Drug interactions
Lopinavir + Pimavanserin
Severity: Major
Lopinavir and Pimavanserin: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Lopinavir is co-formulated with ritonavir, a strong CYP3A4 inhibitor, which increases pimavanserin concentrations. Both drugs can also prolong the QT interval, so the risk of torsades de pointes is increased.
What this interaction means in plain words
Lopinavir and Pimavanserin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Lopinavir belongs to Anti Virals; Pimavanserin belongs to Central Nervous System.
Why it happens
Ritonavir-boosted CYP3A4 inhibition raises pimavanserin exposure, with additive QTc prolongation.
What to do
Reduce pimavanserin to 10 mg daily if coadministration is necessary, and obtain a baseline ECG with periodic QTc monitoring. Correct potassium and magnesium abnormalities.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Pimavanserin
- Lefamulin + Pimavanserin Contraindicated
- Pimavanserin + Pimozide Contraindicated
- Pimavanserin + Vandetanib Contraindicated
- Adagrasib + Pimavanserin Major
- Amiodarone + Pimavanserin Major
- Amisulpride + Pimavanserin Major
Other interactions of Lopinavir
- Alfuzosin + Lopinavir Contraindicated
- Avanafil + Lopinavir Contraindicated
- Cisapride + Lopinavir Contraindicated
- Dronedarone + Lopinavir Contraindicated
- Eletriptan + Lopinavir Contraindicated
- Eplerenone + Lopinavir Contraindicated
Frequently asked questions
Can I take Lopinavir with Pimavanserin?
MediHelp rates the interaction as major. Lopinavir and Pimavanserin can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Lopinavir is co-formulated with ritonavir, a strong CYP3A4 inhibitor, which increases pimavanserin concentrations. Both drugs can also prolong the QT interval, so the risk of torsades de pointes is increased.
How serious is the interaction between Lopinavir and Pimavanserin?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Reduce pimavanserin to 10 mg daily if coadministration is necessary, and obtain a baseline ECG with periodic QTc monitoring. Correct potassium and magnesium abnormalities.
What other medicines interact with Pimavanserin?
MediHelp also lists interactions of Pimavanserin with, for example, Lefamulin, Pimozide, Vandetanib. The full list is on the Pimavanserin page.
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