NORVIR (Brand for RITONAVIR)

Ritonavir 80mg/1mL, Oral solution

Alcohol

· Severity: Major

· Notes for Consumers: Although an interaction is possible, these drugs may be used together with caution. If these drugs are taken together, the effectiveness of your ritonavir medication may be decreased. If you notice your medicines are not working as well for you or any unusual side effects, notify your health care provider immediately. You will be closely monitored.

· Notes for Professionals: Concurrent administration of ethanol with ritonavir may result in decreased plasma concentrations of ritonavir, which may affect antiviral efficacy. Ethanol is an inducer of the hepatic isoenzyme CYP3A4; ritonavir is a substrate of this enzyme. Caution and close monitoring are advised if ethanol and ritonavir are administered together.

Ritonavir 80mg/1mL, Oral solution

Grapefruit juice

· Severity: Moderate

· Notes for Consumers: Although an interaction is possible, these drugs may be given with grapefruit juice. If given with grapefruit juice, you may experience more side effects. If you notice any new or unusual side effects, notify your health care provider immediately. You will be closely monitored.

· Notes for Professionals: Concurrent administration of ritonavir with grapefruit juice may result in elevated ritonavir concentrations. Grapefruit juice is an inhibitor of the hepatic isoenzymes CYP3A4 and CYP2D6, and an inhibitor of the drug transporter P-glycoprotein (P-gp). Ritonavir is metabolized by both enzymes and is a substrate for P-gp. Caution and close monitoring are advised if these drugs are administered together.

Ritonavir 80mg/1mL, Oral solution

Marijuana

· Severity: Moderate

· Notes for Consumers: The effects of marijuana may be increased and side effects may get worse if it is combined with this medicine. Do not drive or operate machinery until you know how this combination will affect you. Contact your health care provider right away if you notice slurred speech, confusion, severe drowsiness, increased heart rate, or any other new or unusual side effects.

· Notes for Professionals: The pharmacokinetic parameters of anti-retroviral medications (anti-retroviral non-nucleoside reverse transcriptase inhibitors (NNRTIs), anti-retroviral nucleoside reverse transcriptase inhibitors (NRTIs), anti-retroviral nucleotide reverse transcriptase inhibitors, and anti-retroviral protease inhibitors) metabolized through the CYP isoenzyme system are slightly altered by smoked and oral marijuana. Despite this interaction, marijuana is not expected to adversely affect anti-retroviral efficacy. However, the incidence of marijuana associated adverse effects may change following coadministration with anti-retroviral drugs. Many anti-retrovirals are inhibitors of CYP3A4, an isoenzyme partially responsible for the metabolism of marijuana's most psychoactive compound, delta-9-tetrahydrocannabinol (Delta-9-THC). When given concurrently with anti-retrovirals, the amount of Delta-9-THC converted to the active metabolite 11-hydroxy-delta-9-tetrahydrocannabinol (11-OH-THC) may be reduced. These changes in Delta-9-THC and 11-OH-THC plasma concentrations may result in an altered marijuana adverse event profile.

<b>DISCLAIMER:</b><em> This drug information content is provided for informational purposes only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Patients should always consult their physician with any questions regarding a medical condition and to obtain medical advice and treatment. Drug information is sourced from GSDD (Gold Standard Drug Database ) provided by Elsevier.</em>