Chemical: Drug
ritonavir

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Annotated Labels

  1. FDA Label for ritonavir
  2. EMA Label for ritonavir and CYP2D6,CYP3A4


last updated 09/15/2014

2. EMA Label for ritonavir and CYP2D6,CYP3A4

Informative PGx

Summary

The EMA European Public Assessment Report (EPAR) for ritonavir (Norvir) does not contain pharmacogenetic information. It contains information regarding use of ritonavir as a pharmacokinetic enhancer for certain drugs to prolong their therapeutic effects. It is a potent inhibitor of CYP3A and CYP2D6-mediated biotransformation, and the EPAR provides a list of drugs contraindicated for concomitant use with ritonavir.

Annotation

The EMA-approved drug ritonavir (Norvir) is tagged with CYP3A4 and CYP2D6 in [Article:24433361].

Excerpts from the ritonavir (Norvir) EPAR:

Ritonavir dosed as a pharmacokinetic enhancer

Pharmacokinetic enhancement by ritonavir is based on ritonavir’s activity as a potent inhibitor of CYP3A- mediated metabolism. The degree of enhancement is related to the metabolic pathway of the co-administered protease inhibitor and the impact of the co-administered protease inhibitor on the metabolism of ritonavir.

Ritonavir has a high affinity for several cytochrome P450 (CYP) isoforms and may inhibit oxidation with the following ranked order: CYP3A4 > CYP2D6. Co-administration of Norvir and medicinal products primarily metabolised by CYP3A may result in increased plasma concentrations of the other medicinal product, which could increase or prolong its therapeutic and adverse effects. For select medicinal products (e.g. alprazolam) the inhibitory effects of ritonavir on CYP3A4 may decrease over time.

For the complete drug label text with sections containing pharmacogenetic information highlighted, see the ritonavir EMA drug label.

*Disclaimer: The contents of this page have not been endorsed by the EMA and are the sole responsibility of PharmGKB.

Genes and/or phenotypes found in this label

  • HIV
    • efficacy, Drug interactions section, Information for patients section, Adverse reactions section, Pregnancy section, Pharmacodynamics section, Pharmacokinetics section
    • source: European Medicines Agency
  • CYP2D6
    • efficacy, metabolism/PK, Contraindications section, Drug interactions section, Pharmacokinetics section
    • source: European Medicines Agency
  • CYP3A4
    • efficacy, metabolism/PK, Contraindications section, Drug interactions section, Pharmacodynamics section, Pharmacokinetics section, Warnings and precautions section
    • source: European Medicines Agency

Clinical Variants that meet the highest level of criteria, manually curated by PharmGKB, are shown below.

To see more Clinical Variants with lower levels of criteria, click the button at the bottom of the page.

Disclaimer: The PharmGKB's clinical annotations reflect expert consensus based on clinical evidence and peer-reviewed literature available at the time they are written and are intended only to assist clinicians in decision-making and to identify questions for further research. New evidence may have emerged since the time an annotation was submitted to the PharmGKB. The annotations are limited in scope and are not applicable to interventions or diseases that are not specifically identified.

The annotations do not account for individual variations among patients, and cannot be considered inclusive of all proper methods of care or exclusive of other treatments. It remains the responsibility of the health-care provider to determine the best course of treatment for a patient. Adherence to any guideline is voluntary, with the ultimate determination regarding its application to be made solely by the clinician and the patient. PharmGKB assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of the PharmGKB clinical annotations, or for any errors or omissions.

? = Mouse-over for quick help

The table below contains information about pharmacogenomic variants on PharmGKB. Please follow the link in the "Variant" column for more information about a particular variant. Each link in the "Variant" column leads to the corresponding PharmGKB Variant Page. The Variant Page contains summary data, including PharmGKB manually curated information about variant-drug pairs based on individual PubMed publications. The PMIDs for these PubMed publications can be found on the Variant Page.

The tags in the first column of the table indicate what type of information can be found on the corresponding Variant Page.

Links in the "Gene" column lead to PharmGKB Gene Pages.

