natgillin/translations-raw huggingface dataset:
Herbal preparations containing St John’ s wort (Hypericum perforatum) must not be used while taking lopinavir and ritonavir due to the risk of decreased plasma concentrations and reduced clinical effects of lopinavir and ritonavir (see section 4.5).
Razen v primerih, kjer je navedeno drugače, so bile vse študije medsebojnega delovanja zdravil izvedene s kapsulami Kaletra, pri katerih je izpostavljenost lopinavirju približno 20% nižja kot pri tabletah Kaletra 200/ 50 mg.
4.4 Special warnings and precautions for use
71 Protiretrovirusna zdravila
Patients with coexisting conditions
Nukleozidni/ nukleotidni zaviralci reverzne transkriptaze (NRTI – Nucleoside/ Nucleotide reverse transcriptase inhibitors):
Hepatic impairment: the safety and efficacy of Kaletra has not been established in patients with significant underlying liver disorders.
Stavudin in lamivudin: med uporabo zdravila Kaletra samega ali v kombinaciji s stavudinom in lamivudinom v kliničnih raziskavah niso opazili sprememb v farmakokinetiki lopinavirja.
Kaletra is contraindicated in patients with severe liver impairment (see section 4.3).
Didanozin: priporočljivo je, da bolnik didanozin vzame na prazen želodec, zato ga lahko uporabi hkrati s tabletami Kaletra brez hrane.
Patients with chronic hepatitis B or C and treated with combination antiretroviral therapy are at an increased risk for severe and potentially fatal hepatic adverse reactions.
Zdravilo Kaletra inducira glukuronidacijo, zato lahko zmanjša plazemsko koncentracijo zidovudina in abakavirja.
In case of concomitant antiviral therapy for hepatitis B or C, please refer to the relevant product information for these medicinal products.
Klinični pomen te možne interakcije ni znan.
Patients with pre-existing liver dysfunction including chronic hepatitis have an increased frequency of liver function abnormalities during combination antiretroviral therapy and should be monitored according to standard practice.
Pri sočasni uporabi tenofovirijevega dizoproksilfumarata z zdravilom Kaletra se je koncentracija tenofovirja zvišala za približno 30%, koncentraciji lopinavirja in ritonavirja pa se nista spremenili.
If there is evidence of worsening liver disease in such patients, interruption or discontinuation of treatment should be considered.
Višje koncentracije tenofovirja bi lahko povečale z njim povezane neželene učinke, vključno z ledvičnimi motnjami.
Renal impairment: since the renal clearance of lopinavir and ritonavir is negligible, increased plasma concentrations are not expected in patients with renal impairment.
Nenukleozidni zaviralci reverzne transkriptaze (NNRTI - Non- nucleoside reverse transcriptase inhibitors):
Haemophilia: there have been reports of increased bleeding, including spontaneous skin haematomas and haemarthrosis in patients with haemophilia type A and B treated with protease inhibitors.
Študija, ki so jo opravili pri zdravih prostovoljcih za proučitev medsebojnega delovanja tablet Kaletra (400/ 100 mg dvakrat na dan) in efavirenza (600 mg štirikrat na dan), je pokazala, da efavirenz zmanjša koncentracijo lopinavirja za 30– 40%.
In more than half of the reported cases, treatment with protease inhibitors was continued or reintroduced if treatment had been discontinued.
Če so pri zdravih prostovoljcih odmerjanje tablet Kaletra med sočasno uporabo s 600 mg efavirenza enkrat na dan povečali na 500/ 125 mg dvakrat na dan, so bili farmakokinetični parametri lopinavirja podobni kot med uporabo samih tablet Kaletra 400/ 100 mg dvakrat na dan.
A causal relationship had been evoked, although the mechanism of action had not been elucidated.
Zato morate med sočasno uporabo s 600 mg efavirenza enkrat na dan odmerjanje tablet Kaletra povečati na 500/ 125 mg dvakrat na dan.
Haemophiliac patients should therefore be made aware of the possibility of increased bleeding.
Tudi v primerih sočasne uporabe teh zdravil veljajo enaka priporočila za spremljanje.
Lipid elevations
Sočasna uporaba z drugimi zaviralci proteaz (ZP) HIV:
Treatment with Kaletra has resulted in increases, sometimes marked, in the concentration of total cholesterol and triglycerides.
