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Case 4: Antiretrovirals and Oral Contraceptives

Author: Bradley W. Kosel, PharmD

Case last updated: June 30, 2004

A 27-year-old female with a CD4 cell count of 182 cells/mm3 presents to clinic three weeks after starting her new salvage antiretroviral regimen. She states she has been taking most of her medications. She admits to not always practicing safe sex and is concerned about getting pregnant. Her medical provider decides to start her on Ortho Novum 7/7/7 Triphasic (norethindrone/ethinyl estradiol) and reinforces her need to use condoms.

Current Medications:
Didanosine (Videx EC): 400 mg PO qd
Lamivudine (Epivir): 300 mg PO qd
Nevirapine (Viramune): 200 mg PO bid
Nelfinavir (Viracept): 1250 mg PO bid
Trimethoprim-sulfamethoxazole (Bactrim): 160 mg/800 mg PO qd
Pantoprazole (Protonix): 40 mg PO qd

Which of the following is TRUE regarding a potential drug-drug interaction?

A Nevirapine reduces the plasma levels of ethinyl estradiol.
B Nevirapine increases the plasma levels of ethinyl estradiol.
C Nelfinavir markedly increases the plasma levels of ethinyl estradiol.
D Pantoprazole decreases absorption of didanosine enteric-coated capsules.