title: Interactions between buprenorphine and antiretrovirals. II. The protease inhibitors nelfinavir, lopinavir/ritonavir, and ritonavir.
abstract: We examined drug interactions between buprenorphine, an opioid partial agonist available by prescription for treatment of opioid dependence, and the protease inhibitors (PIs) nelfinavir (NFV), ritonavir (RTV), and lopinavir/ritonavir (LPV/R). Opioid-dependent, buprenorphine/naloxone-maintained, human immunodeficiency virus (HIV)-negative volunteers (n=10 per PI) participated in 24-h pharmacokinetic studies, before and after administration of each PI. Symptoms of opiate withdrawal and excess were determined before and after PI administration. PI pharmacokinetics were determined and compared between opiate-dependent participants and healthy control participants (n=15 per PI). Administration of RTV, but not of NFV or LPV/R, resulted in a significant increase in the buprenorphine area under the concentration-time curve (AUC). Symptoms of opiate excess, however, were not observed. Buprenorphine had no significant effects on PI AUC. Adjustments of doses of either buprenorphine or NFV, LPV/R, or RTV are not likely to be necessary when these drugs are administered for the treatment of opioid dependence and HIV disease.
authors.affiliation: Virginia Commonwealth University, Richmond, USA. emccancekatz@vcu.edu
authors.forename: Elinore F
authors.initials: EF
authors.lastname: McCance-Katz
authors.forename: David E
authors.initials: DE
authors.lastname: Moody
authors.forename: Patrick F
authors.initials: PF
authors.lastname: Smith
authors.forename: Gene D
authors.initials: GD
authors.lastname: Morse
authors.forename: Gerald
authors.initials: G
authors.lastname: Friedland
authors.forename: Patricia
authors.initials: P
authors.lastname: Pade
authors.forename: Jennifer
authors.initials: J
authors.lastname: Baker
authors.forename: Anika
authors.initials: A
authors.lastname: Alvanzo
authors.forename: Peter
authors.initials: P
authors.lastname: Jatlow
authors.forename: Petrie M
authors.initials: PM
authors.lastname: Rainey
mesh_terms: D000328:Adult; D002047:Buprenorphine / Q000493:pharmacokinetics* / Q000627:therapeutic use; D016022:Case-Control Studies; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004334:Drug Administration Schedule; D004347:Drug Interactions; D005260:Female; D017320:HIV Protease Inhibitors / Q000008:administration & dosage / Q000493:pharmacokinetics*; D018023:HIV Seronegativity; D006801:Humans; D061466:Lopinavir; D008297:Male; D009292:Narcotic Antagonists / Q000493:pharmacokinetics* / Q000627:therapeutic use; D019888:Nelfinavir / Q000008:administration & dosage / Q000493:pharmacokinetics; D009293:Opioid-Related Disorders / Q000175:diagnosis / Q000188:drug therapy*; D011336:Probability; D011744:Pyrimidinones / Q000008:administration & dosage / Q000493:pharmacokinetics; D012016:Reference Values; D018570:Risk Assessment; D019438:Ritonavir / Q000008:administration & dosage / Q000493:pharmacokinetics
chemical_list: D017320:HIV Protease Inhibitors; D009292:Narcotic Antagonists; D011744:Pyrimidinones; D061466:Lopinavir; D002047:Buprenorphine; D019888:Nelfinavir; D019438:Ritonavir