Cardiovascular drugs




Calcium antagonists [1-3,6]

Diltiazem Bosentan


Theoretically: calcium antagonists Î Case report: LPV/r + nifedipine 30 mg BID: nifedipine toxicity: malaise, severe hypotension, oliguria, oedemas, creatinine increase ATV: diltiazem Î 200 % Theoretically: PIs j

Theoretically: antiarrhythmics j TPV/r: potential for severe, life-threatening arrhythmia

Avoid combination or reduce dose of calcium antagonists.

Reduce diltiazem by 50 %. Avoid combination or TDM. Possible alternative: sildenafil (see PDE) [4,5]. Avoid combination or possibly reduce dose of antiarrhythmics and monitor closely.


Calcium antagonists

Bosentan Antiarrhythmics

Theoretically: calcium antagonists

Theoretically: NNRTIs j Theoretically: antiarrhythmics |Î

See above. See above.

Avoid combination or start with low antiarrhythmics dose.


1. German package insert: Aptivus®, Crixivan®, Invirase®, Kaletra®, Prezista®, Telzir®.

2. Rossi DR, Rathbun C, Slater LD. Symptomatic ortostasis with extended-release nifedipine and protease inhibitors. Ann Pharmacother 2002; 22: 1312-6.

3. Clinical Pharmacology, Gold Standard Multimedia, 2006.

4. Ghofrani HA, Olschewski H, Seeger W, et al. Sildenafil for treatment of severe pulmonary hypertension and commencing right-heart failure. Pneumologie 2002; 56: 665-72.

5. Nandwani R, Gourlay Y. Possible Interaction between sildenafil and HIV combination therapy. Lancet 1999; 353: 840.

6. Baeza MT, Merino E, Boix V, et al. Nifedipine-lopinavir/ritonavir severe interaction: a case report. AIDS 2007; 21:119-20.

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