Zdravilo Kaletra (400/ 100 mg dvakrat na dan) so raziskali v kombinaciji z zmanjšanimi odmerki amprenavirja, indinavirja, nelfinavirja in sakvinavirja v ravnotežnem stanju v študijah zdravih prostovoljcev v primerjavi s kliničnimi odmerki vsakega teh zaviralcev proteaz HIV brez ritonavirja.
Triglyceride and cholesterol testing is to be performed prior to initiating Kaletra therapy and at periodic intervals during therapy.
Opisane so tudi primerjave z objavljenimi farmakokinetičnimi podatki za sheme amprenavirja in sakvinavirja z ritonavirjem kot stopnjevalcem.
Particular caution should be paid to patients with high values at baseline and with history of lipid disorders.
Poleg tega razpravljajo o učinku dodatnega ritonavirja na farmakokinetiko lopinavirja.
Lipid disorders are to be managed as clinically appropriate (see also section 4.5 for additional information on potential interactions with HMG-CoA reductase inhibitors).
Opozoriti je treba, da je potrebno retrospektivne primerjave s shemami zaviralcev proteaz, stopnjevanimi z ritonavirjem, tolmačiti previdno (glejte podrobnosti o kombinacijah v nadaljevanju).
Pancreatitis
Amprenavir: glejte priporočila, opisana za sočasno uporabo tablet Kaletra z efavirenzom.
Cases of pancreatitis have been reported in patients receiving Kaletra, including those who developed hypertriglyceridaemia.
Sočasna uporaba standardnih odmerkov lopinavirja/ ritonavirja s fosamprenavirjem bistveno zmanjša koncentracijo amprenavirja.
In most of these cases patients have had a prior history of pancreatitis and/ or concurrent therapy with other medicinal products associated with pancreatitis.
Pri bolnikih, ki so že dobivali zaviralce proteaz, je sočasna uporaba večjih odmerkov fosamprenavirja 1400 mg dvakrat na dan z lopinavirjem/ ritonavirjem 533/ 133 mg dvakrat na dan povečala incidenco neželenih učinkov na prebavila in zvišanja trigliceridov s kombinirano shemo.
Marked triglyceride elevation is a risk factor for development of pancreatitis.
Ob tem se virološka učinkovitost v primerjavi s standardnimi odmerki fosamprenavirja/ ritonavirja ni povečala.
Patients with advanced HIV disease may be at risk of elevated triglycerides and pancreatitis
Sočasna uporaba teh zdravil zato ni priporočljiva.
Pancreatitis should be considered if clinical symptoms (nausea, vomiting, abdominal pain) or abnormalities in laboratory values (such as increased serum lipase or amylase values) suggestive of
72 Indinavir: indinavir v odmerku 600 mg dvakrat na dan v kombinaciji z zdravilom Kaletra doseže podobno AUC, večjo Cmin (za 3, 5- krat) in manjšo Cmax kot sam indinavir v odmerku 800 mg trikrat na dan.
66 pancreatitis should occur.
Nelfinavir: glejte priporočila, opisana za sočasno uporabo tablet Kaletra z efavirenzom.
Patients who exhibit these signs or symptoms should be evaluated and Kaletra therapy should be suspended if a diagnosis of pancreatitis is made (see section 4.8).
Sakvinavir: sakvinavir 800 mg dvakrat na dan doseže ob sočasni uporabi z zdravilom Kaletra 9, 6- krat večjo AUC kot sakvinavir sam v odmerku 1200 mg trikrat na dan.
Hyperglycaemia
Uporaba sakvinavirja v odmerku 800 mg dvakrat na dan sočasno z zdravilom Kaletra je povzročila približno 30% večjo AUC sakvinavirja kot kombinacija sakvinavir/ ritonavir 1000/ 100 mg dvakrat na dan ter podobno izpostavljenost, kot je opisana po kombinaciji sakvinavir/ ritonavir 400/ 400 mg dvakrat na dan.
New onset diabetes mellitus, hyperglycaemia or exacerbation of existing diabetes mellitus has been reported in patients receiving protease inhibitors.
Če so 1200 mg sakvinavirja dvakrat na dan kombinirali z zdravilom Kaletra, niso opazili dodatnega zvečanja koncentracije.
In some of these the hyperglycaemia was severe and in some cases also associated with ketoacidosis.
