Liverpool HIV Interactions

Interaction Checker

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Potential Weak Interaction

Lopinavir/ritonavir (LPV/r)

Abacavir (ABC)

Quality of Evidence: Low

Summary:

Coadministration of abacavir and lopinavir/ritonavir has no effect on lopinavir or ritonavir pharmacokinetics, but appears to decrease abacavir exposure by ~30%. The clinical significance of this is unknown.

Description:

Abacavir has also been shown in vitro not to inhibit CYP 3A4, CYP2C9 or CYP2D6 enzymes at clinically relevant concentrations. Induction of hepatic metabolism has not been observed in clinical studies. Therefore, there is little potential for interactions with antiretroviral PIs.

Ziagen Summary of Product Characteristics, ViiV Healthcare UK Ltd, December 2018.

Abacavir concentrations may be reduced due to increased glucuronidation by lopinavir. The clinical significance of this reduced abacavir concentrations is unknown.
Kaletra Summary of Product Characteristics, AbbVie Ltd, January 2021.

Lopinavir induces glucuronidation and therefore has the potential to reduce abacavir plasma concentrations. The clinical significance of this potential interaction is unknown.
Kaletra Prescribing Information, AbbVie Ltd, October 2020.

Plasma concentrations of abacavir (300 mg twice daily) with lopinavir/ritonavir (400/100 mg twice daily, n=7) or nevirapine (400 mg once daily, n=5) were determined in HIV positive patients. Abacavir AUC, Cmax and Ctrough were 40%, 46% and 29% lower, respectively, in the presence of lopinavir/ritonavir when compared to nevirapine. The authors suggest that the decrease in exposure of abacavir is due to induction of glucuronidation by ritonavir and/or lopinavir.

Pilot pharmacokinetic study of Human Immunodeficiency Virus-infected patients receiving tenofovir disoproxil fumarate (TDF): Investigation of systemic and intracellular interactions between TDF and abacavir, lamivudine, or lopinavir-ritonavir. Pruvost A, Negredo E, Théodoro F, et al. Antimicrob Agents Chemother, 2009, 53(5): 1937-1943.

Coadministration of abacavir (600 mg once daily) and lopinavir/ritonavir (400/100 mg twice daily) was studied in 12 HIV+ subjects. There was no effect on lopinavir or ritonavir pharmacokinetics, but abacavir AUC decreased by 32% and Cmax decreased by 34%.
Abacavir plasma pharmacokinetics in the absence and the presence of atazanavir/ritonavir or lopinavir/ritonavir) and vice versa in HIV+ patients. Waters L, et al. 14th Conference on Retroviruses and Opportunistic Infections, Los Angeles, February 2007, abstract 557.

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