Interactions between malaria drugs and etravirine or darunavir/r

The interactions at steady state between artemether/lumefantrine (40/480 mg for three days) and etravirine (200 mg twice daily) or darunavir/r (600/100 mg twice daily) were investigated in two HIV negative groups (n=14 each).

Etravirine decreased the AUC of artemether, dihydroartemisinin and lumefantrine by 38%, 15% and 13%, respectively. Darunavir/r decreased the AUCs of artemether (16%) and dihydroartimisin (18%) but increased lumefantrine AUC by 2.75-fold. Co-administration of artemether/lumefantrine had no effect on the AUCs of etravirine, darunavir or ritonavir.

The antimalarial activity of artemether may be lowered in the presence of etravirine and therefore, the combination should be used with caution.

Pharmacokinetically, darunavir/r can be co-administered with artemether/lumefantrine without dose adjustment however co-administration is not recommended with other drugs that may cause QTc prolongation (such as lumefantrine).

Kakuda T et al. Pharmacokinetic interaction between etravirine or darunavir/ritonavir and artemether/lumefantrine in healthy volunteers: a randomised trial. 13th PK Workshop, Barcelona, 2012. Oral abstract O_05.