التداخل بين دارونافير ونالوكسيغول

John's wort ( Hypericum perforatum ) Hepatitis C direct acting antiviral: elbasvir/grazoprevir Lipid modifying agents: lomitapide, lovastatin, simvastatin Opioid Antagonist: naloxegol PDE-5 inhibitor: sildenafil when used for treatment of pulmonary arterial hypertension Sedatives/hypnotics: orally administered midazolam, triazolam Co-administration of PREZISTA/ritonavir…

Opioid Antagonist naloxegol ↑ naloxegol Co-administration of PREZISTA/ritonavir and naloxegol is contraindicated due to potential for precipitating opioid withdrawal symptoms.

Clinical monitoring is recommended if PREZISTA/ritonavir and buprenorphine or buprenorphine/naloxone are co-administered. methadone ↓ methadone No adjustment of methadone dosage is required when initiating co-administration of PREZISTA/ritonavir.

Narcotic analgesics/treatment of opioid dependence : buprenorphine, buprenorphine/naloxone ↔ buprenorphine, naloxone ↑ norbuprenorphine (metabolite) No dose adjustment for buprenorphine or buprenorphine/naloxone is required with concurrent administration of PREZISTA/ritonavir.

Patients concomitantly using strong CYP3A4 inhibitors (e.g., clarithromycin, ketoconazole) because these medications can significantly increase exposure to naloxegol which may precipitate opioid withdrawal symptoms such as hyperhidrosis, chills, diarrhea, abdominal pain, anxiety, irritability, and yawning [see Drug Interactions (7.1) and Clinical Pharmacology…

Concomitant use with strong CYP3A4 inhibitors (e.g., clarithromycin, ketoconazole).

Moderate CYP3A4 inhibitors (e.g., diltiazem, erythromycin, verapamil) : Increased naloxegol concentrations; avoid concomitant use; if unavoidable, reduce dosage to 12.5 mg once daily and monitor for adverse reactions.

•Use with strong CYP3A4 inhibitors is contraindicated [see Contraindications (4) ] .

•Moderate CYP3A4 inhibitors (e.g., diltiazem, erythromycin, verapamil) •Avoid use with moderate CYP3A4 inhibitors; if unavoidable, decrease the dosage of MOVANTIK to 12.5 mg once daily and monitor for adverse reactions [see Dosage and Administration (2.4) ] .