Date of report 26 Apr 2022
Reported case interaction between
Rilpivirine and OMEPRAZOL

FLS Science

Drugs suspected to be involved in the DDI

Victim
Rilpivirine
Daily Dose
25 (mg)
Dose adjustment performed
No
Administration Route
Oral
Start date
Oct. 21, 2015
End date
Jan. 20, 2022
Perpetrator
OMEPRAZOL
Daily Dose
40 (mg)
Dose adjustment performed
No
Administration Route
Oral
Start date
Nov. 1, 2021
End date
Ongoing

Complete list of drugs taken by the patient

Antiretroviral treatment
Abacavir/Lamivudine
Rilpivirine
Complete list of all comedications taken by the patient, included that involved in the DDI

Simvastatine, alendronate, calcifediol, lorazepam

Clinical case description

Gender
Female
Age
75
eGFR (mL/min)
>60
Liver function impairment
No
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

No unwanted 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
For more information click here

Personal information from the specialist

Name
Adrián
Surname
Curran
Institution
Hospital Vall d'Hebron
Country
ES