Date of report 10 Dec 2019
Reported case interaction between
 Ritonavir and NEBIVOLOL

FLS Science

Drugs suspected to be involved in the DDI

Perpetrator
Ritonavir
Daily Dose
200 (mg)
Dose adjustment performed
No
Administration Route
Oral
Start date
Feb. 8, 2016
End date
Ongoing
Victim
NEBIVOLOL
Daily Dose
5 (mg)
Dose adjustment performed
No
Administration Route
Oral
Start date
Jan. 15, 2018
End date
Ongoing

Complete list of drugs taken by the patient

Antiretroviral treatment
Darunavir (with Ritonavir or Cobicistat)
Emtricitabine/Tenofovir-DF
Raltegravir
Complete list of all comedications taken by the patient, included that involved in the DDI

Nebivolol, VIII factor

Clinical case description

Gender
Male
Age
49
eGFR (mL/min)
>60
Liver function impairment
No
Description

49-year-old man with history of hemophilia A, HIV infection diagnosed in 1990 and HCV infection, achieving sustained virologic response after treatment. Highly ART-experienced, currently on ART with TDF/FTC (300/200 mg qd) + DRV/r (600/100 mg bid) + RAL (400 mg bid) since 2016. Undetectable viral load, CD4+ T cells 790/mm3. His cardiologist prescribed nebivolol 2.5 mg qd a year ago due to hypertension and the dose was further increased up to 5 mg qd. Although coadministration of darunavir + ritonavir with nebivolol has not been studied we could expect an increase in nebivolol concentrations due to CYP2D6 metabolism of this drug. The patient has been receiving DRV/r and nebivolol for a year with successful control of blood pressure and no evidence of adverse effects.

Clinical Outcome

No unwanted outcome

Editorial Comment

This case represents a common situation in clinical practice in which two drugs could have a theoretical weak interaction but no clinical impact is found in real life experience.

University of Liverpool Recommendation

Potential interaction likely to be of weak intensity. Additional action/monitoring or dosage adjustment is unlikely to be required
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