Na podlagi retrospektivne primerjave s samim zdravilom Kaletra kaže, da kombinirana uporaba zdravila Kaletra in sakvinavirja ne vpliva na koncentracijo lopinavirja.
Many patients had confounding medical conditions some of which required therapy with agents that have been associated with the development of diabetes mellitus or hyperglycaemia.
Zdravilo Kaletra, uporabljena hkrati z dodatnimi 100 mg ritonavirja dvakrat na dan, je zvečala AUC lopinavirja za 33% in Cmin za 64% v primerjavi s samim zdravilom Kaletra.
Fat redistribution and metabolic disorders
Druga zdravila:
Combination antiretroviral therapy has been associated with redistribution of body fat (lipodystrophy) in HIV patients.
Zdravila, ki zmanjšajo izločanje kisline (omeprazol, ranitidin):
The long-term consequences of these events are currently unknown.
Med uporabo tablet Kaletra 400/ 100 mg dvakrat na dan hkrati z omeprazolom ali ranitidinom v študiji pri zdravih prostovoljcih niso ugotovili klinično pomembnih interakcij.
Knowledge about the mechanism is incomplete.
Zdravilo Kaletra je mogoče uporabljati sočasno z zdravili, ki zmanjšajo izločanje kisline, ne da bi bilo treba prilagoditi odmerek.
A connection between visceral lipomatosis and protease inhibitors (PIs) and lipoatrophy and nucleoside reverse transcriptase inhibitors (NRTIs) has been hypothesised.
Antiaritmiki (bepridil, sistemski lidokain in kinidin): med sočasno uporabo z zdravilom Kaletra se njihova koncentracija lahko zveča.
A higher risk of lipodystrophy has been associated with individual factors such as older age, and with drug related factors such as longer duration of antiretroviral treatment and associated metabolic disturbances.
Priporočljiva je previdnost in, če je mogoče, merjenje terapevtskih koncentracij.
Clinical examination should include evaluation for physical signs of fat redistribution.
Zdravila proti raku (npr. vinkristin, vinblastin):
Consideration should be given to measurement of fasting serum lipids and blood glucose.
Antikoagulanti: če je varfarin uporabljen hkrati z zdravilom Kaletra, to lahko vpliva na njegovo koncentracijo.
Lipid disorders should be managed as clinically appropriate (see section 4.8).
Priporočljivo je nadziranje INR (mednarodnega normaliziranega razmerja).
Immune Reactivation Syndrome
Antiepileptiki:
In HIV-infected patients with severe immune deficiency at the time of institution of combination antiretroviral therapy (CART), an inflammatory reaction to asymtomatic or residual opportunistic pathogens may arise and cause serious clinical conditions, or aggravation of symptoms.
(fenobarbital, fenitoin, karbamazepin): inducirajo CYP3A4 in lahko zmanjšajo koncentracijo lopinavirja.
Relevant examples are cytomegalovirus retinitis, generalised and/ or focal mycobacterial infections, and Pneumocystis carinii pneumonia.
Poleg tega je sočasna uporaba fenitoina in kombinacije lopinavir/ ritonavir povzročila zmerno zmanjšanje koncentracije fenitoina v stanju dinamičnega ravnovesja.
Any inflammatory symptoms should be evaluated and treatment instituted when necessary.
Med sočasno uporabo kombinacije lopinavir/ ritonavir morate kontrolirati koncentracijo fenitoina.
Osteonecrosis
Bupropion:
Although the etiology is considered to be multifactorial (including corticosteroid use, alcohol consumption, severe immunosuppression, higher body mass index), cases of osteonecrosis have been reported particularly in patients with advanced HIV-disease and/ or long-term exposure to combination antiretroviral therapy (CART).
To je morda posledica indukcije presnove bupropiona.
Patients should be advised to seek medical advice if they experience joint aches and pain, joint stiffness or difficulty in movement.
Če presodite, da je sočasna uporaba lopinavirja/ ritonavirja z bupropionom neizogibna, morate med sočasno uporabo teh zdravil natančno klinično spremljati učinkovitost bupropiona in kljub opaženi indukciji ne smete preseči priporočenega odmerka.
PR interval prolongation
Po sočasni uporabi trazodona in ritonavirja so v
Lopinavir/ ritonavir has been shown to cause modest asymptomatic prolongation of the PR interval in some healthy adult subjects.
73 tej študiji opazili naslednje neželene učinke: navzejo, omotico, hipotenzijo in sinkopo.
