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AccessPak for HIV PEP Expanded with Kaletra and Aristada

Determining the interaction of AccessPak for HIV PEP Expanded with Kaletra and Aristada and the possibility of their joint administration.

Check result:
AccessPak for HIV PEP Expanded with Kaletra <> Aristada
Relevance: 08.06.2022 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Using ritonavir together with tenofovir can cause damage to the kidneys. Symptoms of kidney damage include swelling, weight gain, feeling short of breath, drowsiness, confusion, mood changes, increased thirst, loss of appetite, nausea and vomiting, pain in your lower back, and urinating more or less than usual or not at all. If you take both medications together, tell your doctor if you have any of these symptoms. You may need a dose adjustment or special tests to safely use these medications together. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

MONITOR: Coadministration with ritonavir, with or without lopinavir, has been suggested in postmarketing reports to increase the proximal tubular intracellular concentrations of tenofovir and potentiate the risk of tenofovir-induced nephrotoxicity. The proposed mechanism is ritonavir inhibition of tenofovir renal tubular secretion into the urine via multidrug resistance protein MRP2. Analysis of data from a compassionate access study in which 271 patients with advanced HIV disease received the combination for a mean duration of 63 weeks revealed no clinically significant nephrotoxicity associated with coadministration. However, there have been case reports of renal failure associated with acute tubular necrosis, Fanconi's syndrome, and nephrogenic diabetes insipidus in patients treated with tenofovir disoproxil fumarate in combination with ritonavir. Some patients had incomplete recovery of renal function more than a year after cessation of tenofovir therapy. Ritonavir given in combination with lopinavir has also been reported to modestly increase the plasma concentrations of tenofovir. In contrast, both slight decreases and no change in lopinavir and ritonavir concentrations have been reported.

MANAGEMENT: Caution is advised if tenofovir disoproxil fumarate is prescribed with ritonavir. Renal function should be monitored regularly, including surveillance for signs of tubulopathy such as glycosuria, acidosis, increases in serum creatinine level, electrolyte disturbances (e.g., hypokalemia, hypophosphatemia), and proteinuria. The same precaution may be applicable during therapy with other protease inhibitors based on their similar pharmacokinetic profile, although clinical data are lacking. Nelfinavir reportedly does not alter the pharmacokinetics of tenofovir, or vice versa. Tenofovir administration should be discontinued promptly if nephropathy develops.

References
  • Verhelst D, Monge M, Meynard JL, et al. "Fanconi syndrome and renal failure induced by tenofovir: A first case report." Am J Kidney Dis 40 (2002): 1331-3
  • Zimmermann AE, Pizzoferrato T, Bedford J, Morris A, Hoffman R, Braden G "Tenofovir-associated acute and chronic kidney disease: a case of multiple drug interactions." Clin Infect Dis 42 (2006): 283-90
  • Kearney BP, Mittan A, Sayre J, et al "Pharmacokinetic drug interaction and long term safety profile of tenofovir DF and lopinavir/ritonavir. Available from: URL: http://www.icaac.org/ICAAC.asp." ([2003 Sep 14-7]):
  • Creput C, Gonzalez-Canali G, Hill G, Piketty C, Kazatchkine M, Nochy D "Renal lesions in HIV-1-positive patient treated with tenofovir." AIDS 17 (2003): 935-7
  • "Product Information. Viread (tenofovir)." Gilead Sciences, Foster City, CA.
  • Karras A, Lafaurie M, Furco A, et al. "Tenofovir-related nephrotoxicity in human immunodeficiency virus-infected patients: three cases of renal failure, fanconi syndrome, and nephrogenic diabetes insipidus." Clin Infect Dis 36 (2003): 1070-3
  • Rollot F, Nazal EM, Chauvelot-Moachon L, et al. "Tenofovir-related fanconi syndrome with nephrogenic diabetes insipidus in a patient with acquired immunodeficiency syndrome: the role of lopinavir-ritonavir-Didanosine." Clin Infect Dis 37 (2003): E174-6
  • Kapadia J, Shah S, Desai C, et al. "Tenofovir induced Fanconi syndrome: a possible pharmacokinetic interaction." Indian J Pharmacol 45 (2013): 191-2
AccessPak for HIV PEP Expanded with Kaletra

Generic Name: emtricitabine / lopinavir / ritonavir / tenofovir

Brand name: AccessPak for HIV PEP Expanded with Kaletra

Synonyms: n.a.

Aristada

Generic Name: aripiprazole

Brand name: Abilify Maintena, Aristada, Abilify, Abilify Discmelt, Abilify MyCite, Aristada Initio

Synonyms: Aristada Injection

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.