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Herb-drug interaction between Echinacea purpurea and darunavir/ritonavir in HIV-infected patients

  • 1,
  • 2,
  • 1,
  • 3,
  • 1,
  • 4 and
  • 3
Journal of the International AIDS Society201013 (Suppl 4) :P187

  • Published:


  • Public Health
  • Confidence Interval
  • Body Mass Index
  • Infectious Disease
  • Protease Inhibitor

Purpose of the study

To investigate the potential of a commonly used botanical supplement, Echinacea purpurea, to interact with the boosted protease inhibitor darunavir/ritonavir.


Open-label, fixed-sequence study in 15 HIV-infected patients receiving antiretroviral therapy including darunavir/ritonavir (600/100 mg twice daily) for at least 4 weeks. Echinacea purpurea root extract-containing capsules were added to the antiretroviral treatment (500 mg every 6 hours) from days 1 to 14. Darunavir concentrations in plasma were determined by using HPLC immediately before and 1, 2, 4, 6, 8, 10 and 12 hours after a morning dose of darunavir/ritonavir on days 0 (darunavir/ritonavir) and 14 (darunavir/ritonavir + echinacea). Individual darunavir pharmacokinetic parameters were calculated by using non-compartmental analysis, and were compared between days 0 and 14 by using the geometric mean ratio (GMR) and its 95% confidence interval (95% CI).


Median (range) age was 49 (43-67) years, and body mass index was 24.2 (18.7-27.5) kg/m2. Echinacea was well tolerated and all participants completed the study. Relative to administration of darunavir/ritonavir alone, its coadministration with Echinacea purpurea resulted in little change in darunavir pharmacokinetic parameters. Table 1

Table 1



DRV/r + Echinacea

GMR (95% CI)


Cτ (ng/mL)

2.1 (1.6-2.7)

1.7 (1.4-2.2)

0.84 (0.59-1.19)


AUCτ (ng.h/mL)

46.2 (39.0-54.7)

41.6 (35.1-49.2)

0.90 (0.71-1.14)


Cmax (ng/mL)

6.4 (5.5-7.4)

6.2 (5.3-7.25)

0.98 (0.79-1.21)



coadministration of Echinacea purpurea with darunavir/ritonavir was safe and well tolerated in HIV-infected patients; data suggest that no dose adjustment for darunavir/ritonavir is necessary.

Authors’ Affiliations

Hospital Universitari Germans Trias i Pujol, “Lluita contra la Sida” Foundation, HIV Clinic, Badalona, Spain
Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, PK/PD modelling and simulation, Barcelona, Spain
Hospital Universitari Germans Trias i Pujol, "IrsiCaixa" Foundation, HIV Clinic, Badalona, Spain
Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Centre d'Investigació del Medicament, Barcelona, Spain


© Moltó et al; licensee BioMed Central Ltd. 2010

This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.