Lopinavir / ritonavir

Almotriptan

Dosage adjustment is recommended.

No pharmaceutical opinion available for this interaction.

Mechanism

Lopinavir / ritonavir can inhibit the metabolism (CYP 3A4) and increase the plasma concentration of Almotriptan.

Lopinavir / ritonavir

Pharmacodynamic effects

Recommendations

Alternative solution(s)

Almotriptan

Pharmacodynamic effects

Possible increase of adverse effects.

Recommendations

Start with a small dose or reduce the dose if already used.

Adjust the dose according to tolerability and clinical efficacy.

US monograph suggests to start with a dose of 6.25 mg when co-administered with potent CYP3A4 inhibitors and not to exceed 12.5 mg QD.

They also suggest avoiding concomitant use in patients with renal or hepatic impairment.

Alternative solution(s)

Monitor

Migraine symptoms and almotriptan adverse effects : chest tightness, vasoconstriction, hypertension, nausea, drowsiness and serotonin syndrome.

Tests

Pharmacokinetic parameters

Comment

Ref #3121 : Coadministration of almotriptan with ketoconazole, a strong CYP3A4 inhibitor, (400 mg QD for 3 days) resulted in an increase of approximately 60% in almotriptan AUC and Cmax.

Reference
  • 3121
    Almotriptan, Sanis Health, Ontario, Canada, 4 août 2017.
  • 3439
    Almotriptan (Axert), Janssen Pharmaceuticals Inc.,Titusville, NJ, USA, May 2017.