1. RITONAVIR INTERACTIONS AND SIDE EFFECTS Present by PEERAKARN BANJERDKIJ

2. OUTLINE Introduction HIV Therapy Types of HIV-drugs Protease Inhibitors work Ritonavir Pharmacology Drug Interactions Side effects Conclusion

3. INTRODUCTION Why is the “HIV Therapy” called “multiple therapies”? Ans. : Immune system What is the “medical problem”? Ans. : Drug interactions How many types of HIV-drugs? Ans. : 3 Types

4. Types of HIV-drugs 2 main groups 1. Reverse Transcriptase 1.1 Nucleoside Reverse Transcriptase Inhibitors (NRTIs) zidovudine (AZT) didanosine (ddI) 1.2 Non-nucleoside Reverse Transcriptase Inhibitors (NNRTIs) nevirapine delaviridine 2. Protease Inhibitors (PIs) indinavir ritonavir

5. What is HIV protease?

6. How do protease inhibitors work?

7. How do protease inhibitors differ from other available anti-HIV drugs?

8. OUTLINE Introduction Ritonavir Pharmacology Drug Interactions Side effects

9. Pharmacology Block maturation of virus By interfering Act at the stage of HIV replication cycle Produce resistance Bound plasma 98-99% Cross resistance combine with NNRTIs or NRTIs combine with PIs Cross resistance RITONAVIR

10. OUTLINE Introduction Ritonavir Pharmacology Drug Interactions Side effects

11. What types of other medications can interact with PIs? Ans.1 : HIV-HIV drugs - Combination Therapy - Double-Drug ; PIs + PIs, PIs + NRTIs - Triple-Drug ; PIs+PIs+NNRTIs Ans.2 : HIV-Other drugs ; PIs+Antivirals Combinations & Interactions RITONAVIR

12. Drug Interactions Metabolized by P450 at the liver Combine with competition drugs ; can occur 1. Metabolism of these drugs 2. Concentration of Ritonavir and these drugs RITONAVIR

13. Between Other drugs and Ritonavir DRUG INTERACTION http://www.hivinsite.UCSF.edu/topics/research_advances/2098.339b.html

14. Between Other drugs and PIs http://www.thebody.com/hivatis/agents1/table14.html DRUG INTERACTION

15. Between PIs and PIs * Invirase or Fortovase, + Conducted with Invirase, # with Fortovase http://www.thebody.com/hivatis/agents1/table15.html DRUG COMBINATION

16. OUTLINE Introduction Ritonavir Pharmacology Drug Interactions Side effects

17. Adverse Drug Reaction SIDE EFFECTS http://www.utoledo.edu/pharmacy/clinical/aids.html http://www.iapac.org/clinmgt/avtherapies/patient/proinbk.html#top

18. HIV Drugs -Toxicities SIDE EFFECTS http://www.thebody.com/hivatis/agents1/table16.html

19. OUTLINE Introduction Ritonavir Pharmacology Drug Interactions Side effects Conclusion

20. CONCLUSIONS Protease Inhibitors can cure or not! Combination ; more efficiency Side effects ; different ways Resistance Problems Cross resistance problems

21. THE END THANK YOU Dr. SUVITDr. SUVIT Dr. MARIADr. MARIA Mr. SOMJERDMr. SOMJERD CRI OFFIER & OUR CLASSCRI OFFIER & OUR CLASS……...

22. Advantages & Disadvantages of Class-Sparing Regimens SIDE EFFECTS http://www.thebody.com/hivatis/agents1/table7.html