indinavir dose to 600 mg 3 times/day. |
| Isoniazid |
Should not be used together*. Decreases ketoconazole level in blood. |
| Kaletra |
Increases ketoconazole level by 3 times in blood. Ketoconazole dose should not exceed 200 mg/day. |
| Loratadine |
Increases loratadine level by 300% in blood. |
| Methylprednisolone |
Should be used together with caution. May increase methylprednisolone level in blood. Check blood level of cyclosporine and adjust dose accordingly. |
| Miconazole |
Should be used together with great caution. May lead to severe hypoglycemia (low blood sugar). |
| Midazolam |
Should not be used together*. Increases midazolam level in blood. |
| Nelfinavir |
Increases nelfinavir level by 35% in blood. No dose adjustment recommended. |
| Nevirapine |
Should not be used together. Significantly decreases ketoconazole level in blood. |
| Omeprazole |
Should be used together with caution. Decreases ketoconazole and increases omeprazole level in blood. |
| Phenytoin |
Should be used together with caution. May affect ketoconazole and phenytoin levels in blood. Check phenytoin and ketoconazole levels and adjust dose accordingly. |
| Prednisolone |
May increase prednisolone level in blood. |
| Ranitidine |
Should be taken 2 hours apart, otherwise may decrease ketoconazole level in blood. |
| Rifabutin |
May decrease ketoconazole level in blood. |
| Rifampin |
Should not be used together*. Significantly decreases ketoconazole level in blood. |
| Ritonavir |
Should be used together with caution. Significantly increases ketoconazole level in blood. Ketoconazole dose should not exceed 200 mg/day. |
| Saquinavir (Fortovase) |
Significantly increases saquinavir level in blood. However, no dose adjustment recommended. |
| Saquinavir (Invirase) |
Significantly increases saquinavir level in blood. However, no dose adjustment recommended. |
| Tacrolimus |
Should be used together with caution. May increase tacrolimus level in blood. Check tacrolimus level. |
| Tedalafil |
Should be used together with caution. Increases tedalafil level in blood. Tedalafil dose should not exceed 10 mg in a 72 hour period. |
| Testosterone |
May decrease testosterone level in blood, especially when ketoconazole is used at higher doses. |
| Tolbutamide |
May increase risk of low blood sugar level. |
| Trazodone |
Increases trazodone level in blood. Trazodone dose may need to be reduced. |
| Triazolam |
Should not be used together*. Increases triazolam level in blood. |
| Trimetrexate |
May affect trimetrexate and/or ketoconazole level in blood. |
| Vardenafil |
Should be used together with caution. Increases vardenafil level in blood. If taking ketoconazole 400 mg/day, vardenafil dose should not exceed 2.5 mg/day. If taking ketoconazole 200 mg/day, vardenafil dose should not exceed 5 mg/day. |
| Warfarin |
Should be used together with caution. May increase prothrombin (coagulation) time and increase anticoagulant effects. Check warfarin dose closely. |
| Nelfinavir (Viracept) plus ... |
| 3TC |
Increases 3TC level by 10% in blood. No dose adjustment recommended. |
| Amiodarone |
Should not be used together*. Increases risk of side effects. |
| Amprenavir |
Increases nelfinavir level by 15% in blood. No dose adjustment recommended. |
| Astemizole |
Should not be used together*. Increases risk of side effects. |
| Atorvastatin |
Should be used together with great caution. May increase atorvastatin level in blood. |
| Azithromycin |
Should be used together with caution. Increases azithromycin level in blood. No dose adjustment recommended, but check for hearing and liver side effects. |
| AZT |
Decreases AZT level by 35% in blood. No dose adjustment recommended. |
| Carbamazepine |
Should be used together with caution. May decrease nelfinavir level in blood. |
| Cisapride |
Should not be used together*. Increases risk of side effects. |
| ddI or ddI EC |
Nelfinavir should be taken 2 hours before or after taking ddI or ddI EC. Nelfinavir should be taken with food, and ddI and ddI EC should only be taken on an empty stomach. |
| Dihydroergotamine |
Should not be used together*. Increases risk of side effects. |
| Delavirdine |
