Drug interactions
Lopinavir + Verapamil
Severity: Major
Lopinavir and Verapamil: 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, boosted with ritonavir, inhibits CYP3A4 and can raise verapamil concentrations. This may result in bradycardia, AV block or hypotension, and verapamil may also raise lopinavir levels.
What this interaction means in plain words
Lopinavir and Verapamil 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; Verapamil belongs to Cardiovascular.
Why it happens
Ritonavir-boosted lopinavir inhibits CYP3A4, reducing verapamil metabolism.
What to do
Use lower verapamil doses with ECG and blood pressure monitoring, or choose an alternative agent. Watch for PR prolongation.
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
- Half Securon SR 120 mg modified-release tablets - SmPC sections 4.3/4.5 (class statement: HIV antiviral agents; "Due to the metabolic inhibitory potential of some of the HIV antiviral agents , such as ritonavir , plasma concentrations of verapamil may increase.") — electronic medicines compendium (UK SmPC)
Other interactions of Verapamil
- Dofetilide + Verapamil Contraindicated
- Flibanserin + Verapamil Contraindicated
- Lomitapide + Verapamil Contraindicated
- Lonafarnib + Verapamil Contraindicated
- Pimozide + Verapamil Contraindicated
- Acebutolol + Verapamil 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 Verapamil?
MediHelp rates the interaction as major. Lopinavir and Verapamil 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, boosted with ritonavir, inhibits CYP3A4 and can raise verapamil concentrations. This may result in bradycardia, AV block or hypotension, and verapamil may also raise lopinavir levels.
How serious is the interaction between Lopinavir and Verapamil?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use lower verapamil doses with ECG and blood pressure monitoring, or choose an alternative agent. Watch for PR prolongation.
What other medicines interact with Verapamil?
MediHelp also lists interactions of Verapamil with, for example, Dofetilide, Flibanserin, Lomitapide. The full list is on the Verapamil page.
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