Delamanid is primarily metabolised by albumin to DM-6705; metabolism of DM-6705 to other metabolites is thought to involve pathways mediated by CYP enzymes, including CYP3A4. Co-administration of delamanid (100 mg twice daily) and lopinavir/ritonavir (400/100 mg twice daily) had no effect on lopinavir Cmax or AUC (increases of 5% and 4%), but increased delamanid Cmax and AUC by 18% and 22%. DM-6705 exposure has been reported to increase by 25-30% with lopinavir/ritonavir. QTc prolongation has been reported with delamanid (and is very closely correlated with the metabolite DM-6705), therefore, caution is advised due to potent CYP3A4 inhibition and due to the risk of QT prolongation associated with both drugs. If coadministration is considered necessary, frequent ECG monitoring is recommended throughout the full delamanid treatment period (for example, at least fortnightly for the first month and if the QTc interval remains within normal range to reduce this to monthly thereafter).