A case of a probable drug interaction between lurasidone and atazanavir-based antiretroviral therapy.
The cytochrome P450 isoform that is primarily involved in the metabolism of the antipsychotic lurasidone is CYP3A4. Drugs that inhibit or induce this enzyme would then be expected to increase or decrease serum concentrations of lurasidone, respectively. Atazanavir, an HIV-1 protease inhibitor, has demonstrated to be an inhibitor of CYP3A4 and would be expected to increase the exposure of any drug metabolized by this enzyme. We report a case of an atazanavir-precipitated drug-drug interaction that led to elevated serum concentrations of lurasidone and associated clinical symptoms of drug toxicity.
Department of Infectious Diseases & HIV, St Michael's Hospital, Toronto, ON, Canada.
Mark
M
Naccarato
Department of Psychiatry, St Michael's Hospital, Toronto, ON, Canada.
Elise
E
Hall
Department of Psychiatry, St Michael's Hospital, Toronto, ON, Canada.
Alan
A
Wai
Department of Infectious Diseases & HIV, St Michael's Hospital, Toronto, ON, Canada.|Faculty of Medicine, University of Toronto, Toronto, ON, Canada.|Keenan Research Centre for Biomedical Science of St Michael's Hospital, Toronto, ON, Canada.
Mario
M
Ostrowski
Department of Psychiatry, St Michael's Hospital, Toronto, ON, Canada.|Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
Adriana
A
Carvalhal
D014150:Antipsychotic Agents / Q000493:pharmacokinetics*; D000069446:Atazanavir Sulfate / Q000494:pharmacology* / Q000627:therapeutic use; D065692:Cytochrome P-450 CYP3A Inhibitors / Q000494:pharmacology; D004347:Drug Interactions; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000494:pharmacology*; D006801:Humans; D000069056:Lurasidone Hydrochloride / Q000493:pharmacokinetics*; D008297:Male; D008875:Middle Aged
D014150:Antipsychotic Agents; D065692:Cytochrome P-450 CYP3A Inhibitors; D017320:HIV Protease Inhibitors; D000069446:Atazanavir Sulfate; D000069056:Lurasidone Hydrochloride