Interaksi Nirmatrelvir dan ritonavir dan Kuinin

Therefore, the concomitant administration of ritonavir with quinine sulfate capsules should be avoided [see also DRUG INTERACTIONS ( 7.2 )] .

However, due to the significant effect of ritonavir on quinine pharmacokinetics, the concomitant administration of quinine sulfate capsules with ritonavir should be avoided [see also DRUG INTERACTIONS ( 7.1 )] .

Ritonavir In healthy subjects who received a single oral 600 mg dose of quinine sulfate with the 15 th dose of ritonavir (200 mg every 12 hours for 9 days), there were 4-fold increases in the mean quinine AUC and C max , and an increase in the mean elimination half-life (13.4 hours versus 11.2 hours), compared to when quinine was given alone.

Although a causal relationship between a specific drug and the arrhythmia was not established in this case, erythromycin is a CYP3A4 inhibitor and has been shown to increase quinine plasma levels when used concomitantly.

Ketoconazole (CYP3A4 Inhibitor) In a crossover study, healthy subjects (N=9) who received a single oral dose of quinine hydrochloride (500 mg) concomitantly with ketoconazole (100 mg twice daily for 3 days) had a mean quinine AUC that was higher by 45% and a mean oral clearance of quinine that was 31% lower than after receiving quinine alone.