Increases nelfinavir level by about 95% but decreases nelfinavir active metabolite by about 45% in blood. Decreases delavirdine level by about 40%. No data exist to guide dose adjustments. |
| Ergonovine |
Should not be used together*. Increases risk of side effects. |
| Ergotamine |
Should not be used together*. Increases risk of side effects. |
| Ethinyl estradiol |
Should not be used together. Decreases ethinyl estradiol level by 47% in blood. Use another form of contraception. |
| Fluvastatin |
May interact somewhat with nelfinavir. No dose adjustment currently recommended. |
| Food |
Increases nelfinavir level in blood. Nelfinavir should be taken with food. |
| Indinavir |
Increases indinavir level by 51% and increases nelfinavir level by 83% in blood. Increase indinavir dose to 1,000 mg every 8 hours or boost indinavir with ritonavir. |
| Kaletra |
Decreases lopinavir level in blood. Kaletra dose may need to be increased. Optimal dose is under study. |
| Ketoconazole |
Increases nelfinavir level by 35% in blood. No dose adjustment recommended. |
| Lovastatin |
Should not be used together. Increases lovastatin level in blood. |
| Methadone |
Decreases methadone level in blood. Check for methadone withdrawal symptoms and adjust methadone dose accordingly. |
| Methylergonovine |
Should not be used together*. Increases risk of side effects. |
| Midazolam |
Should not be used together*. Increases risk of side effects. |
| Nevirapine |
Modestly decreases nelfinavir level in blood. No dose adjustment recommended. |
| Norethindrone |
Should be used together with caution. Decreases norethindrone level by 18% in blood. |
| Phenobarbital |
Should be used together with caution. May decrease level of nelfinavir in blood. |
| Phenytoin |
Should be used together with caution. May increase rate of metabolism of phenytoin. Check phenytoin level and adjust dose accordingly. |
| Pimozide |
Should not be used together*. Increases risk of side effects. |
| Quinidine |
Should not be used together*. Increases risk of side effects. |
| Rifabutin |
Should be used together with caution. Increases rifabutin and decreases nevirapine level in blood. Reduce rifabutin dose by ½ and use nevirapine at 1,250 mg twice a day. |
| Rifampin |
Should not be used together*. Decreases nelfinavir level by 82% in blood. |
| Ritonavir |
Increases ritonavir level by 9% and increases nelfinavir level by 152% in blood. Alternate doses under study include nelfinavir at 500–750 mg + ritonavir 400 mg twice a day. |
| Saquinavir (Fortovase) |
Increases nelfinavir level 18% and increases saquinavir level 4 times in blood. Saquinavir dose may be reduced to 800 mg 3 times a day or 1,200 mg twice a day. |
| Saquinavir (Invirase) |
Increases saquinavir level by 4 times and increases nelfinavir level by 18% in blood. Saquinavir dose may be reduced to 800 mg 3 times a day or 1,200 mg twice a day. |
| Sildenafil |
Should be used together with caution. Increases sildenafil level in blood. Sildenafil dose should be reduced to no more than 25 mg every 48 hours. |
| Simvastatin |
Should not be used together. Increases simvastatin level in blood. |
| St. John's Wort |
Should not be used together. May decrease nelfinavir level in blood. |
| Tedalafil |
Should be used together with caution. May increase tedalafil level in blood. |
| Triazolam |
Should not be used together*. Increases risk of side effects. |
| Vardenafil |
Should be used together with caution. May increase vardenafil level in blood. |
| Nevirapine (Viramune) plus ... |
| Amiodarone |
Should be used together with caution. May decrease amiodarone level in blood. |
| Amoxicillin |
May increase risk of rashes and Stevens Johnson Syndrome. Requires careful monitoring. |
| Amprenavir |
May decrease amprenavir level in blood. If boosting amprenavir with ritonavir, increase ritonavir to 200 mg twice a day. |
| Carbamazepine |
Should be used together with caution. May decrease carbamazepine level in blood. |
| Cimetidine |
Should be used together with caution. May slightly increase nevirapine level in blood. |
| Cisapride |
Should be used together with caution. May decrease cisapride level in blood. |
| Clarithromycin |