List of all variant annotations for ritonavir

Gene ? Variant?
(147)
Alternate Names ? Chemicals ? Alleles ?
(+ chr strand)
Function ? Amino Acid?
Translation
No VIP available CA VA ABCB1 *1 N/A N/A N/A
No VIP available CA VA ABCB1 *2 (PMID: 11503014) N/A N/A N/A
No VIP available CA No VIP available CYP3A5 *1A N/A N/A N/A
No VIP available CA VA CYP3A5 *3A N/A N/A N/A
No VIP available CA VA CYP3A5 *6 N/A N/A N/A
No VIP available CA VA CYP3A5 *7 N/A N/A N/A
No VIP available No VIP available VA UGT1A1 *1 N/A N/A N/A
No VIP available No VIP available VA UGT1A1 *28 N/A N/A N/A
rs1042640 NC_000002.11:g.234681544G>C, NC_000002.12:g.233772898G>C, NG_002601.2:g.188155G>C, NG_033238.1:g.17626G>C, NM_000463.2:c.*339G>C, NM_001072.3:c.*339G>C, NM_007120.2:c.*339G>C, NM_019075.2:c.*339G>C, NM_019076.4:c.*339G>C, NM_019077.2:c.*339G>C, NM_019078.1:c.*339G>C, NM_019093.2:c.*339G>C, NM_021027.2:c.*339G>C, NM_205862.1:c.*339G>C, XR_241238.1:n.2134G>C, rs17190748, rs35909575, rs61636700
G > C
SNP
rs1045642 NC_000007.13:g.87138645A>G, NC_000007.14:g.87509329A>G, NG_011513.1:g.208920T>C, NM_000927.4:c.3435T>C, NP_000918.2:p.Ile1145=, rs10239679, rs11568726, rs117328163, rs17210003, rs2229108, rs386513066, rs60023214, rs9690664
A > G
SNP
I1145I
rs10929303 NC_000002.11:g.234681416T>C, NC_000002.12:g.233772770T>C, NG_002601.2:g.188027T>C, NG_033238.1:g.17498T>C, NM_000463.2:c.*211T>C, NM_001072.3:c.*211T>C, NM_007120.2:c.*211T>C, NM_019075.2:c.*211T>C, NM_019076.4:c.*211T>C, NM_019077.2:c.*211T>C, NM_019078.1:c.*211T>C, NM_019093.2:c.*211T>C, NM_021027.2:c.*211T>C, NM_205862.1:c.*211T>C, XR_241238.1:n.2006T>C, XR_241239.1:n.1969T>C, XR_241240.1:n.2105T>C, XR_241241.1:n.2024T>C, rs35926297, rs59599681
T > C
SNP
rs1128503 NC_000007.13:g.87179601A>G, NC_000007.14:g.87550285A>G, NG_011513.1:g.167964T>C, NM_000927.4:c.1236T>C, NP_000918.2:p.Gly412=, rs116989428, rs17276907, rs2032587, rs2229105, rs28365046, rs386518005, rs58257317
A > G
SNP
G412G
rs1523127 NC_000003.11:g.119501039C>A, NC_000003.12:g.119782192C>A, NG_011856.1:g.6709C>A, NM_003889.3:c.-131C>A, NM_022002.2:c.-566C>A, NM_033013.2:c.-131C>A, XM_005247866.1:c.-296C>A, rs58645792
C > A
SNP
rs1523130 NC_000003.11:g.119499507T>C, NC_000003.12:g.119780660T>C, NG_011856.1:g.5177T>C, NM_003889.3:c.-1663T>C, NM_033013.2:c.-1663T>C, XM_005247866.1:c.-1828T>C, rs118196528, rs3814054, rs59854583, rs61314694
T > C
SNP
rs15524 NC_000007.13:g.99245914A>G, NC_000007.14:g.99648291A>G, NG_007938.1:g.36708T>C, NM_000777.4:c.*14T>C, NM_001291829.1:c.*14T>C, NM_001291830.1:c.*14T>C, NR_033807.2:n.3257T>C, NR_033808.1:n.2125T>C, NR_033809.1:n.1885T>C, XM_005250169.1:c.*14T>C, XM_005250170.1:c.*14T>C, XM_005250171.1:c.*14T>C, XM_005250172.1:c.*14T>C, XM_005250173.1:c.*14T>C, XM_005250197.1:c.*768A>G, XM_005250198.1:c.805+24111A>G, XM_011515843.1:c.*14T>C, XM_011515844.1:c.*14T>C, XM_011515845.1:c.*14T>C, XM_011515846.1:c.*14T>C, XM_011515847.1:c.*14T>C, XM_011515909.1:c.806-20804A>G, XM_011515910.1:c.*768A>G, XR_927402.1:n.1466+24111A>G, rs10372852, rs17161789, rs3173576, rs59358441
A > -
A > G
SNP
rs17863778 NC_000002.11:g.234590974C>A, NC_000002.12:g.233682328C>A, NG_002601.2:g.97585C>A, NM_019075.2:c.855+44951C>A, NM_019076.4:c.855+63766C>A, NM_019077.2:c.391C>A, NM_021027.2:c.855+9539C>A, NP_061950.2:p.Arg131=, XM_005246081.1:c.391C>A, XP_005246138.1:p.Arg131=, XR_241241.1:n.941+9539C>A
C > A
SNP
R131R
rs17868323 NC_000002.11:g.234590970T>G, NC_000002.12:g.233682324T>G, NG_002601.2:g.97581T>G, NM_019075.2:c.855+44947T>G, NM_019076.4:c.855+63762T>G, NM_019077.2:c.387T>G, NM_021027.2:c.855+9535T>G, NP_061950.2:p.Asn129Lys, XM_005246081.1:c.387T>G, XP_005246138.1:p.Asn129Lys, XR_241241.1:n.941+9535T>G
T > G
SNP
N129K
rs2032582 NC_000007.13:g.87160618A>C, NC_000007.13:g.87160618A>T, NC_000007.14:g.87531302A>C, NC_000007.14:g.87531302A>T, NG_011513.1:g.186947T>A, NG_011513.1:g.186947T>G, NM_000927.4:c.2677T>A, NM_000927.4:c.2677T>G, NP_000918.2:p.Ser893Ala, NP_000918.2:p.Ser893Thr, rs10228331, rs2229106, rs386553610, rs57135550, rs9641018
A > C
A > T
SNP
S893A
rs212091 NC_000016.10:g.16142793T>C, NC_000016.9:g.16236650T>C, NG_028268.1:g.198217T>C, NM_004996.3:c.*1512T>C, NT_187607.1:g.1800685T>C, XM_005255326.1:c.*1512T>C, XM_005255327.1:c.*1512T>C, XM_005255328.1:c.*1512T>C, XM_005255329.1:c.*1512T>C, XM_011522497.1:c.*1512T>C, XM_011522498.1:c.*1512T>C, XR_933134.1:n.-960T>C, XR_951923.1:n.-989T>C, rs16967633, rs212647, rs3186999, rs58366070
T > C
SNP
rs2306283 NC_000012.11:g.21329738A>G, NC_000012.12:g.21176804A>G, NG_011745.1:g.50611A>G, NM_006446.4:c.388A>G, NP_006437.3:p.Asn130Asp, rs17389242, rs52832430, rs60767041
A > G
SNP
N130D
rs2472677 NC_000003.11:g.119518417C>T, NC_000003.12:g.119799570C>T, NG_011856.1:g.24087C>T, NM_003889.3:c.-22-7659C>T, NM_022002.2:c.96-7659C>T, NM_033013.2:c.-22-7659C>T, XM_005247866.1:c.-187-7659C>T, rs57813967
C > T
SNP
rs2853826
G > A
SNP
rs2854116 NC_000011.10:g.116829453C>T, NC_000011.9:g.116700169C>T, NG_008949.1:g.4546C>T, NM_000040.1:c.-501C>T, rs17251249, rs35523410, rs45537037
C > T
SNP
rs2854117 NC_000011.10:g.116829426T>C, NC_000011.9:g.116700142T>C, NG_008949.1:g.4519T>C, NM_000040.1:c.-528T>C, rs17251242, rs33989105
T > C
SNP
rs3213619 NC_000007.13:g.87230193A>G, NC_000007.14:g.87600877A>G, NG_011513.1:g.117372T>C, NM_000927.4:c.-129T>C, rs17249446, rs60679736
A > G
SNP
rs3732359 NC_000003.11:g.119536429G>A, NC_000003.12:g.119817582G>A, NG_011856.1:g.42099G>A, NM_003889.3:c.*370G>A, NM_022002.2:c.*370G>A, NM_033013.2:c.*370G>A, XM_005247866.1:c.995+1751G>A, rs56590291, rs57193083
G > A
SNP
rs3732360 NC_000003.11:g.119536581C>T, NC_000003.12:g.119817734C>T, NG_011856.1:g.42251C>T, NM_003889.3:c.*522C>T, NM_022002.2:c.*522C>T, NM_033013.2:c.*522C>T, XM_005247866.1:c.995+1903C>T, rs386584908, rs57419996
C > T
SNP
rs3743527 NC_000016.10:g.16141824C>T, NC_000016.9:g.16235681C>T, NG_028268.1:g.197248C>T, NM_004996.3:c.*543C>T, NT_187607.1:g.1799715C>T, XM_005255326.1:c.*543C>T, XM_005255327.1:c.*543C>T, XM_005255328.1:c.*543C>T, XM_005255329.1:c.*543C>T, XM_011522497.1:c.*543C>T, XM_011522498.1:c.*543C>T, XR_933134.1:n.-1929C>T, XR_951923.1:n.-1959C>T, rs386585277, rs57742638
