Liverpool HIV Interactions

Interaction Checker

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Potential Interaction

Raltegravir (RAL)

Riboflavin (Vitamin B2) [in multivitamins]

Quality of Evidence: Very Low

Summary:

Coadministration has not been studied. A pharmacokinetic interaction is unlikely with riboflavin itself. However, riboflavin can be found in multivitamin preparations which may also contain polyvalent cations. As the effect of cationic complexation with raltegravir cannot be excluded, caution is recommended as raltegravir concentrations may be reduced.

Description:

In vitro studies have shown raltegravir cellular permeativity was decreased in the presence of the divalent cations magnesium and calcium, but not in the presence of the monovalent cation potassium. Raltegravir may bind to the divalent metals and form a metal-drug complex which is unable to cross the cell membrane.

Divalent metals and pH alter raltegravir disposition in Vitro. Moss DM, Siccardi M, Murphy M, at al. Antimicrob Agents Chemother, 2012, 56(6): 3020-6.

Riboflavin is absorbed from the GI tract and in the circulation is bound to plasma proteins. Although widely distributed, little is stored in the body, and amounts in excess of requirements are excreted in the urine.Vitamin B Compound Strong Tablets UK Summary of Product Characteristics, Actavis UK Ltd, July 2012.

Riboflavin is readily absorbed from the gastrointestinal tract. Although riboflavin is widely distributed to body tissues little is stored in the body. Riboflavin is converted in the body to the coenzyme flavine mononucleotide (FMN; riboflavin 5′-phosphate) and then to another coenzyme flavine adenine dinucleotide (FAD). About 60% of FMN and FAD are bound to plasma proteins. Riboflavin is excreted in urine, partly as metabolites. As the dose increases, larger amounts are excreted unchanged.
Martindale Complete Drug Reference. Pharmaceutical Press (via Medicines Complete), modified: 05-Dec-2011.

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