Date of report 17 Jul 2024
Reported case interaction between
Rilpivirine LA and ESCITALOPRAM
Rilpivirine LA and ESCITALOPRAM
Drugs suspected to be involved in the DDI
Complete list of drugs taken by the patient
Escitalopram 15 mg/d
Clonazepam 1mg/d
Clinical case description
A male person with HIV requested a switch from oral antiretroviral therapy (ART) with DRV/c + 3TC to intramuscular long-acting ART with CAB-RPV. He requested an immediate switch without an oral lead-in. He was already being treated with escitalopram prescribed by a private psychiatrist. Although the potential for QT prolongation due to citalopram and rilpivirine co-administration was considered, starting RPV after discontinuing DRV/c was expected to have a neutral effect on the QT interval (DRV/c is expected to increase exposure to citalopram). An ECG was performed before the first injection, showing a QT interval within the normal range. Subsequent ECGs at weeks 4 and 8 showed no changes in the QT interval.
Clinical Outcome
Editorial Comment
Rilpivirine has been associated with the prolongation of the QTc interval at supra-therapeutic doses, but this is unlikely to occur when co-administered with escitalopram, given that escitalopram does not inhibit rilpivirine metabolism. The label nevertheless recommends caution when co-administering with drugs associated with a known QT prolongation risk, such as escitalopram. This real-life case provides reassuring data.
University of Liverpool Recommendation
Potential interaction - may require close monitoring, alteration of drug dosage or timing of administration