C > T
SNP
rs3806596 NC_000002.11:g.234637707T>C, NC_000002.12:g.233729061T>C, NG_002601.2:g.144318T>C, NM_001072.3:c.861+35196T>C, NM_007120.2:c.867+9374T>C, NM_019075.2:c.856-37973T>C, NM_019076.4:c.856-37973T>C, NM_019077.2:c.856-37973T>C, NM_019078.1:c.867+15203T>C, NM_019093.2:c.-66T>C, NM_021027.2:c.856-37973T>C, NM_205862.1:c.60+35196T>C, XR_241238.1:n.923+9374T>C, XR_241240.1:n.1022+35196T>C, XR_241241.1:n.942-37973T>C, rs17864456, rs56448245, rs57616406
T > C
SNP
rs3814057 NC_000003.11:g.119537254A>C, NC_000003.12:g.119818407A>C, NG_011856.1:g.42924A>C, NM_003889.3:c.*1195A>C, NM_022002.2:c.*1195A>C, NM_033013.2:c.*1195A>C, XM_005247866.1:c.995+2576A>C
A > C
SNP
rs3814058 NC_000003.11:g.119537291T>C, NC_000003.12:g.119818444T>C, NG_011856.1:g.42961T>C, NM_003889.3:c.*1232T>C, NM_022002.2:c.*1232T>C, NM_033013.2:c.*1232T>C, XM_005247866.1:c.995+2613T>C, rs60918337
T > C
SNP
rs3842 NC_000007.13:g.87133366T>C, NC_000007.14:g.87504050T>C, NG_011513.1:g.214199A>G, NM_000927.4:c.*193A>G, rs3747805, rs60395104
T > C
SNP
rs4148323 NC_000002.11:g.234669144G>A, NC_000002.12:g.233760498G>A, NG_002601.2:g.175755G>A, NG_033238.1:g.5226G>A, NM_000463.2:c.211G>A, NM_001072.3:c.862-6536G>A, NM_007120.2:c.868-6536G>A, NM_019075.2:c.856-6536G>A, NM_019076.4:c.856-6536G>A, NM_019077.2:c.856-6536G>A, NM_019078.1:c.868-6536G>A, NM_019093.2:c.868-6536G>A, NM_021027.2:c.856-6536G>A, NM_205862.1:c.61-6536G>A, NP_000454.1:p.Gly71Arg, XR_241238.1:n.924-6536G>A, XR_241239.1:n.233G>A, XR_241240.1:n.1023-6536G>A, XR_241241.1:n.942-6536G>A, rs113525835, rs34360183, rs58105808, rs58585123
G > A
SNP
G71R
rs4149056 NC_000012.11:g.21331549T>C, NC_000012.12:g.21178615T>C, NG_011745.1:g.52422T>C, NM_006446.4:c.521T>C, NP_006437.3:p.Val174Ala, rs52816141, rs60037639
T > C
SNP
V174A
rs429358 NC_000019.10:g.44908684T>C, NC_000019.9:g.45411941T>C, NG_007084.2:g.7903T>C, NM_000041.3:c.388T>C, NM_001302688.1:c.466T>C, NM_001302689.1:c.388T>C, NM_001302690.1:c.388T>C, NM_001302691.1:c.388T>C, NP_000032.1:p.Cys130Arg, NP_001289617.1:p.Cys156Arg, NP_001289618.1:p.Cys130Arg, NP_001289619.1:p.Cys130Arg, NP_001289620.1:p.Cys130Arg, XM_005258867.1:c.466T>C, XM_005258868.1:c.388T>C, XP_005258924.1:p.Cys156Arg, XP_005258925.1:p.Cys130Arg, rs61228756, rs630496
T > C
SNP
C130R
rs5128 NC_000011.10:g.116832924G>C, NC_000011.9:g.116703640G>C, NG_008949.1:g.8017G>C, NM_000040.1:c.*40G>C, rs17257817, rs3168249, rs45487004
G > C
SNP
rs628031 NC_000006.11:g.160560845A>G, NC_000006.12:g.160139813A>G, NM_003057.2:c.1222A>G, NM_153187.1:c.1222A>G, NP_003048.1:p.Met408Val, NP_694857.1:p.Met408Val, XM_005267102.1:c.1222A>G, XM_005267102.3:c.1222A>G, XM_005267103.1:c.1222A>G, XM_005267104.1:c.646A>G, XM_005267104.3:c.646A>G, XM_005267105.1:c.646A>G, XM_005267105.3:c.646A>G, XM_006715552.1:c.1222A>G, XM_011536074.1:c.646A>G, XP_005267159.1:p.Met408Val, XP_005267160.1:p.Met408Val, XP_005267161.1:p.Met216Val, XP_005267162.1:p.Met216Val, XP_006715615.1:p.Met408Val, XP_011534376.1:p.Met216Val, rs1086277, rs17202481, rs60990824
A > G
SNP
M408V
rs6785049 NC_000003.11:g.119533733G>A, NC_000003.12:g.119814886G>A, NG_011856.1:g.39403G>A, NM_003889.3:c.795-93G>A, NM_022002.2:c.912-93G>A, NM_033013.2:c.684-93G>A, XM_005247866.1:c.630-93G>A, rs58368790
G > A
SNP
rs717620 NC_000010.10:g.101542578C>T, NC_000010.11:g.99782821C>T, NG_011798.1:g.5116C>T, NM_000392.4:c.-24C>T, XM_005269536.1:c.-24C>T, XM_006717631.2:c.-24C>T, XM_011539291.1:c.-24C>T, XR_945604.1:n.166C>T, XR_945605.1:n.168C>T, rs17216163, rs386485129, rs58371376
C > T
SNP
rs7412 NC_000019.10:g.44908822C>T, NC_000019.9:g.45412079C>T, NG_007084.2:g.8041C>T, NM_000041.3:c.526C>T, NM_001302688.1:c.604C>T, NM_001302689.1:c.526C>T, NM_001302690.1:c.526C>T, NM_001302691.1:c.526C>T, NP_000032.1:p.Arg176Cys, NP_001289617.1:p.Arg202Cys, NP_001289618.1:p.Arg176Cys, NP_001289619.1:p.Arg176Cys, NP_001289620.1:p.Arg176Cys, XM_005258867.1:c.604C>T, XM_005258868.1:c.526C>T, XP_005258924.1:p.Arg202Cys, XP_005258925.1:p.Arg176Cys, rs3200542
C > T
SNP
R176C
rs7586110 NC_000002.11:g.234590527T>G, NC_000002.12:g.233681881T>G, NG_002601.2:g.97138T>G, NM_019075.2:c.855+44504T>G, NM_019076.4:c.855+63319T>G, NM_019077.2:c.-57T>G, NM_021027.2:c.855+9092T>G, XM_005246081.1:c.-57T>G, XR_241241.1:n.941+9092T>G, rs60348498
T > G
SNP
rs776746 NC_000007.13:g.99270539C>T, NC_000007.14:g.99672916T>C, NG_007938.1:g.12083G=, NG_007938.1:g.12083G>A, NM_000777.4:c.219-237A>G, NM_000777.4:c.219-237G>A, NM_001190484.2:c.219-237A>G, NM_001190484.2:c.219-237G>A, NM_001291829.1:c.-253-1A>G, NM_001291829.1:c.-253-1G>A, NM_001291830.1:c.189-237A>G, NM_001291830.1:c.189-237G>A, NR_033807.2:n.717-1A>G, NR_033807.2:n.717-1G>A, NR_033808.1:n.689-1G>A, NR_033809.1:n.581-237G>A, NR_033810.1:n.689-1G>A, NR_033811.1:n.321-1G>A, NR_033812.1:n.321-1G>A, XM_005250169.1:c.189-237G>A, XM_005250170.1:c.-357-1G>A, XM_005250171.1:c.-253-1G>A, XM_005250172.1:c.-254G>A, XM_005250173.1:c.-331-237G>A, XM_005250198.1:c.806-4288C>T, XM_006715859.2:c.219-237A>G, XM_011515843.1:c.-254A>G, XM_011515844.1:c.-229-237A>G, XM_011515845.1:c.-463-1A>G, XM_011515846.1:c.-331-237A>G, XM_011515847.1:c.-571-1A>G, XR_927383.1:n.344-237A>G, XR_927402.1:n.1466+48736T>C, rs10361242, rs11266830, rs386613022, rs58244770
C > T
SNP
rs8175347
(TA)6 > (TA)5
(TA)6 > (TA)7
(TA)6 > (TA)8
microsatellite
rs8330 NC_000002.11:g.234681645G>C, NC_000002.12:g.233772999G>C, NG_002601.2:g.188256G>C, NG_033238.1:g.17727G>C, NM_000463.2:c.*440G>C, NM_001072.3:c.*440G>C, NM_007120.2:c.*440G>C, NM_019075.2:c.*440G>C, NM_019076.4:c.*440G>C, NM_019077.2:c.*440G>C, NM_019078.1:c.*440G>C, NM_019093.2:c.*440G>C, NM_021027.2:c.*440G>C, NM_205862.1:c.*440G>C, XR_241238.1:n.2235G>C, rs3182134, rs35609787, rs386496306, rs57500970
G > C
SNP
Alleles, Functions, and Amino Acid Translations are all sourced from dbSNP 147