Decreases clarithromycin level by 30% and increases nevirapine level by 26% in blood. Consider using alternatives to clarithromycin. |
| Clonazepam |
Should be used together with caution. May decrease clonazepam level in blood. |
| Cyclophosphamide |
Should be used together with caution. May decrease cyclophosphamide level in blood. |
| Cyclosporin |
Should be used together with caution. May decrease cyclosporin level in blood. |
| Dihydroergotamine |
Should be used together with caution. May decrease dihydroergotamine level in blood. |
| Dicumarol |
Should not be used together*. May increase dicumarol level in blood. |
| Diltiazem |
Should be used together with caution. May decrease diltiazem level in blood. |
| Disopyramide |
Should be used together with caution. May decrease disopyramide level in blood. |
| Efavirenz |
Decreases efavirenz level by 22% in blood. Efavirenz dose may need to be increased to 800 mg once a day. |
| Ergonovine |
Should be used together with caution. May decrease ergonovine level in blood. |
| Ergotamine |
Should be used together with caution. May decrease ergotamine level in blood. |
| Erythromycin |
Should be used together with great caution. May increase risk of liver toxicity. |
| Ethinyl estradiol |
Should not be used together. Decreases ethinyl estradiol level in blood. Use another form of contraception. |
| Ethosuximide |
Should be used together with caution. May decrease ethosuximide level in blood. |
| Fentanyl |
Should be used together with caution. May decrease fentanyl level in blood. |
| Indinavir |
Decreases indinavir level by 27% in blood. Indinavir dose should be increased to 1,000 mg 3 times a day or 800 mg twice daily if boosted with ritonavir. |
| Itraconazole |
Should be used together with caution. May decrease itraconazole level in blood. Itraconazole dose may need to be increased. |
| Kaletra |
Decreases Kaletra level in blood. Kaletra dose should be increased to 4 capsules twice a day. |
| Ketoconazole |
Should not be used together. Significantly decreases ketoconazole level in blood. |
| Lidocaine (systemic) |
Should be used together with caution. May decrease lidocaine level in blood. |
| Methadone |
Decreases methadone level by about 60% in blood. Check for methadone withdrawal symptoms and adjust methadone dose accordingly. |
| Methylergonovine |
Should be used together with caution. May decrease methylergonovine level in blood. |
| Nelfinavir |
Modestly decreases nelfinavir level in blood. No dose adjustment recommended. |
| Nifedipine |
Should be used together with caution. May decrease nifedipine level in blood. |
| Norethindrone |
Decreases norethindrone level in blood. Use another form of contraception. |
| Prednisone |
May increase risk of rash. |
| Rifabutin |
Should be used together with caution. May significantly affect rifabutin level in blood. |
| Rifampin |
Should not be used together. Decreases nevirapine level in blood. |
| Ritonavir |
Decreases ritonavir level by 11% in blood. No dose adjustment recommended. |
| Saquinavir (Fortovase) |
Decreases saquinavir level by 24% in blood. Saquinavir may require ritonavir boosting. |
| Saquinavir (Invirase) |
Decreases saquinavir level by 27% in blood. Saquinavir may require ritonavir boosting. |
| Sirolimus |
Should be used together with caution. May decrease sirolimus level in blood. |
| Steroids |
May increase rate of metabolism of steroids. |
| St. John's Wort |
Should not be used together. May decrease nevirapine level in blood. |
| Tacrolimus |
Should be used together with caution. May decrease tacrolimus level in blood. |
| TMP/SMX |
Should not be initiated together for the first 4–6 weeks. May increase risk of rashes. |
| Voriconazole |
Should be used together with caution. May increase nevirapine side effects and
decrease effectiveness of voriconazole. |
| Warfarin |
Should be used together with great caution. Interaction is complex. Warfarin level in blood should be checked carefully. |
| Pentamidine (Pentam) plus ... |
| Adefovir |
Should not be used together*. Increases risk of kidney toxicity. |
| Amphotericin B |
Should be used together with great caution. May increase risk of kidney toxicity. |