Rare reports of 2nd or 3rd degree atroventricular block in patients with underlying structural heart disease and pre-existing conduction system abnormalities or in patients receiving drugs known to prolong the PR interval (such as verapamil or atazanavir) have been reported in patients receiving lopinavir/ ritonavir.
Ni znano, ali lahko tudi kombinacija lopinavir/ ritonavir podobno poveča izpostavljenost trazodonu.
Kaletra should be used with caution in such patients (see section 5.1).
Kombinacijo uporabljajte previdno; v poštev pride zmanjšanje odmerka trazodona.
Interactions with medicinal products
Digoksin:
Kaletra contains lopinavir and ritonavir, both of which are inhibitors of the P450 isoform CYP3A.
Med sočasno uporabo z zdravilom Kaletra se lahko koncentracija digoksina v plazmi zviša.
Kaletra is likely to increase plasma concentrations of medicinal products that are primarily metabolised by CYP3A.
V primeru sočasne uporabe zdravila Kaletra in digoksina morate biti previdni.
These increases of plasma concentrations of co-administered medicinal products could increase or prolong their therapeutic effect and adverse events (see sections 4.3 and 4.5).
Priporočljiva je terapevtska kontrola koncentracije digoksina, če ta možnost obstaja.
67 The HMG-CoA reductase inhibitors simvastatin and lovastatin are highly dependent on CYP3A for metabolism, thus concomitant use of Kaletra with simvastatin or lovastatin is not recommended due to an increased risk of myopathy including rhabdomyolysis.
Posebna previdnost je potrebna pri predpisovanju zdravila Kaletra bolnikom, ki jemljejo digoksin, kajti pričakovati je treba, da akutno zaviralno delovanje ritonavirja na PgP občutno zviša koncentracijo digoksina.
Caution must also be exercised and reduced doses should be considered if Kaletra is used concurrently with rosuvastatin or with atorvastatin, which is metabolised to a lesser extent by CYP3A4.
Pričakovati je mogoče, da uvedba digoksina pri bolnikih, ki že jemljejo zdravilo Kaletra, doseže manjši porast koncentracije digoksina.
If treatment with a HMG-CoA reductase inhibitor is indicated, pravastatin or fluvastatin is recommended (see section 4.5).
Zdravilo Kaletra lahko zveča njihovo koncentracijo v serumu.
Particular caution must be used when prescribing Kaletra and medicinal products known to induce QT interval prolongation such as: chlorpheniramine, quinidine, erythromycin, clarithromycin.
Presnova atorvastatina je manj odvisna od CYP3A.
Indeed, Kaletra could increase concentrations of the co-administered medicinal products and this may result in an increase of their associated cardiac adverse events.
Ko so atorvastatin uporabili hkrati z zdravilom Kaletra, so opažali v povprečju 4, 7- kratno zvečanje Cmax in 5, 9- kratno zvečanje AUC atorvastatina.
Cardiac events have been reported with Kaletra in preclinical studies; therefore, the potential cardiac effects of Kaletra cannot be currently ruled out (see sections 4.8 and 5.3).
Toda med sočasno uporabo rosuvastatina in zdravila Kaletra so opažali v povprečju 5- kratno povečanje Cmax in 2- kratno povečanje AUC rosuvastatina.
Co-administration of Kaletra with rifampicin is not recommended.
Previdnost je potrebna, kadar zdravilo Kaletra uporabljate hkrati z rosuvastatinom.
Rifampicin in combination with Kaletra causes large decreases in lopinavir concentrations which may in turn significantly decrease the lopinavir therapeutic effect.
Rezultati interakcijske raziskave z zdravilom Kaletra in pravastatinom ne kažejo klinično pomembnega medsebojnega delovanja.
Adequate exposure to lopinavir/ ritonavir may be achieved when a higher dose of Kaletra is used but this is associated with a higher risk of liver and gastrointestinal toxicity.
Presnova pravastatina in fluvastatina ni odvisna od CYP3A4 in medsebojnega delovanja z zdravilom Kaletra ni pričakovati.
Therefore, this co-administration should be avoided unless judged strictly necessary (see section 4.5).
Če je indicirano zdravljenje z zaviralcem reduktaze HMG- CoA, sta priporočljiva pravastatin ali fluvastatin.
Other
Deksametazon: lahko inducira CYP3A4 in zmanjša koncentracijo lopinavirja.
