Table 1.

Examples of Lopinavir/ritonavir's Drug Interactions ³⁸

Lopinavir (A)/ritonavir (B)	Avoid combination (X)	Need therapy change or monitoring (X)
Increased the serum concentration of ‘X’
‘A/B’ (strong CYP3A4 Inhibitor) may increase the serum concentration of ‘X’	Ado‐trastuzumab emtansine, avanafil, ticagrelor, budesonide(systemic), dasatinib, delamanid, domperidone, dronedarone, everolimus, lovastatin, lercanidipine, salmeterol, tamsulosin, terfenadine	amlodipine, aripiprazole, budesonide (oral, nasal, topical), clozapine, corticosteroids, CYP3A4 substrates, evogliptin, fentanyl, imatinib, lacosamide, mirtazapine, oxycodone, pranlukast, thiotepa, trazodone
‘A/B’ (strong CYP3A4 and P‐glycoprotein inhibitor) may increase the serum concentration of ‘X’	rivaroxaban	apixaban
‘A/B’ (P‐glycoprotein/ABCB1 inhibitor) may increase the serum concentration of ‘X’	pazopanib, topotecan	afatinib, betrixaban, celiprolol, colchicine, doxorubicine, edoxaban, rifaximin, venetoclax
‘A/B’ (protease inhibitors) may increase the serum concentration of ‘X’ or decrease the metabolism of ‘X’	alfuzocin, midazolam, lovastatin, simeprevir, simvastatin	atorvastatin, rosuvastatin, sildenafil, TCAs, CCBs, tacrolimus(topical)
‘A/B’ (protease inhibitor) may enhance the adverse/toxic effects of ‘X’		cyclophosphamide, temsilolimus
‘A’ may enhance the QTc‐prolonging effect of ‘X’	amiodarone, quinidine	methadone
‘A’ may increase the serum concentration of ‘X’	antihepaciviral combination products, voxilaprevir	rifabutine, bedaquilline, elvitegravir, itraconazole, vincristine, vinblastine
‘B’ may increase the serum concentration of ‘X’ or may enhance the adverse effects	amiodarone, metronidazole, flecainide, glecaprevir/pibrentasvir, propafenone	cyclosporin, digoxin, itraconazole, ketoconazole, linagliptin, prednisolone, quetiapine, tadalafil, zolpidem
Decreased the serum concentration of ‘X’
‘A/B’ (protease inhibitors) may decrease the serum concentration of ‘X’		abacavir, estrogen derivatives, valproate products, tacrolimus, zidovudine
‘A’ may decrease the serum concentration of ‘X’	darunavir, quinine, voriconazole	didanosine, progestines, warfarin
‘B’ may decrease the serum concentration of ‘X’	quinine, voriconazole	canagliflozin, deferoxamine, methadone, olanzapine, theophylline derivatives, warfarin, clopidogrel, thyroid products
Increased the serum concentration of ‘A/B’
‘X’ may increase the serum concentration of ‘A’		ketoconazole
‘X’ may enhance the QTc‐prolonging effect of ‘A’	clarithromycin
Decreased the serum concentration of ‘A/B’
‘X’ may decrease the serum concentration of ‘A/B’ (CYP3A4 Substrate)		orlistat, sarilumab, siltuximab, tocilizumab
‘X’ may decrease the serum concentration of ‘A’	fosamprevir	fosphenytoin, phenytoin, nelfinavir, carbamazepine, efavirenz, phenobarbital

Abbreviations: CCB, calcium channel blocker; CYP3A4, cytochrome P450 3A4; QTc, corrected QT Interval; TCA, tricyclic antidepressants.