Ritonavir/Lopinavir and Its Potential Interactions With Psychiatric Medications: A COVID-19 Perspective

摘要

© 2020.The coronavirus disease 2019 (COVID-19) pandemic is a global catastrophe. One of the medications being proposed for the treatment of COVID-19 is the antiretroviral drug combination of ritonavir and lopinavir.1 Ritonavir is a potent cytochrome P450 (CYP) 2D6, 3A4, and 1A2 inhibitor and a CYP2B6, CYP2C19, and glucuronidation inducer.1 It is also an inducer and inhibitor of p-glycoprotein (a transmembrane drug efflux pump that extrudes toxins and hence protects organs).2 It is also a CYP2D6 and CYP3A4 substrate. CYP inhibition of ritonavir rises with increased dose, and it affects CYP2D6 more than other CYP enzymes. Lopinavir is primarily metabolized by CYP3A4. Lopinavir, when combined with a low dose of ritonavir, inhibits its own metabolism and thus augments its effect.3 Psychotropics are metabolized by the CYP enzymes and have a multitude of drug interactions with this antiretroviral combination.1.