Kaletra is not a cure for HIV infection or AIDS.
Zaviralci fosfodiesteraze:
It does not reduce the risk of passing HIV to others through sexual contact or blood contamination.
Pričakovati je, da sočasna uporaba zaviralcev fosfodiesteraze, odvisnih od presnove s CYP3A4 (npr. tadalafila in sildenafila), in shem z ritonavirjem (vključno z zdravilom Kaletra) približno 2- krat (tadalafil) oz.
Appropriate precautions should be taken.
11- krat (sildenafil) poveča AUC teh zaviralcev.
People taking Kaletra may still develop infections or other illnesses associated with HIV disease and AIDS.
Bolnikom, ki jemljejo zdravilo Kaletra, morate sildenafil oz. tadalafil predpisovati posebno previdno in jih pogosteje nadzorovati glede neželenih učinkov.
Concomitant use of Kaletra and fluticasone or other glucocorticoids that are metabolised by CYP3A4 is not recommended unless the potential benefit of treatment outweighs the risk of systemic corticosteroid effects, including Cushing’ s syndrome and adrenal suppression (see section 4.5).
Pričakovati je, da sočasna uporaba vardenafila s shemami, ki vključujejo ritonavir (vključno z zdravilom Kaletra), povzroči 49- kratno povečanje AUC vardenafila.
4.5 Interaction with other medicinal products and other forms of interaction
Uporaba vardenafila z zdravilom Kaletra je kontraindicirana (glejte poglavje 4. 3).
Kaletra contains lopinavir and ritonavir, both of which are inhibitors of the P450 isoform CYP3A in vitro.
Ciklosporin, sirolimus (rapamicin) in takrolimus: med sočasno uporabo z zdravilom Kaletra se njihova koncentracija lahko zveča.
Kaletra does not inhibit CYP2D6, CYP2C9, CYP2C19, CYP2E1, CYP2B6 or CYP1A2 at clinically relevant concentrations (see section 4.3).
Dokler se koncentracija teh zdravil v plazmi ne stabilizira, je priporočljivo pogostejše kontroliranje terapevtske koncentracije.
Kaletra has been shown in vivo to induce its own metabolism and to increase the biotransformation of some medicinal products metabolised by cytochrome P450 enzymes and by glucuronidation.
Zdravilo Kaletra lahko zveča njuno koncentracijo v serumu.
This may result in lowered plasma concentrations and potential decrease of efficacy of co-administered medicinal products.
Veliki odmerki ketokonazola in itrakonazola (> 200 mg/ dan) niso priporočljivi.
Medicinal products that are contraindicated specifically due to the expected magnitude of interaction and potential for serious adverse events are listed in section 4.3.
Zaradi možnega zmanjšanja koncentracije vorikonazola se je treba izogniti sočasni uporabi vorikonazola in nizkih odmerkov ritonavirja (100 mg dvakrat na dan), kot jih vsebuje zdravilo Kaletra, razen če ocena koristi in tveganja pri bolniku upravičuje uporabo vorikonazola.
All interaction studies, when otherwise not stated, were performed using Kaletra capsules, which gives an approximately 20% lower exposure of lopinavir than the 200/ 50 mg tablets.
Pri bolnikih z okvaro ledvic ali jeter je treba razmisliti o zmanjšanju odmerka klaritromicina (glejte poglavje 4. 4).
Antiretroviral agents
74 Buprenorfin:
Nucleoside/ Nucleotide reverse transcriptase inhibitors (NRTIs):
Med sočasno uporabo buprenorfina (v odmerku 16 mg na dan) in kombinacije lopinavir/ ritonavir (v odmerku 400/ 100 mg dvakrat na dan) niso ugotovili klinično pomembnega medsebojnega delovanja.
Stavudine and Lamivudine: no change in the pharmacokinetics of lopinavir was observed when Kaletra was given alone or in combination with stavudine and lamivudine in clinical studies.
Zdravilo Kaletra lahko uporabite sočasno z buprenorfinom brez prilagoditve odmerka.
68 Didanosine: it is recommended that didanosine be administered on an empty stomach; therefore, didanosine may be co-administered with Kaletra tablets without food.
Priporočljivo je nadziranje koncentracije metadona v plazmi.
Zidovudine and Abacavir:
Kontraceptivi:
Kaletra induces glucuronidation; therefore Kaletra has the potential to reduce zidovudine and abacavir plasma concentrations.
