HIV protease inhibitor (boosted)
Darunavir
Brand names: Prezista
Adult dose
Dose: 800mg OD with ritonavir 100mg OD or cobicistat 150mg OD with food
Route: Oral
Frequency: OD
Clinical pearls
- BHIVA / EACS HIV guidelines: high genetic barrier — option for treatment-experienced or poor adherence cohorts
- Always boosted (ritonavir or cobicistat); take with food
Contraindications
- Severe hepatic impairment
- Concurrent contraindicated CYP3A4 substrates (ergots, midazolam, lovastatin/simvastatin)
- Hypersensitivity (sulfonamide cross-reactivity possible)
Side effects
- Diarrhoea
- Nausea
- Rash (SJS/TEN rare)
- Hepatotoxicity
- Hyperglycaemia
- Hyperlipidaemia
- Lipodystrophy
Interactions
- Many CYP3A4 — statins, PPIs (atazanavir not darunavir issue), ergots, midazolam, oral contraceptives, rifampicin
Monitoring
- VL/CD4
- LFTs
- Lipids
- Glucose
- Drug interactions
Reference: BNF; BHIVA HIV guidelines; EACS; https://bnf.nice.org.uk/drugs/darunavir/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- SMART Risk Score for Recurrent CVD · Cardiovascular Risk
- PCSK9 Inhibitor Eligibility Assessment · Lipid Management
- Immune-Related Adverse Events (irAE) -- GI Toxicity Colitis Grading · Oncology-Related GI
- irAE Hepatitis Grading (CTCAE) · Immunotherapy
- DIPSS — Dynamic International Prognostic Scoring System for Myelofibrosis · Cancer Prognosis
- BALL Score for Relapsed/Refractory CLL · Leukaemia
Pathways
- Infective Endocarditis · ESC 2023 Infective Endocarditis Guidelines; NICE NG41
- Eczema Herpeticum · BAD; NICE CKS
- Suspected Bacterial Meningitis (Adult) · NICE NG240 (2024); NICE NG143 (paeds)
- Clostridioides difficile Colitis · NICE NG199 (2021); IDSA/SHEA 2021
- Returning Traveller — Fever · NaTHNaC; PHE; ESCMID 2018
- Malaria — Diagnosis & Management · PHE 2016; WHO 2023