PROTEASE INHIBITORS WITH KETOCONAZOLE

Most protease inhibitors increase the levels of ketoconazole (up to about 3.5-fold with ritonavir). Ketoconazole may increase the levels of protease inhibitors, but this is usually not clinically significant. The exception may be indinavir, see below.
Ritonavir alone, ritonavir combined with darunavir, fosamprenavir, lopinavir, saquinavir and theoretically tipranavir may increase the adverse effects of ketoconazole. Most protease inhibitor manufacturers (except amprenavir, see below) say that doses greater than 200 mg a day of ketoconazole are not recommended. Dose changes of the protease inhibitors are generally not needed (but see indinavir, below).