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Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Contributing EditorIndividualAuthor
To the Editor: The Consensus Statement on antiretroviral
therapy in adults by Dr Carpenter and colleagues1
contains an inaccuracy regarding the effect of coadministration of ritonavir
on the exposure of saquinavir in the soft-gelatin formulation (saquinavir
SGF). Table 2 states that ritonavir coadministration results in an increase
in saquinavir exposure (area under the plasma concentration curve [AUC]) of
121%. This estimate, however, is too low by greater than an order of magnitude.2
The increase of 121% results from a comparison of the 24-hour saquinavir
exposures obtained with the combination of 400 mg of ritonavir twice daily
plus 400 mg of saquinavir SGF twice daily against exposures obtained with
saquinavir SGF, 1200 mg, administered 3 times daily (the licensed dosage).3,4 This comparison was previously
presented because it was considered to be clinically meaningful in view of
the wide use of the ritonavir, 400 mg, and saquinavir SGF, 400 mg, twice daily
dosage combination in clinical practice.
When saquinavir SGF and ritonavir are coadministered, the doses of both
drugs should be adjusted because of the substantial effect of ritonavir on
the metabolism of saquinavir.
Buss N. Effect of Ritonavir on Saquinavir Metabolism. JAMA. 2000;283(22):2936–2937. doi:10.1001/jama.283.22.2931
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