See Contraindications and Dose Modification. Avoid Class IA (quinidine, procainamide) or Class III (dofetilide, amiodarone, sotalol) antiarrhythmic agents. May increase serum theophylline, carbamazepine, omeprazole, and digoxin, drugs metabolized by CYP3A, colchicine, saquinavir, tolterodine, and itraconazole levels. Bradyarrhythmias and lactic acidosis observed w/ verapamil. Hypotension and acute kidney injury may occur w/ calcium channel blockers metabolized by CYP3A4 (eg, verapamil, amlodipine, diltiazem). Increased levels w/ fluconazole, itraconazole, and saquinavir. Avoid doses of >1000mg/day w/ protease inhibitors. May potentiate oral anticoagulant effects. Risk of serious hemorrhage and significant elevations in PT/INR w/ warfarin; monitor PT/INR frequently. Caution w/ other drugs known to be CYP3A enzyme substrates, especially if substrate has a narrow safety margin (eg, carbamazepine) and/or substrate is extensively metabolized by this enzyme. Decreased levels w/ CYP3A inducers (eg, efavirenz, rifampicin, rifapentine); consider alternative antibacterial treatment. May increase levels of rifabutin and increase risk of uveitis w/ rifabutin. Etravirine may decrease exposure; consider alternative for treatment of MAC. Concomitant use w/ phosphodiesterase inhibitors (sildenafil, tadalafil, vardenafil) is not recommended. Consider reduction of sildenafil dose. CNS effects, increased sedation, and prolongation of sedation reported w/ concomitant triazolobenzodiazepines (eg, triazolam, midazolam); monitor for additive CNS effects and consider appropriate dose adjustments. May increase AUC of midazolam; possible prolongation and intensity of effect should be anticipated. Occurrence of torsades de pointes w/ quinidine or disopyramide reported; monitor serum levels and for QT prolongation. Interactions may occur w/ cyclosporine, tacrolimus, alfentanil, rifabutin, methylprednisolone, cilostazol, bromocriptine, vinblastine, phenobarbital, St. John's wort, hexobarbital, phenytoin, and valproate. Significant hypoglycemia may occur w/ oral hypoglycemic agents (eg, nateglinide, pioglitazone, repaglinide) and/or insulin. Caution when prescribing w/ statins; if concomitant use w/ atorvastatin or pravastatin cannot be avoided, do not exceed 20mg/day of atorvastatin and 40mg/day of pravastatin. Consider use of a statin that is not dependent on CYP3A metabolism (eg, fluvastatin); prescribe the lowest registered dose if concomitant use cannot be avoided. (Tab) May decrease levels of zidovudine; separate zidovudine administration by at least 2 hrs.
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