Overview

Generic Names
  • Abbott 84538
  • ritonavir
Trade Names
  • Norvir
  • Norvir Sec
Brand Mixture Names
  • Kaletra (Lopinavir + Ritonavir)

PharmGKB Accession Id

PA451260

Type(s):

Drug

Description

An HIV protease inhibitor that works by interfering with the reproductive cycle of HIV.

Source: Drug Bank

Indication

Indicated in combination with other antiretroviral agents for the treatment of HIV-infection.

Source: Drug Bank

Other Vocabularies

Information pulled from DrugBank has not been reviewed by PharmGKB.

Pharmacology, Interactions, and Contraindications

Mechanism of Action

Ritonavir inhibits the HIV viral proteinase enzyme which prevents cleavage of the gag-pol polyprotein, resulting in noninfectious, immature viral particles.

Source: Drug Bank

Pharmacology

Ritonavir is a protease inhibitor with activity against Human Immunodeficiency Virus Type 1 (HIV-1). Protease inhibitors block the part of HIV called protease. HIV-1 protease is an enzyme required for the proteolytic cleavage of the viral polyprotein precursors into the individual functional proteins found in infectious HIV-1. Ritonavir binds to the protease active site and inhibits the activity of the enzyme. This inhibition prevents cleavage of the viral polyproteins resulting in the formation of immature non-infectious viral particles. Protease inhibitors are almost always used in combination with at least two other anti-HIV drugs.

