Date of report: 22 Jun 2020
Reported case interaction between
Raltegravir and Clopidogrel
Raltegravir and Clopidogrel
Drugs suspected to be involved in the DDI
Drug A
Raltegravir
(Perpetrator)
Daily Dose
800
(mg)
Dose adjustment performed
No
Administration Route
Oral
Start date
Jan. 11, 2019
End date
Ongoing
Drug B
Clopidogrel
(Victim)
Daily Dose
75
(mg)
Dose adjustment performed
No
Administration Route
Oral
Start date
Jan. 11, 2019
End date
Ongoing
Complete list of drugs taken by the patient
Antiretroviral treatment
Emtricitabine/Tenofovir-AF
Raltegravir
Complete list of all comedications taken by the patient, included that involved in the DDI
Clopidogrel, aspirin, rosuvastatin, metoprolol, ramipril, amlodipin
Clinical case description
Gender
Male
Age
52
eGFR (mL/min)
>60
Liver function impairment
Yes
Child-Pugh
Child-Pugh A
Description
This patient was diagnosed with HIV/HCV in 1997 and received several antiretroviral regimens. He had an acute myocardial infarction, treated with coronary stent and dual antiplatelet treatment (clopidogrel plus aspirin) while on cART with lopinavir/ritonavir plus raltegravir. His regimen was changed to raltegravir plus etravirine. In 2019 he had a second AMI (on aspirin), treated with drug-eluting stent and dual antiplatelet treatment (clopidogrel plus aspirin); his HAART was then changed to TAF/FTC plus raltegravir. No major bleeding nor recurrence of coronary syndrome was observed in the year of follow up.
Outcome
No unwanted outcome
Editorial Comment
Clopidogrel is a prodrug that is converted to its active metabolites via CYPs 3A4, 2B6, 2C19 and 1A2. Administration of clopidogrel with potent CYP3A4 inhibitors decreases the AUC and Cmax of clopidogrel’s active metabolite, leading to insufficient inhibition of platelet aggregation. The same may be applied to etravirine, possibly due to inhibition of CYP2C19. Coadministration of clopidogrel and raltegravir has not been studied, but based on metabolism and clearance a clinically significant interaction is unlikely.