Dexamethasone and Lopinavir and ritonavir interaction

• Avoid concomitant use of strong CYP3A4 inhibitors or inducers.

Avoid coadministration of strong CYP3A4 inhibitors or consider alternative medication that are not strong CYP3A4 inhibitors.

If concomitant use of strong CYP3A4 inhibitors cannot be avoided, closely monitor for adverse drug reactions.

( ‎7.2 ) 7.1 Effect of Other Drugs on HEMADY Strong CYP3A4 inhibitors Coadministration of strong and moderate CYP3A4 inhibitors increased dexamethasone exposure [see Clinical Pharmacology (‎ 12.3 )] , which may increase the risk of adverse reactions [see Warnings and Precautions (‎ 5 ) and Adverse Reactions (‎ 6 )] .

…Nasal/Ophthalmic Corticosteroids: e.g., betamethasone budesonide ciclesonide dexamethasone fluticasone methylprednisolone mometasone prednisone triamcinolone ↓ lopinavir ↑ glucocorticoids Coadministration with oral dexamethasone or other systemic corticosteroids that induce CYP3A may result in loss of therapeutic effect and development of resistance to lopinavir.

Consider alternative corticosteroids.

Coadministration with corticosteroids whose exposures are significantly increased by strong CYP3A inhibitors can increase the risk for Cushing’s syndrome and adrenal suppression.

Alternative corticosteroids including beclomethasone and prednisolone (whose PK and/or PD are less affected by strong CYP3A inhibitors relative to other studied steroids) should be considered, particularly for long-term use. * see Clinical Pharmacology ( 12.3 ) for magnitude of interaction. # refers to interaction with apalutamide.

Contraceptive: ethinyl estradiol* ↓ ethinyl estradiol Because contraceptive steroid concentrations may be altered when KALETRA is co-administered with oral contraceptives or with the contraceptive patch, alternative methods of nonhormonal contraception are recommended.