Drug interactions
Lopinavir + Quinine
Severity: Major
Lopinavir and Quinine: major interaction.
Last updated Sources: UK SmPC
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/ritonavir inhibits CYP3A4 and can raise quinine concentrations, increasing the risk of cinchonism and QT prolongation. Lopinavir itself can also prolong the QT interval.
What this interaction means in plain words
Lopinavir and Quinine 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; Quinine belongs to Anti Parasitic.
Why it happens
CYP3A4 inhibition by ritonavir-boosted lopinavir reduces quinine clearance, plus additive QT effects.
What to do
Avoid if possible. If unavoidable, monitor ECG, electrolytes, and glucose, and watch for quinine toxicity.
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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References
- Quinine Sulfate 200mg Film-coated Tablets - SmPC sections 4.3/4.5 (class statement: HIV protease inhibitors; "There is the potential for increased Quinine toxicity with concurrent use of potent CYP3A4 inhibitors, which include azole antifungal drugs and HIV protease inh") — electronic medicines compendium (UK SmPC)
Other interactions of Quinine
- Arsenic trioxide + Quinine Contraindicated
- Dofetilide + Quinine Contraindicated
- Dronedarone + Quinine Contraindicated
- Ibutilide + Quinine Contraindicated
- Mefloquine + Quinine Contraindicated
- Nilotinib + Quinine Contraindicated
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 Quinine?
MediHelp rates the interaction as major. Lopinavir and Quinine 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/ritonavir inhibits CYP3A4 and can raise quinine concentrations, increasing the risk of cinchonism and QT prolongation. Lopinavir itself can also prolong the QT interval.
How serious is the interaction between Lopinavir and Quinine?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid if possible. If unavoidable, monitor ECG, electrolytes, and glucose, and watch for quinine toxicity.
What other medicines interact with Quinine?
MediHelp also lists interactions of Quinine with, for example, Arsenic trioxide, Dofetilide, Dronedarone. The full list is on the Quinine page.
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