The levels of atazanavir/ritonavir and nelfinavir are reduced by omeprazole: all
proton pump inhibitors are expected to interact similarly. However, in some patients taking
omeprazole the levels of nelfinavir were raised. Indinavir levels are also reduced however the addition of
ritonavir may negate this effect. Tipranavir reduces
esomeprazole and
omeprazole levels.
It has been said that
omeprazole should probably not be used with indinavir unless
ritonavir is used to boost the indinavir levels. This would be likely to apply to other
proton pump inhibitors used with indinavir as well. Atazanavir or atazana- vir/ritonavir, and nelfinavir should not be given with
proton pump inhibitors. Similar caution would seem prudent with
amprenavir. The use of
tipranavir with
omeprazole or esomeprazole is not recommended, but if both drugs are given, consider increasing the dose of the proton pump inhibitor, according to response.