Drug Interactions between estradiol topical and ombitasvir / paritaprevir / ritonavir
This report displays the potential drug interactions for the following 2 drugs:
- estradiol topical
- ombitasvir/paritaprevir/ritonavir
Interactions between your drugs
estradiol topical paritaprevir
Applies to: estradiol topical and ombitasvir / paritaprevir / ritonavir
MONITOR CLOSELY: Theoretical concerns exist that coadministration of estrogen-containing products may increase the risk of liver enzyme elevations associated with the use of ombitasvir/paritaprevir/ritonavir, with or without dasabuvir. The proposed mechanism is the inhibition of UDP-glucuronosyltransferase (UGT) by ombitasvir, paritaprevir, and dasabuvir. During clinical trials, approximately 1% of all subjects experienced post-baseline serum ALT levels greater than 5 times the upper limit of normal (ULN) after starting treatment, with or without ribavirin. The incidence increased to 25% (4/16) among women taking a concomitant medication containing ethinyl estradiol. Although the incidence of clinically relevant ALT elevations among women using estrogens other than ethinyl estradiol, such as estradiol and conjugated estrogens used in hormone replacement therapy, was just 3% (2/59), a similarly increased risk cannot be ruled out due to the limited number of subjects taking these other estrogens. In general, ALT elevations were asymptomatic, occurred during the first 4 weeks of treatment (mean 20 days; range 8 to 57 days), and declined within two to eight weeks of onset despite continued therapy. Elevations in ALT were typically not associated with bilirubin elevations, and cirrhosis was not a risk factor.
MANAGEMENT: Caution is recommended if estrogen-containing products are used in patients receiving ombitasvir/paritaprevir/ritonavir, with or without dasabuvir. Liver function tests should be performed on all patients during the first 4 weeks of treatment and as clinically indicated thereafter. If ALT is elevated above baseline at any time during treatment, the test should be repeated and monitored closely. Therapy should be discontinued if ALT levels remain persistently greater than 10 times the ULN, or if ALT elevations are accompanied by signs or symptoms of liver inflammation or increasing conjugated bilirubin, alkaline phosphatase, or INR. Patients should be advised to seek medical attention if they experience potential signs and symptoms of hepatotoxicity such as fever, rash, itching, anorexia, nausea, vomiting, fatigue, malaise, right upper quadrant pain, dark urine, pale stools, and jaundice.
References (1)
- (2022) "Product Information. Viekira Pak (dasabuvir/ombitasvir/paritaprev/ritonav)." AbbVie US LLC
Drug and food interactions
ritonavir food
Applies to: ombitasvir / paritaprevir / ritonavir
ADJUST DOSING INTERVAL: Administration with food may modestly affect the bioavailability of ritonavir from the various available formulations. When the oral solution was given under nonfasting conditions, peak ritonavir concentrations decreased 23% and the extent of absorption decreased 7% relative to fasting conditions. Dilution of the oral solution (within one hour of dosing) with 240 mL of chocolate milk or a nutritional supplement (Advera or Ensure) did not significantly affect the extent and rate of ritonavir absorption. When a single 100 mg dose of the tablet was administered with a high-fat meal (907 kcal; 52% fat, 15% protein, 33% carbohydrates), approximately 20% decreases in mean peak concentration (Cmax) and systemic exposure (AUC) were observed relative to administration after fasting. Similar decreases in Cmax and AUC were reported when the tablet was administered with a moderate-fat meal. In contrast, the extent of absorption of ritonavir from the soft gelatin capsule formulation was 13% higher when administered with a meal (615 KCal; 14.5% fat, 9% protein, and 76% carbohydrate) relative to fasting.
MANAGEMENT: Ritonavir should be taken with meals to enhance gastrointestinal tolerability.
References (1)
- (2001) "Product Information. Norvir (ritonavir)." Abbott Pharmaceutical
paritaprevir food
Applies to: ombitasvir / paritaprevir / ritonavir
ADJUST DOSING INTERVAL: Food enhances the oral bioavailability of ombitasvir, paritaprevir, ritonavir, and dasabuvir. Relative to fasting conditions, administration of ombitasvir, paritaprevir, ritonavir, and dasabuvir with a moderate-fat meal (approximately 600 Kcal; 20% to 30% calories from fat) increased the mean systemic exposure (AUC) by 82%, 211%, 49%, and 30%, respectively. Relative to fasting conditions, administration of ombitasvir, paritaprevir, ritonavir, and dasabuvir with a high-fat meal (approximately 900 Kcal; with 60% calories from fat) increased the mean AUC by 76%, 180%, 44%, and 22%, respectively.
MANAGEMENT: Ombitasvir/paritaprevir/ritonavir plus dasabuvir should always be administered with a meal. The fat or calorie content does not matter.
References (1)
- (2022) "Product Information. Viekira Pak (dasabuvir/ombitasvir/paritaprev/ritonav)." AbbVie US LLC
Therapeutic duplication warnings
No warnings were found for your selected drugs.
Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.
See also
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
No interaction information available. |
Further information
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