Source: Drug Bank

Food Interaction

Avoid St.John's Wort.|Take with food.

Source: Drug Bank

Absorption, Distribution, Metabolism, Elimination & Toxicity

Biotransformation

Hepatic. Five metabolites have been identified. The isopropylthiazole oxidation metabolite (M-2) is the major metabolite and has antiviral activity similar to that of ritonavir, however, plasma concentrations are low. The cytochrome P450 enzymes CYP3A and CYP2D6 are primarily involved in the metabolism of ritonavir.

Source: Drug Bank

Protein Binding

98-99%

Source: Drug Bank

Absorption

The absolute bioavailability of ritonavir has not been determined.

Source: Drug Bank

Half-Life

3-5 hours

Source: Drug Bank

Toxicity

Human experience of acute overdose with ritonavir is limited. One patient in clinical trials took ritonavir 1500 mg/day for two days. The patient reported paresthesias which resolved after the dose was decreased. A post-marketing case of renal failure with eosinophilia has been reported with ritonavir overdose. The approximate lethal dose was found to be greater than 20 times the related human dose in rats and 10 times the related human dose in mice.

Source: Drug Bank

Chemical Properties

Chemical Formula

C37H48N6O5S2

Source: Drug Bank

Isomeric SMILES

CC(C)c1nc(cs1)CN(C)C(=O)N[C@@H](C(C)C)C(=O)N[C@@H](Cc2ccccc2)C[C@@H]([C@H](Cc3ccccc3)NC(=O)OCc4cncs4)O

Source: OpenEye

Canonical SMILES

CC(C)[C@H](NC(=O)N(C)CC1=CSC(=N1)C(C)C)C(=O)N[C@H]

Source: Drug Bank

Average Molecular Weight

720.944

Source: Drug Bank

Monoisotopic Molecular Weight

720.312760056

Source: Drug Bank

SMILES

CC(C)[C@H](NC(=O)N(C)CC1=CSC(=N1)C(C)C)C(=O)N[C@H](C[C@H](O)[C@H](CC1=CC=CC=C1)NC(=O)OCC1=CN=CS1)CC1=CC=CC=C1

Source: Drug Bank

InChI String

InChI=1S/C37H48N6O5S2/c1-24(2)33(42-36(46)43(5)20-29-22-49-35(40-29)25(3)4)34(45)39-28(16-26-12-8-6-9-13-26)18-32(44)31(17-27-14-10-7-11-15-27)41-37(47)48-21-30-19-38-23-50-30/h6-15,19,22-25,28,31-33,44H,16-18,20-21H2,1-5H3,(H,39,45)(H,41,47)(H,42,46)/t28-,31-,32-,33-/m0/s1

Source: Drug Bank

Genes that are associated with this drug in PharmGKB's database based on (1) variant annotations, (2) literature review, (3) pathways or (4) information automatically retrieved from DrugBank, depending on the "evidence" and "source" listed below.

Curated Information ?

