No pharmaceutical opinion available for this interaction.
Lopinavir / ritonavir can inhibit the CYP 3A4 and P-gp and increase the plasma concentration of Ticagrelor.
Lopinavir / ritonavir can inhibit the metabolism (CYP 3A4) and decrease the active metabolite formation of Ticagrelor.
3A4 (major), 13 identified metabolites, 5 of these metabolites are linked to the metabolism of ritonavir, transporters: MRP1, MRP2, OATP1A2, OATP1B1, P-gp
2C19 (strong), 1A2, 2C9 (moderate) UGT (moderate)
3A4 and 2D6 (strong), transporters: BCRP, MRP2, OATP1A2, OATP1B1, OATP1B3, OATP2B1, P-gp
3A4 and 3A5: Active metabolite that is similar in activity to ticagrelor; P-gp
3A4 (weak), P-gp (weak)
Possible increase of adverse effects.
Possible decrease of clinical efficacy.
Contraindicated. Use alternative.
Adverse effects of ticagrelor: Bleeding (epistaxis, gastrointestinal/cutaneous hemorrhage), bruising, dyspnea, headache, dizziness, gastrointestinal effects (nausea, vomiting, dyspepsia, diarrhea or constipation), bradycardia.
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.