https://interactions.guidetherapeutiquevih.com/en/interaction-details?id=10343

Darunavir / ritonavir

Ticagrelor

Contraindicated.

No pharmaceutical opinion available for this interaction.

Mechanism

Darunavir / ritonavir can inhibit the CYP 3A4 and P-gp and increase the plasma concentration of Ticagrelor.

Darunavir / ritonavir can inhibit the metabolism (CYP 3A4) and decrease the active metabolite formation of Ticagrelor.

Darunavir / ritonavir

Pharmacodynamic effects

–

Recommendations

–

Alternative solution(s)

Antiretrovirals that do not inhibit or induce CYP3A4, such as bictegravir, dolutegravir, or doravirine.

Ticagrelor

Pharmacodynamic effects

Possible decrease of clinical efficacy.

Possible increase of adverse effects.

Recommendations

Contraindicated. Use alternative.

Alternative solution(s)

Prasugrel (Efficient)

Monitor

Adverse effects of ticagrelor: Bleeding (epistaxis, gastrointestinal/cutaneous hemorrhage), bruising, dyspnea, headache, dizziness, gastrointestinal effects (nausea, vomiting, dyspepsia, diarrhea or constipation), bradycardia.

Tests

–

Pharmacokinetic parameters

–

Comment

Ref #3164 : An in vitro study with healthy volunteers showed that ketoconazole, a potent inhibitor of CYP3A4, increased ticagrelor AUC by more than 7.3-fold and Cmax by 2.4-fold and decreased the active metabolite AUC and Cmax by 56% and 89%, respectively.

Comment
Reference
  • 2647
    Ticagrelor (Brilinta), AstraZeneca, Ontario, Canada, 14 novembre 2023.
  • 2971
    Egan G, Hughes CA, Ackman ML. Drug interactions between antiplatelet or novel anticoagulant medications and antiretroviral medications. Ann Pharmacother. 2014 Jun; 48 (6): 734-40.
  • 2992
    Zhou D, Anderson TB, Grimm SW. In vitro evaluation of potential drug-drug interactions with ticagrelor: cytochrome P450 reaction phenotyping, inhibition, induction and differential kinetics. Drug Metabolism and Disposition 2011 39: 703-710.
  • 3164
    Teng R, Butler K. Effect of the CYP3A inhibitors, diltiazem and ketoconazole, on ticagrelor pharmacokinetics in healthy volunteers. Journal of Drug Assessment 2013; 2: 30-9.