Drug Interactions

Interaction Description
alfuzosin - ritonavir Ritonavir increases the effect/toxicity of alfuzosin (source: Drug Bank )
alprazolam - ritonavir The protease inhibitor increases the effect of the benzodiazepine (source: Drug Bank )
alprazolam - ritonavir The protease inhibitor increases the effect of the benzodiazepine (source: Drug Bank )
aminophylline - ritonavir Ritonavir decreases the effect of theophylline (source: Drug Bank )
amiodarone - ritonavir Ritonavir increases the effect and toxicity of amiodarone (source: Drug Bank )
amiodarone - ritonavir Ritonavir increases the effect and toxicity of amiodarone (source: Drug Bank )
amitriptyline - ritonavir Ritonavir increases the effect and toxicity of tricyclics (source: Drug Bank )
amitriptyline - ritonavir Ritonavir may increase the effect and toxicity of the tricyclic antidepressant, amitriptyline, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of amitriptyline if ritonavir if initiated, discontinued or dose changed. (source: Drug Bank )
amoxapine - ritonavir Ritonavir increases the effect and toxicity of tricyclics (source: Drug Bank )
amoxapine - ritonavir Ritonavir may increase the effect and toxicity of the tricyclic antidepressant, amoxapine, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of amoxapine if ritonavir if initiated, discontinued or dose changed. (source: Drug Bank )
aprepitant - ritonavir This CYP3A4 inhibitor increases the effect and toxicity of aprepitant (source: Drug Bank )
astemizole - ritonavir Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank )
astemizole - ritonavir Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank )
atazanavir - ritonavir Association with dose adjustment (source: Drug Bank )
atazanavir - ritonavir Association with dose adjustment (source: Drug Bank )
atomoxetine - ritonavir The CYP2D6 inhibitor could increase the effect and toxicity of atomoxetine (source: Drug Bank )
atorvastatin - ritonavir Ritonavir increases the effect and toxicity of the statin (source: Drug Bank )
atorvastatin - ritonavir Ritonavir increases the effect and toxicity of the statin (source: Drug Bank )
bepridil - ritonavir Ritonavir increases the effect and toxicity of bepridil (source: Drug Bank )
bepridil - ritonavir Ritonavir increases the effect and toxicity of bepridil (source: Drug Bank )
bromazepam - ritonavir Ritonavir, a strong CYP3A4 inhibitor, may increase the serum concentration of bromazepam by decreasing its metabolism. Consider alternate therapy or monitor for changes in the therapeutic and adverse effects of bromazepam if ritonavir is initiated, discontinued or dose changed. Dosage adjustments may be required. (source: Drug Bank )
bupropion - ritonavir Ritonavir increases the effect and toxicity of bupropion (source: Drug Bank )
bupropion - ritonavir Ritonavir increases the effect and toxicity of bupropion (source: Drug Bank )
buspirone - ritonavir Ritonavir increases the effect and toxicity of buspirone (source: Drug Bank )
buspirone - ritonavir Ritonavir increases the effect and toxicity of buspirone (source: Drug Bank )
carbamazepine - ritonavir Ritonavir increases the effect of carbamazepine (source: Drug Bank )
carbamazepine - ritonavir Ritonavir increases the effect of carbamazepine (source: Drug Bank )
chlordiazepoxide - ritonavir The protease inhibitor increases the effect of the benzodiazepine (source: Drug Bank )
chlordiazepoxide - ritonavir The protease inhibitor increases the effect of the benzodiazepine (source: Drug Bank )
ciclesonide - ritonavir Increased effects/toxicity of ciclesonide (source: Drug Bank )
cisapride - ritonavir Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank )
cisapride - ritonavir Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank )
clomipramine - ritonavir Ritonavir increases the effect and toxicity of tricyclics (source: Drug Bank )
clomipramine - ritonavir Ritonavir may increase the effect and toxicity of the tricyclic antidepressant, clomipramine, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of clomipramine if ritonavir if initiated, discontinued or dose changed. (source: Drug Bank )
clonazepam - ritonavir The protease inhibitor increases the effect of the benzodiazepine (source: Drug Bank )
clonazepam - ritonavir The protease inhibitor increases the effect of the benzodiazepine (source: Drug Bank )
clorazepate - ritonavir The protease inhibitor increases the effect of the benzodiazepine (source: Drug Bank )
clozapine - ritonavir Ritonavir increases the effect and toxicity of clozapine (source: Drug Bank )
clozapine - ritonavir Ritonavir increases the effect and toxicity of clozapine (source: Drug Bank )
cyclosporine - ritonavir The protease inhibitor increases the effect of cyclosporine (source: Drug Bank )
cyclosporine - ritonavir The protease inhibitor, ritonavir, may increase the effect of cyclosporine. (source: Drug Bank )
dantrolene - ritonavir Ritonavir may increase the serum concentration of dantrolene by decreasing its metabolism. Consider alternate therapy or monitor for changes in the therapeutic and adverse effects of dantrolene if ritonavir is initiated, discontinued or dose changed. (source: Drug Bank )
darifenacin - ritonavir This potent CYP3A4 inhibitor slows darifenacin/solifenacin metabolism (source: Drug Bank )
darifenacin - ritonavir This potent CYP3A4 inhibitor slows darifenacin/solifenacin metabolism (source: Drug Bank )
delavirdine - ritonavir Increases the effect of ritonavir (source: Drug Bank )
delavirdine - ritonavir Increases the effect of ritonavir (source: Drug Bank )
desipramine - ritonavir Ritonavir increases the effect and toxicity of tricyclics (source: Drug Bank )
desipramine - ritonavir Ritonavir may increase the effect and toxicity of the tricyclic antidepressant, desipramine, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of desipramine if ritonavir if initiated, discontinued or dose changed. (source: Drug Bank )
diazepam - ritonavir The protease inhibitor increases the effect of the benzodiazepine (source: Drug Bank )
diazepam - ritonavir The protease inhibitor increases the effect of the benzodiazepine (source: Drug Bank )
digoxin - ritonavir Ritonavir increases levels/effect of digoxin (source: Drug Bank )
digoxin - ritonavir Ritonavir increases levels/effect of digoxin (source: Drug Bank )
dihydroergotamine - ritonavir The protease inhibitor increases the effect and toxicity of ergot derivative (source: Drug Bank )
dihydroergotamine - ritonavir The protease inhibitor, ritonavir, may increase the effect and toxicity of the ergot derivative, dihydroergotamine. (source: Drug Bank )
diltiazem - ritonavir Ritonavir increases diltiazem levels (source: Drug Bank )
diltiazem - ritonavir Ritonavir increases diltiazem levels (source: Drug Bank )
divalproex sodium - ritonavir Possible decrease of valproate levels (source: Drug Bank )
doxepin - ritonavir Ritonavir increases the effect and toxicity of tricyclics (source: Drug Bank )
doxepin - ritonavir Ritonavir may increase the effect and toxicity of the tricyclic antidepressant, doxepin, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of doxepin if ritonavir if initiated, discontinued or dose changed. (source: Drug Bank )
eletriptan - ritonavir The protease inhibitor increases the effect and toxicity of eletriptan (source: Drug Bank )
eletriptan - ritonavir The protease inhibitor, ritonavir, may increase the effect and toxicity of eletriptan. (source: Drug Bank )
eplerenone - ritonavir This protease inhibitor, ritonavir, may increase the effect and toxicity of eplerenone. (source: Drug Bank )
ergotamine - ritonavir The protease inhibitor increases the effect and toxicity of ergot derivative (source: Drug Bank )
ergotamine - ritonavir The protease inhibitor, ritonavir, may increase the effect and toxicity of the ergot derivative, ergotamine. (source: Drug Bank )
erythromycin - ritonavir Increased toxicity of both agents (source: Drug Bank )
erythromycin - ritonavir Increased toxicity of both agents (source: Drug Bank )
estazolam - ritonavir The protease inhibitor increases the effect of the benzodiazepine (source: Drug Bank )
estazolam - ritonavir The protease inhibitor increases the effect of the benzodiazepine (source: Drug Bank )
ethinyl estradiol - ritonavir Ritonavir could decrease the contraceptive efficacy (source: Drug Bank )
ethinyl estradiol - ritonavir Ritonavir could decrease the contraceptive efficacy (source: Drug Bank )
fentanyl - ritonavir Ritonavir increases the effect and toxicity of fentanyl/alfentanyl (source: Drug Bank )
flecainide - ritonavir Ritonavir increases the toxicity of the anti-arrhythmic (source: Drug Bank )
flecainide - ritonavir Ritonavir increases the toxicity of the anti-arrhythmic (source: Drug Bank )
fluoxetine - ritonavir Increased risk of serotonin syndrome (source: Drug Bank )
fluoxetine - ritonavir Increased risk of serotonin syndrome (source: Drug Bank )
flurazepam - ritonavir The protease inhibitor increases the effect of the benzodiazepine (source: Drug Bank )
flurazepam - ritonavir The protease inhibitor increases the effect of the benzodiazepine (source: Drug Bank )
fusidic acid - ritonavir The protease inhibitor, ritonavir, may increase the effect and toxicity of fusidic acid. (source: Drug Bank )
gefitinib - ritonavir This CYP3A4 inhibitor increases levels/toxicity of gefitinib (source: Drug Bank )
gefitinib - ritonavir This CYP3A4 inhibitor increases levels/toxicity of gefitinib (source: Drug Bank )
imipramine - ritonavir Ritonavir increases the effect and toxicity of tricyclics (source: Drug Bank )
imipramine - ritonavir Ritonavir may increase the effect and toxicity of the tricyclic antidepressant, imipramine, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of imipramine if ritonavir if initiated, discontinued or dose changed. (source: Drug Bank )
itraconazole - ritonavir The imidazole increases the effect and toxicity of ritonavir (source: Drug Bank )
itraconazole - ritonavir The imidazole increases the effect and toxicity of ritonavir (source: Drug Bank )
ketoconazole - ritonavir The imidazole increases the effect and toxicity of ritonavir (source: Drug Bank )
ketoconazole - ritonavir The imidazole increases the effect and toxicity of ritonavir (source: Drug Bank )
lovastatin - ritonavir Ritonavir increases the effect and toxicity of the statin (source: Drug Bank )
lovastatin - ritonavir Ritonavir increases the effect and toxicity of the statin (source: Drug Bank )
