Date of report 26 Apr 2022
Reported case interaction between
Rilpivirine and OMEPRAZOL
Rilpivirine and OMEPRAZOL
Drugs suspected to be involved in the DDI
Complete list of drugs taken by the patient
Simvastatine, alendronate, calcifediol, lorazepam
Clinical case description
75 year-old female. HIV infection diagnosed in 2008 (CD4 nadir 144, PJP at diagnosis). Started on TDF/FTC/EFV, switched to ABC/3TC+RPV on 2015 to prevent renal toxicity. Undetectable viral load since 2008.
On October 2021, due to ferropenic anemia, a a gastroscopy was performed, which revealed a large hiatal hernia. For this reason, omeprazole 20 mg/12 hours was prescribed, which the patient took along with ART that included rilpivirine. In January 2022 the patient was visited at the HIV clinic. She still had an undetectable viral load, but it was decided to change the ART to TAF/FTC/BIC as she needed to continue with omeprazole.
Although rilpivirine is contraindicated with omeprazole, virologic failure was not observed in this patient despite receiving omeprazole twice daily.
Clinical Outcome
Editorial Comment
Despite no virological failure was observed in this patient, rilpivirine should not be co-administered with omeprazol as significant decreases in rilpivirine plasma concentrations may occur due to gastric pH increase. If this combination is maintained, this may result in loss of virologic response and possible resistance to rilpivirine or to the class of NNRTIs. Alternative options include famotidine intead of rilpivirine, or doravirine, INSTI or PI instead of rilpivirine.
University of Liverpool Recommendation
These drugs should not be coadministered