Table. 10 Drugs that should not be used with protease inhibitors

Drug Category	Indinavir	Ritonavir*	Saquinavir (given as Invirase or Fortovase)	Nelfinavir	Alternatives
Analgesics	(none)	meperidine piroxicam propoxyphene	(none)	(none)	ASA oxycodon acetaminophen
Cardiac	(none)	amioderone ecainide flecainide propafenone quinidine	(none)	(none)	limited experience
Anti-Mycobacterial	rifampin	rifabutin**	rifampin rifabutin	rifampin	For rifabutin (as alternative for MAI treatment): clarithromycin, ethambutol (treatment, not prophylaxis), or azithromycin
Ca++ channel blocker	(none)	bepridil	(none)	(none)	limited experience
Antihistimine	astemizole terfenadine	astemizole terfenadine	astemizole terfenadine	astemizole terfenadine	loratadine
GI	cisapride	cisapride	cisapride	cisapride	limited experience
Antidepressant	(none)	bupropion	(none)	(none)	fluoxetine desipramine
Neuroleptic	(none)	clozapine pimozide	(none)	(none)	limited experience
Psychotropic	midazolam triazolam	clorazepate diazepam triazolam estazolam flurazepam midazolam triazolam zolpidem	midazolam triazolam	midazolam triazolam	temazepam lorazepam
Ergot Alkaloid (vasoconstrictor)	dihydro- ergotamine (D.H.E. 45) ergotamine*** (various firm)	dihydroergotamine (D.H.E. 45) ergotamine*** (various forms)	dihydro- ergotamine (D.H.E. 45) ergotamine*** (various firm)	dihydroergotamine D.H.E. 45), ergotamine*** (various forms)	limited experience

* The contraindicated drugs listed are based on theoretical considerations. Thus, drugs with low therapeutic indices yet with suspected major metabolic contribution from cytochrome P450 3A, CYP2D6, or unknown pathways are included in this table. Actual interactions may or may not occur in patients.

** Reduce rifabutin dose to one quarter of the standard dose.

*** This is likely a class effect. --