Ob sočasni uporabi estrogenskih peroralnih kontraceptivov in zdravila Kaletra se je koncentracija etinilestradiola zmanjšala.
The clinical significance of this potential interaction is unknown.
Med sočasno uporabo zdravila Kaletra s kontraceptivi, ki vsebujejo etinilestradiol (ne glede na formulacijo kontraceptiva, npr. peroralni ali obliž), je treba uporabiti druge načine kontracepcijske zaščite.
Tenofovir: when tenofovir disoproxil fumarate was co-administered with Kaletra, tenofovir concentrations were increased by approximately 30% with no changes noted in lopinavir or ritonavir concentrations.
Rifabutin: med 10- dnevno sočasno uporabo rifabutina in zdravila Kaletra, se je Cmax rifabutina (matične substance in aktivnega 25- O- dezacetilnega presnovka) zvečala za 3, 5- krat, AUC pa za 5, 7 - krat.
Higher tenofovir concentrations could potentiate tenofovir associated adverse events, including renal disorders.
Na podlagi teh podatkov je med hkratno uporabo rifabutina in zdravila Kaletra priporočljivo 75% zmanjšanje odmerka rifabutina (t. j.
Non-nucleoside reverse transcriptase inhibitors (NNRTIs):
Potrebno utegne biti še nadaljnje zmanjšanje.
In a study performed in healthy volunteers to explore the interaction between Kaletra tablets (400/ 100 mg twice daily) and efavirenz (600 mg once daily), efavirenz has been shown to decrease the lopinavir concentrations by 30 - 40%.
Rifampicin: sočasna uporaba zdravila Kaletra in rifampicina ni priporočljiva.
When Kaletra tablet dosages were increased to 500/ 125 mg twice daily during co-administration of efavirenz 600 mg once daily in healthy volunteers, lopinavir pharmacokinetic parameters were similar to those obtained with Kaletra tablets 400/ 100 mg twice daily administered alone.
Uporaba rifampicina z zdravilom Kaletra povzroči veliko zmanjšanje koncentracij lopinavirja, s posledičnim pomembnim zmanjšanjem terapevtskega učinka lopinavirja.
Therefore, the Kaletra tablets dosage should be increased to 500/ 125 mg twice daily when co-administered with efavirenz 600 mg once daily.
Prilagoditev odmerka zdravila Kaletra 400 mg/ 400 mg dvakrat na dan kompenzira inducibilni učinek rifampicina na CYP3A4.
Similar pharmacokinetic interactions are expected for the co-administration of Kaletra tablets with the NNRTI nevirapine and with the protease inhibitors nelfinavir and amprenavir.
Vendar je taka prilagoditev odmerka lahko povezana z zvišanjem ALT/ AST in s povečanjem bolezni prebavil.
The same recommendations for monitoring apply in these cases of co-administration.
Zato naj se taka sočasna uporaba izogiba, razen če se presodi, da je absolutno potrebna.
Co-administration with other HIV protease inhibitors (PIs):
Dvigajoče titriranje odmerka zdravila Kaletra se lahko prične šele po začetku jemanja rifampicina (glejte poglavje 4. 4).
Kaletra (400/ 100 mg twice daily) has been studied in combination with reduced doses of amprenavir, indinavir, nelfinavir and saquinavir in steady-state controlled healthy volunteer studies relative to clinical doses of each HIV protease inhibitor in the absence of ritonavir.
Šentjanževka: sočasna uporaba zeliščnih pripravkov šentjanževke (Hypericum perforatum) lahko zmanjša koncentracijo lopinavirja in ritonavirja v serumu.
Comparisons to published pharmacokinetic data with ritonavir-enhanced amprenavir and saquinavir regimens are also described.
To je posledica indukcije encimov, ki presnavljajo zdravila, s šentjanževko.
Additionally, the effect of additional ritonavir on the pharmacokinetics of lopinavir are discussed.
Zeliščnih izdelkov, ki vsebujejo šentjanževko, se zato ne sme kombinirati z lopinavirjem in ritonavirjem.
Note that the historical comparisons to ritonavir-enhanced protease inhibitor regimens should be interpreted with caution (see details of combinations below).
Če bolnik že jemlje šentjanževko, njeno jemanje prekinite in, če je mogoče, kontrolirajte raven virusov.