mefloquine - ritonavir Mefloquine decreases the effect of ritonavir (source: Drug Bank )
mefloquine - ritonavir Mefloquine decreases the effect of ritonavir (source: Drug Bank )
meperidine - ritonavir Ritonavir increases the levels of analgesic (source: Drug Bank )
meperidine - ritonavir Ritonavir increases the levels of analgesic (source: Drug Bank )
methadone - ritonavir The protease inhibitor decreases the effect of methadone (source: Drug Bank )
methadone - ritonavir The protease inhibitor, ritonavir, may decrease the effect of methadone. (source: Drug Bank )
midazolam - ritonavir The protease inhibitor increases the effect of benzodiazepine (source: Drug Bank )
midazolam - ritonavir The protease inhibitor increases the effect of benzodiazepine (source: Drug Bank )
nortriptyline - ritonavir Ritonavir increases the effect and toxicity of the tricyclics (source: Drug Bank )
nortriptyline - ritonavir Ritonavir may increase the effect and toxicity of the tricyclic antidepressant, nortriptyline, by decreasing its metabolism. Monitor for changes in the therapeutic and adverse effects of nortriptyline if ritonavir if initiated, discontinued or dose changed. (source: Drug Bank )
olanzapine - ritonavir Ritonavir decreases the effect of olanzapine (source: Drug Bank )
olanzapine - ritonavir Ritonavir decreases the effect of olanzapine (source: Drug Bank )
oxtriphylline - ritonavir Ritonavir decreases the effect of theophylline (source: Drug Bank )
pimozide - ritonavir The protease inhibitor increases the effect and toxicity of pimozide (source: Drug Bank )
pimozide - ritonavir The protease inhibitor, ritonavir, may increase the effect and toxicity of pimozide. (source: Drug Bank )
piroxicam - ritonavir Ritonavir increases the toxicity of piroxicam (source: Drug Bank )
piroxicam - ritonavir Ritonavir increases the toxicity of piroxicam (source: Drug Bank )
propafenone - ritonavir Ritonavir increases the effect and toxicity of propafenone (source: Drug Bank )
propafenone - ritonavir Ritonavir increases the effect and toxicity of propafenone (source: Drug Bank )
propoxyphene - ritonavir Ritonavir increases the levels of analgesic (source: Drug Bank )
propoxyphene - ritonavir Ritonavir increases the levels of analgesic (source: Drug Bank )
quinidine - ritonavir Ritonavir increases the effect and toxicity of quinidine (source: Drug Bank )
quinidine - ritonavir Ritonavir increases the effect and toxicity of quinidine (source: Drug Bank )
quinupristin - ritonavir This combination presents an increased risk of toxicity (source: Drug Bank )
ranolazine - ritonavir Increased levels of ranolazine - risk of toxicity (source: Drug Bank )
rifabutin - ritonavir Rifabutin decreases the effect of ritonavir (source: Drug Bank )
rifabutin - ritonavir Rifabutin decreases the effect of ritonavir (source: Drug Bank )
rifampin - ritonavir Rifampin decreases the effect of ritonavir (source: Drug Bank )
rifampin - ritonavir Rifampin decreases the effect of ritonavir (source: Drug Bank )
tadalafil - ritonavir Ritonavir may reduce the metabolism of Tadalafil. Concomitant therapy should be avoided if possible due to high risk of Tadalafil toxicity. (source: Drug Bank )
tamoxifen - ritonavir Ritonavir may decrease the therapeutic effect of Tamoxifen by decreasing the production of active metabolites. Concomitant therapy should be avoided. (source: Drug Bank )
tamoxifen - ritonavir Ritonavir may decrease the therapeutic effect of Tamoxifen by decreasing the production of active metabolites. Concomitant therapy should be avoided. (source: Drug Bank )
tamsulosin - ritonavir Ritonavir, a CYP3A4/2D6 inhibitor, may decrease the metabolism and clearance of Tamsulosin, a CYP3A4/2D6 substrate. Monitor for changes in therapeutic/adverse effects of Tamsulosin if Ritonavir is initiated, discontinued, or dose changed. (source: Drug Bank )
tamsulosin - ritonavir Ritonavir, a CYP3A4/2D6 inhibitor, may decrease the metabolism and clearance of Tamsulosin, a CYP3A4/2D6 substrate. Monitor for changes in therapeutic/adverse effects of Tamsulosin if Ritonavir is initiated, discontinued, or dose changed. (source: Drug Bank )
telithromycin - ritonavir Ritonavir may increase the plasma concentration of Telithromycin. Consider alternate therapy or monitor therapeutic/adverse effects. (source: Drug Bank )
teniposide - ritonavir The strong CYP3A4 inhibitor, Ritonavir, may decrease the metabolism and clearance of Teniposide, a CYP3A4 substrate. Consider alternate therapy or monitor for changes in the therapeutic/adverse effects of Teniposide if Ritonavir is initiated, discontinued or dose changed. (source: Drug Bank )
terfenadine - ritonavir Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank )
terfenadine - ritonavir Increased risk of cardiotoxicity and arrhythmias (source: Drug Bank )
theophylline - ritonavir Ritonavir decreases the effect of theophylline (source: Drug Bank )
theophylline - ritonavir Ritonavir decreases the effect of theophylline (source: Drug Bank )
tiagabine - ritonavir The strong CYP3A4 inhibitor, Ritonavir, may decrease the metabolism and clearance of Tiagabine, a CYP3A4 substrate. Consider alternate therapy or monitor for changes in the therapeutic/adverse effects of Tiagabine if Ritonavir is initiated, discontinued or dose changed. (source: Drug Bank )
tolterodine - ritonavir Ritonavir may decrease the metabolism and clearance of Tolterodine. Adjust Tolterodine dose and monitor for efficacy and toxicity. (source: Drug Bank )
tolterodine - ritonavir Ritonavir may decrease the metabolism and clearance of Tolterodine. Adjust Tolterodine dose and monitor for efficacy and toxicity. (source: Drug Bank )
topotecan - ritonavir The p-glycoprotein inhibitor, Ritonavir, may increase the bioavailability of oral Topotecan. A clinically significant effect is also expected with IV Topotecan. Concomitant therapy should be avoided. (source: Drug Bank )
tramadol - ritonavir Ritonavir may increase Tramadol toxicity by decreasing Tramadol metabolism and clearance. Ritonavir may decrease the effect of Tramadol by decreasing active metabolite production. (source: Drug Bank )
trazodone - ritonavir Ritonavir increases levels/effect of trazodone (source: Drug Bank )
trazodone - ritonavir The protease inhibitor, Ritonavir, may increase the efficacy/toxicity of Trazodone by inhibiting Trazodone metabolism and clearance. Monitor for changes in Trazodone efficacy/toxicity if Ritonavir is initiated, discontinued or dose changed. (source: Drug Bank )
trazodone - ritonavir The protease inhibitor, Ritonavir, may increase the efficacy/toxicity of Trazodone by inhibiting Trazodone metabolism and clearance. Monitor for changes in Trazodone efficacy/toxicity if Ritonavir is initiated, discontinued or dose changed. (source: Drug Bank )
triazolam - ritonavir The protease inhibitor increases the effect of the benzodiazepine (source: Drug Bank )
triazolam - ritonavir The protease inhibitor increases the effect of the benzodiazepine (source: Drug Bank )
trimipramine - ritonavir The strong CYP3A4/CYP2D6 inhibitor, Ritonavir, may decrease the metabolism and clearance of Trimipramine, a CYP3A4/CYP2D6 substrate. Consider alternate therapy or monitor for changes in therapeutic and adverse effects of Trimipramine if Ritonavir is initiated, discontinued or dose changed. (source: Drug Bank )
vardenafil - ritonavir Ritonavir, a potent CYP3A4 inhibitor, may decrease the metabolism and clearance of Vardenafil. Concomitant therapy is contraindicated. (source: Drug Bank )
venlafaxine - ritonavir Ritonavir, a CYP2D6 and CYP3A4 inhibitor, may decrease the metabolism and clearance of Venlafaxine, a CYP2D6 and CYP3A4 substrate. Monitor for changes in therapeutic/adverse effects of Venlafaxine if Ritonavir is initiated, discontinued, or dose changed. (source: Drug Bank )
verapamil - ritonavir Ritonavir, a strong CYP3A4 inhibitor, may increase the serum concentration of Veramapil, a CYP3A4 substrate, by decreasing its metabolism and clearance. Consider alternate therapy or monitor for changes in the therapeutic/adverse effects of Verapamil if Ritonavir is initiated, discontinued or dose changed. (source: Drug Bank )
vincristine - ritonavir Ritonavir, a strong CYP3A4 and p-glycoprotein inhibitor, may increase the serum concentration of Vincristine by decreasing its metabolism and/or increasing efflux. Consider alternate therapy to avoid Vincristine toxicity. Monitor for changes in the therapeutic and adverse effects of Vincristine if Ritonavir is initiated, discontinued or dose changed. (source: Drug Bank )
vinorelbine - ritonavir Ritonavir, a strong CYP3A4 inhibitor, may increase the serum concentration of Vinorelbine by decreasing its metabolism. Consider alternate therapy to avoid Vinorelbine toxicity. Monitor for changes in the therapeutic and adverse effects of Vinorelbine if Ritonavir is initiated, discontinued or dose changed. (source: Drug Bank )
voriconazole - ritonavir Ritonavir may decrease the serum concentration of voriconazole by increasing its metabolism. Concomitant therapy with high dose ritonavir is contraindicated. Caution should be used with lower doses as decreased voriconazole efficacy may occur. (source: Drug Bank )
zolpidem - ritonavir Ritonavir, a strong CYP3A4 inhibitor, may increase the serum concentration of zolpidem by decreasing its metabolism. Consider alternate therapy or monitor for changes in the therapeutic and adverse effects of zolpidem if ritonavir is initiated, discontinued or dose changed. (source: Drug Bank )
zonisamide - ritonavir Ritonavir, a strong CYP3A4 inhibitor, may increase the serum concentration of zonisamide by decreasing its metabolism. Consider alternate therapy or monitor for changes in the therapeutic and adverse effects of zonisamide if ritonavir is initiated, discontinued or dose changed. (source: Drug Bank )
zopiclone - ritonavir Ritonavir, a strong CYP3A4 inhibitor, may increase the serum concentration of zopiclone by decreasing its metabolism. Consider alternate therapy or monitor for changes in the therapeutic and adverse effects of zopiclone if ritonavir is initiated, discontinued or dose changed. (source: Drug Bank )
zuclopenthixol - ritonavir Ritonavir, a strong CYP2D6 inhibitor, may increase the serum concentration of zuclopenthixol by decreasing its metabolism. Consider alternate therapy or monitor for changes in the therapeutic and adverse effects of zuclopenthixol if ritonavir is initiated, discontinued or dose changed. (source: Drug Bank )

