OPIOIDS AND PROTEASE INHIBITORS - OTHER OPIOIDS
Ritonavir is predicted to increase the effects of dihydrocodeine, oxycodone, and tramadol. However, there is no clinical evidence that this occurs. Ritonavir may also decrease the effects of codeine by inhibiting its metabolism to an active metabolite.
Caution and careful monitoring of effects is warranted with dihydrocodeine, oxycodone, and tramadol as high levels may lead to CNS depression. Smaller initial doses may be appropriate. In contrast, codeine may be less effective than expected. Low-dose ritonavir would be expected to have a less potent effect on the metabolism of these opioids and dose adjustments would not generally be required.
Caution and careful monitoring of effects is warranted with dihydrocodeine, oxycodone, and tramadol as high levels may lead to CNS depression. Smaller initial doses may be appropriate. In contrast, codeine may be less effective than expected. Low-dose ritonavir would be expected to have a less potent effect on the metabolism of these opioids and dose adjustments would not generally be required.