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Antimicrobial Agents and Chemotherapy, February 1998, p. 223-227, Vol. 42, No. 2
Division of Infectious Diseases,
Received 25 March 1997/Returned for modification 10 October
1997/Accepted 15 November 1997
To evaluate a potential pharmacokinetic interaction of
coadministration of fluconazole, and indinavir, a human
immunodeficiency virus (HIV) protease inhibitor, 13 patients were
enrolled in a multiple-dose, three-period, placebo-controlled,
crossover study. Patients were randomly assigned to receive indinavir
at 1,000 mg every 8 h for 7
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
Effect of Fluconazole on Indinavir Pharmacokinetics
in Human Immunodeficiency Virus-Infected Patients
days (with fluconazole placebo), fluconazole at 400 mg once daily for 8 days (with indinavir placebo), and indinavir with fluconazole in combination. The
pharmacokinetics of both drugs were measured on day 8 of each treatment
period. The peak concentration in plasma (Cmax)
and the time to reach Cmax were obtained by
inspection, and the area under curve (AUC) was calculated for indinavir
and fluconazole for each treatment period in which the respective drugs
were administered. There was a marginally (P = 0.08)
statistically significant decrease in the AUC from 0 to 8 h
(AUC0-8) for indinavir when it was administered with
fluconazole. However, the magnitudes of the decreases in
Cmax and the concentration at 8 h
postdosing (C8) were not as great as the
decrease in AUC0-8. Although the 90% confidence interval
for the geometric mean ratio was within the hypothesized limits, the
clinical significance is not clear. Indinavir coadministration with
fluconazole had no statistically (P > 0.5) or
clinically significant effect on the Cmax and
C8 of indinavir. Fluconazole coadministration
with indinavir had no statistically or clinically significant effect on
the pharmacokinetics of fluconazole. One patient was discontinued
because of mild to moderate abdominal pain and diarrhea while on
indinavir and fluconazole in combination. No serious adverse experience
according to the results of laboratory tests was noted. Total bilirubin
levels in serum were mildly increased in most patients treated with
indinavir. This was not clinically significant and was not affected by
the coadministration of fluconazole. Although the values of the
pharmacokinetic parameters for indinavir decrease in the presence of
fluconazole, indinavir and fluconazole can be administered
concomitantly to HIV-infected patients without adjustment of the dose
of either drug, and both drugs are generally well tolerated.
*
Corresponding author. Mailing address: Division of
Infectious Diseases (PL5), C.H.U. Saint-Pierre, rue Haute 322, B-1000
Brussels, Belgium. Phone: 32.2/535.41.30. Fax: 32.2/539.36.14. E-mail:
NCLUMECK{at}ULB.AC.BE.
Antimicrobial Agents and Chemotherapy, February 1998, p. 223-227, Vol. 42, No. 2
0066-4804/98/$04.00+0
Copyright © 1998, American Society for Microbiology. All rights reserved.
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