Curated Information ?

Relationships from National Drug File - Reference Terminology (NDF-RT)

May Treat
Contraindicated With

Publications related to ritonavir: 72

No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Genetic Variation among 82 Pharmacogenes: the PGRN-Seq data from the eMERGE Network. Clinical pharmacology and therapeutics. 2016. Bush William S, et al. PubMed
No Dosing Guideline available No Drug Label available CA No Variant Annotation available No VIP available No VIP available
Treatment response to unboosted atazanavir in combination with tenofovir disoproxil fumarate and lamivudine in human immunodeficiency virus-1-infected patients who have achieved virological suppression: A therapeutic drug monitoring and pharmacogenetic study. Journal of microbiology, immunology, and infection = Wei mian yu gan ran za zhi. 2016. Tsai Mao-Song, et al. PubMed
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
Polymorphisms associated with renal adverse effects of antiretroviral therapy in a Southern Brazilian HIV cohort. Pharmacogenetics and genomics. 2015. da Rocha Ivete M, et al. PubMed
No Dosing Guideline available No Drug Label available CA No Variant Annotation available No VIP available No VIP available
Pharmacogenetic testing can identify patients taking atazanavir at risk for hyperbilirubinemia. Journal of acquired immune deficiency syndromes (1999). 2015. Avihingsanon Anchalee, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Ritonavir is the best alternative to ketoconazole as an index inhibitor of cytochrome P450-3A in drug-drug interaction studies. British journal of clinical pharmacology. 2015. Greenblatt David J, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
Cholelithiasis and Nephrolithiasis in HIV-Positive Patients in the Era of Combination Antiretroviral Therapy. PloS one. 2015. Lin Kuan-Yin, et al. PubMed
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
Single-nucleotide polymorphisms in the UDP-glucuronosyltransferase 1A-3' untranslated region are associated with atazanavir-induced nephrolithiasis in patients with HIV-1 infection: a pharmacogenetic study. The Journal of antimicrobial chemotherapy. 2014. Nishijima Takeshi, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Voriconazole and atazanavir: a CYP2C19-dependent manageable drug-drug interaction. Pharmacogenomics. 2014. Calcagno Andrea, et al. PubMed
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
Intracellular accumulation of atazanavir/ritonavir according to plasma concentrations and OATP1B1, ABCB1 and PXR genetic polymorphisms. The Journal of antimicrobial chemotherapy. 2014. D'Avolio Antonio, et al. PubMed
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
High prevalence of the UGT1A1*28 variant in HIV-infected individuals in Greece. International journal of STD & AIDS. 2014. Panagopoulos P, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Understanding variability with voriconazole using a population pharmacokinetic approach: implications for optimal dosing. The Journal of antimicrobial chemotherapy. 2014. Dolton Michael J, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
EMA Initiatives and Perspectives on Pharmacogenomics. British journal of clinical pharmacology. 2014. Ehmann Falk, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Impact of CYP polymorphisms, ethnicity and sex differences in metabolism on dosing strategies: the case of efavirenz. European journal of clinical pharmacology. 2014. Naidoo Panjasaram, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available VA No VIP available No VIP available
Clinical and pharmacogenetic factors affecting neonatal bilirubinemia following atazanavir treatment of mothers during pregnancy. AIDS research and human retroviruses. 2013. Eley Timothy, et al. PubMed
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
Mitochondrial DNA Variation and Changes in Adiponectin and Endothelial Function in HIV-Infected Adults After Antiretroviral Therapy Initiation. AIDS research and human retroviruses. 2013. Hulgan Todd, et al. PubMed
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
ABCB1 and ABCC1 variants associated with virological failure of first-line protease inhibitors antiretroviral regimens in Northeast Brazil patients. Journal of clinical pharmacology. 2013. Coelho Antonio V C, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Evaluating the in vitro inhibition of UGT1A1, OATP1B1, OATP1B3, MRP2, and BSEP in predicting drug-induced hyperbilirubinemia. Molecular pharmaceutics. 2013. Chang Jae H, et al. PubMed
No Dosing Guideline available No Drug Label available CA No Variant Annotation available No VIP available No VIP available
Effect of the UGT1A1*28 allele on unconjugated hyperbilirubinemia in HIV-positive patients receiving Atazanavir: a systematic review. The Annals of pharmacotherapy. 2013. Culley Celia L, et al. PubMed
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
Impact of UGT1A1 Gilbert variant on discontinuation of ritonavir-boosted atazanavir in AIDS Clinical Trials Group Study A5202. The Journal of infectious diseases. 2013. Ribaudo Heather J, et al. PubMed
No Dosing Guideline available No Drug Label available CA No Variant Annotation available No VIP available No VIP available
Effect of Adherence as Measured by MEMS, Ritonavir Boosting, and CYP3A5 Genotype on Atazanavir Pharmacokinetics in Treatment-Naive HIV-Infected Patients. Clinical pharmacology and therapeutics. 2012. Savic R M, et al. PubMed
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
Switching to unboosted atazanavir reduces bilirubin and triglycerides without compromising treatment efficacy in UGT1A1*28 polymorphism carriers. The Journal of antimicrobial chemotherapy. 2012. Ferraris Laurenzia, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available VIP No VIP available
PharmGKB summary: very important pharmacogene information for CYP3A5. Pharmacogenetics and genomics. 2012. Lamba Jatinder, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
The Dual Role of Pharmacogenetics in HIV Treatment: Mutations and Polymorphisms Regulating Antiretroviral Drug Resistance and Disposition. Pharmacological reviews. 2012. Michaud Veronique, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
HIV-1 antiretroviral drug therapy. Cold Spring Harbor perspectives in medicine. 2012. Arts Eric J, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Complex drug interactions of the HIV protease inhibitors 3: effect of simultaneous or staggered dosing of digoxin and ritonavir, nelfinavir, rifampin, or bupropion. Drug metabolism and disposition: the biological fate of chemicals. 2012. Kirby Brian J, et al. PubMed
No Dosing Guideline available No Drug Label available CA No Variant Annotation available No VIP available No VIP available
Severe atazanavir-associated hyperbilirubinemia revealing Canton G6PD deficiency in an Asian HIV-infected patient. AIDS (London, England). 2012. Javelle Emilie, et al. PubMed
No Dosing Guideline available No Drug Label available CA No Variant Annotation available No VIP available No VIP available
Short communication: use of serum bilirubin levels as surrogate marker of early virological response to atazanavir-based antiretroviral therapy. AIDS research and human retroviruses. 2011. Morello Judit, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Complex Drug Interactions of HIV Protease Inhibitors 2: In Vivo Induction and In Vitro to In Vivo Correlation of Induction of Cytochrome P450 1A2, 2B6 and 2C9 by Ritonavir or Nelfinavir. Drug metabolism and disposition: the biological fate of chemicals. 2011. Kirby Brian J, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Complex Drug Interactions of HIV Protease Inhibitors 1: Inactivation, Induction and Inhibition of Cytochrome P450 3A by Ritonavir or Nelfinavir. Drug metabolism and disposition: the biological fate of chemicals. 2011. Kirby Brian J, et al. PubMed
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
Detrimental effect of atazanavir plasma concentrations on total serum bilirubin levels in the presence of UGT1A1 polymorphisms. Journal of acquired immune deficiency syndromes (1999). 2011. Cicconi Paola, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available VIP No VIP available
Very important pharmacogene summary: ABCB1 (MDR1, P-glycoprotein). Pharmacogenetics and genomics. 2011. Hodges Laura M, et al. PubMed
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
Association of pharmacogenetic markers with premature discontinuation of first-line anti-HIV therapy: an observational cohort study. The Journal of infectious diseases. 2011. Lubomirov Rubin, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Successful tacrolimus treatment following renal transplant in a HIV-infected patient with raltegravir previously treated with a protease inhibitor based regimen. Drug metabolism and drug interactions. 2011. Cousins Darren, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Nuclear receptor-mediated induction of CYP450 by antiretrovirals: functional consequences of NR1I2 (PXR) polymorphisms and differential prevalence in whites and sub-Saharan Africans. Journal of acquired immune deficiency syndromes (1999). 2010. Svärd Jenny, et al. PubMed
No Dosing Guideline available No Drug Label available CA No Variant Annotation available No VIP available No VIP available
Genetic factors influencing severe atazanavir-associated hyperbilirubinemia in a population with low UDP-glucuronosyltransferase 1A1*28 allele frequency. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2010. Park Wan Beom, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Prediction of adverse drug reactions using decision tree modeling. Clinical pharmacology and therapeutics. 2010. Hammann F, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Coprescription of tamoxifen and medications that inhibit CYP2D6. Journal of clinical oncology : official journal of the American Society of Clinical Oncology. 2010. Sideras Kostandinos, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
A Phenotype-Genotype Approach to Predicting CYP450 and P-Glycoprotein Drug Interactions With the Mixed Inhibitor/Inducer Tipranavir/Ritonavir. Clinical pharmacology and therapeutics. 2010. Dumond J B, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ADME pharmacogenetics: investigation of the pharmacokinetics of the antiretroviral agent lopinavir coformulated with ritonavir. Pharmacogenetics and genomics. 2010. Lubomirov Rubin, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Pharmacokinetics and pharmacodynamics of GS-9350: a novel pharmacokinetic enhancer without anti-HIV activity. Clinical pharmacology and therapeutics. 2010. Mathias A A, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Pharmacogenomic adaptation of antiretroviral therapy: overcoming the failure of lopinavir in an African infant with CYP2D6 ultrarapid metabolism. European journal of clinical pharmacology. 2010. Gorny Matthias, et al. PubMed
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Atazanavir pharmacokinetics in genetically determined CYP3A5 expressors versus non-expressors. The Journal of antimicrobial chemotherapy. 2009. Anderson Peter L, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Is there a place for drug combination strategies using clinical pharmacology attributes?--review of current trends in research. Current clinical pharmacology. 2009. Srinivas Nuggehally R. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
ABCB1 polymorphisms and the concentrations of lopinavir and ritonavir in blood, semen and saliva of HIV-infected men under antiretroviral therapy. Pharmacogenomics. 2009. Estrela Rita de Cassia, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
CYP3A5 genotype has no impact on plasma trough concentrations of lopinavir and ritonavir in HIV-infected subjects. Clinical pharmacology and therapeutics. 2008. Estrela R C E, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Structure, function and regulation of P-glycoprotein and its clinical relevance in drug disposition. Xenobiotica; the fate of foreign compounds in biological systems. 2008. Zhou S-F. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Pharmacokinetics and safety of saquinavir/ritonavir and omeprazole in HIV-infected subjects. Clinical pharmacology and therapeutics. 2008. Singh K, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Pharmacogenetics of antiretroviral agents. Current opinion in HIV and AIDS. 2008. Owen Andrew, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Lopinavir-ritonavir dramatically affects the pharmacokinetics of irinotecan in HIV patients with Kaposi's sarcoma. Clinical pharmacology and therapeutics. 2008. Corona G, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
The effect of lopinavir/ritonavir on the renal clearance of tenofovir in HIV-infected patients. Clinical pharmacology and therapeutics. 2008. Kiser J J, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Ritonavir 100 mg does not cause QTc prolongation in healthy subjects: a possible role as CYP3A inhibitor in thorough QTc studies. Clinical pharmacology and therapeutics. 2008. Sarapa N, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
The effect of ABCB1 polymorphism on the pharmacokinetics of saquinavir alone and in combination with ritonavir. Clinical pharmacology and therapeutics. 2007. la Porte C J L, et al. PubMed
No Dosing Guideline available No Drug Label available CA No Variant Annotation available No VIP available No VIP available
Contribution of 20 single nucleotide polymorphisms of 13 genes to dyslipidemia associated with antiretroviral therapy. Pharmacogenetics and genomics. 2007. Arnedo Mireia, et al. PubMed
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
Genetic factors influencing atazanavir plasma concentrations and the risk of severe hyperbilirubinemia. AIDS (London, England). 2007. Rodríguez-Nóvoa Sonia, et al. PubMed
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
Gilbert's disease and atazanavir: from phenotype to UDP-glucuronosyltransferase haplotype. Hepatology (Baltimore, Md.). 2006. Lankisch Tim O, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Ritonavir-fluticasone interaction causing Cushing syndrome in HIV-infected children and adolescents. The Pediatric infectious disease journal. 2006. Arrington-Sanders Renata, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Orosomucoid (alpha1-acid glycoprotein) plasma concentration and genetic variants: effects on human immunodeficiency virus protease inhibitor clearance and cellular accumulation. Clinical pharmacology and therapeutics. 2006. Colombo Sara, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Systematic screening for polymorphisms in the CYP3A4 gene in the Chinese population. Pharmacogenomics. 2006. Du Jing, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Drug-drug interaction between pitavastatin and various drugs via OATP1B1. Drug metabolism and disposition: the biological fate of chemicals. 2006. Hirano Masaru, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Drug interactions with lipid-lowering drugs: mechanisms and clinical relevance. Clinical pharmacology and therapeutics. 2006. Neuvonen Pertti J, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Evaluation of 170 xenobiotics as transactivators of human pregnane X receptor (hPXR) and correlation to known CYP3A4 drug interactions. Current drug metabolism. 2006. Sinz Michael, et al. PubMed
No Dosing Guideline available No Drug Label available CA No Variant Annotation available No VIP available No VIP available
Associations among race/ethnicity, ApoC-III genotypes, and lipids in HIV-1-infected individuals on antiretroviral therapy. PLoS medicine. 2006. Foulkes Andrea S, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Overview of the pharmacogenetics of HIV therapy. The pharmacogenomics journal. 2006. Rodríguez-Nóvoa S, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
In vitro inhibition of UDP glucuronosyltransferases by atazanavir and other HIV protease inhibitors and the relationship of this property to in vivo bilirubin glucuronidation. Drug metabolism and disposition: the biological fate of chemicals. 2005. Zhang Donglu, et al. PubMed
No Dosing Guideline available No Drug Label available CA No Variant Annotation available No VIP available No VIP available
Gilbert syndrome and the development of antiretroviral therapy-associated hyperbilirubinemia. The Journal of infectious diseases. 2005. Rotger Margalida, et al. PubMed
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
Modeling the influence of APOC3, APOE, and TNF polymorphisms on the risk of antiretroviral therapy-associated lipid disorders. The Journal of infectious diseases. 2005. Tarr Philip E, et al. PubMed
No Dosing Guideline available No Drug Label available CA VA No VIP available No VIP available
MDR1 gene polymorphisms and phase 1 viral decay during HIV-1 infection: an adult AIDS Clinical Trials Group study. Journal of acquired immune deficiency syndromes (1999). 2003. Haas David W, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
CYP3A4 induction by drugs: correlation between a pregnane X receptor reporter gene assay and CYP3A4 expression in human hepatocytes. Drug metabolism and disposition: the biological fate of chemicals. 2002. Luo Gang, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Med-psych drug-drug interactions update. Psychosomatics. 2002. Armstrong Scott C, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Peptide mimetic HIV protease inhibitors are ligands for the orphan receptor SXR. The Journal of biological chemistry. 2001. Dussault I, et al. PubMed
No Dosing Guideline available No Drug Label available No Clinical Annotation available No Variant Annotation available No VIP available No VIP available
Simple high-performance liquid chromatographic determination of the protease inhibitor indinavir in human plasma. Journal of chromatography. B, Biomedical sciences and applications. 1998. Jayewardene A L, et al. PubMed
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Clinical pharmacokinetics of prednisone and prednisolone. Clinical pharmacokinetics. 1990. Frey B M, et al. PubMed

LinkOuts

Web Resource:
Wikipedia
DrugBank:
DB00503
PDB:
RIT
KEGG Compound:
C07240
KEGG Drug:
D00427
PubChem Compound:
392622
PubChem Substance:
46505050
612199
Drugs Product Database (DPD):
2241480
BindingDB:
520
ChemSpider:
347980
HET:
RIT
Therapeutic Targets Database:
DAP000169

Clinical Trials

These are trials that mention ritonavir and are related to either pharmacogenetics or pharmacogenomics.

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NURSA Datasets

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No NURSA datasets available.

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Sources for PharmGKB drug information: DrugBank, PubChem.