| Anticancer drugs |
May increase risk of anemia. |
| AZT |
May increase risk of anemia. |
| Cidofovir |
Should not be used together*. Increases risk of kidney toxicity. |
| ddC |
Should be used with great caution. May increase risk of peripheral neuropathy and pancreatitis. |
| ddI or ddI EC |
May increase risk of pancreatitis. |
| d4T |
May increase risk of pancreatitis. |
| Foscarnet |
Should be used with caution. May increase risk of kidney toxicity. Check closely. |
| Ganciclovir |
Should be used together with great caution. May increase risk of bone marrow toxicity. |
| Interferon-alfa |
May increase risk of bone marrow toxicity. |
| Tenofovir |
Should not be used together*. May increase risk of side effects. |
| Probenecid (Benemid, ColBenemid) plus ... |
| Acetaminophen |
Should be used together with caution. Increases acetaminophen level in blood. |
| Acyclovir |
Increases acyclovir level in blood. Impact of interaction is uncertain. |
| Aspirin |
Should be used together with caution. Decreases activity of probenecid. |
| AZT |
Should be used together with caution. Increases AZT level by 106% in blood. Check for AZT side effects. |
| Benzodiazepines |
Increases benzodiazepine level in blood. |
| Bumetadine |
Should not be used together. Probenecid decreases the effectiveness of bumetadine. |
| Captopril |
Should be used together with caution. May increase captopril level in blood. |
| Cidofovir |
Needs to be taken together to decrease risk of kidney toxicity. |
| Cilastatin |
Should be used together with caution. May increase cilastatin level in blood and increase risk of side effects. |
| Ciprofloxacin |
Should be used together with caution. May increase ciprofloxacin level in blood and increase risk of side effects. |
| Cisplatin |
Should be used together with caution. May increase cisplatin level in blood and increase risk of side effects. |
| Clofibrate |
Should be used together with caution. May increase clofibrate level in blood and increase risk of side effects. |
| Dapsone |
Should be used together with caution. May increase dapsone level in blood and increase risk of side effects. |
| ddC |
Significantly increases ddC level in blood. Check for toxicity and consider lower ddC dose. |
| Famotidine |
Should be used together with caution. Significantly increases famotidine level in blood. |
| Furosemide |
May increase risk of inner ear poisoning (ototoxicity). |
| Ganciclovir |
Should be used together with caution. May increase ganciclovir level in blood and increase risk of side effects. |
| Indomethacin |
Should be used together with caution. Increases indomethacin level in blood. May allow for lower indomethacin dose. |
| Imipenem |
Should be used together with caution. May increase imipenem level in blood and increases risk of side effects. |
| Ketamine |
Should be used together with caution. Increases ketamine level in blood. |
| Ketoprofen |
Should not be used together. Increases ketoprofen level in blood and increases risk of side effects. |
| Lorazepam |
Should be used together with caution. Increases lorazepam level in blood. |
| Meclofenamate |
Increases meclofenamate level in blood. |
| Methotrexate |
Should be used together with caution. Increases methotrexate level in blood and increases risk of side effects. |
| Naproxen |
Should be used together with caution. Increases naproxen level in blood. |
| Penicillin |
Should be used together with caution. Increases penicillin level 2–4 times in blood and increases risk of side effects. |
| Pyrazinamide |
Should be used together with caution. Decreases activity of probenecid. |
| Rifabutin |
Should be used together with caution. May increase rifabutin level in blood and increase risk of side effects. |
| Rifampin |
Should be used together with caution. May increase rifampin level in blood and increase the risk of side effects. |
| Sulfonamide |
Increases sulfonamide level in blood. |
| Sulindac |
Increases sulindac level in blood and decreases activity of probenecid. |
| Theophylline |
May increase theophylline level in blood. |
| Thiopental |
Should be used together with caution. Increases thiopental level in blood. |
