Darunavir (Prezista) and Ketamine Therapy | Tovani Health
Prezista (Darunavir) (also: Symtuza) — HIV protease inhibitor (boosted with ritonavir or cobicistat)
Verdict at Tovani Health
Boosted darunavir has strong CYP3A4 inhibition — same magnitude as Paxlovid.
Darunavir alongside ketamine requires individual evaluation. Darunavir is always given with a pharmacokinetic booster — either ritonavir or cobicistat — both of which are strong CYP3A4 inhibitors. The boosted regimen substantially raises ketamine plasma levels via CYP3A4 inhibition, similar to Paxlovid in magnitude. Unlike Paxlovid (5-day course), darunavir-based regimens are chronic, so this isn't a 'wait it out' situation. We coordinate KAP dose downward and may delay onset until alternative HIV regimens (integrase-inhibitor-based without booster, like Biktarvy) are an option to discuss with your HIV team.
If you take Prezista regularly and are considering at-home ketamine therapy, eligibility depends on your specific situation — we evaluate case by case. This page covers the brief pharmacologic context and what we do at intake.
How Prezista interacts with ketamine
Darunavir inhibits HIV protease. The booster (ritonavir or cobicistat) potently inhibits CYP3A4 — its sole purpose in this combination. Ketamine clearance via CYP3A4 slows substantially.
What we do at intake
Disclose your full HIV regimen including booster (ritonavir or cobicistat). We adjust KAP dose to account for the CYP3A4 inhibition, or coordinate with your HIV provider on regimen options.
Bottom line
Darunavir alongside ketamine requires individual evaluation. Darunavir is always given with a pharmacokinetic booster — either ritonavir or cobicistat — both of which are strong CYP3A4 inhibitors. The boosted regimen substantially raises ketamine plasma levels via CYP3A4 inhibition, similar to Paxlovid in magnitude. Unlike Paxlovid (5-day course), darunavir-based regimens are chronic, so this isn't a 'wait it out' situation. We coordinate KAP dose downward and may delay onset until alternative HIV regimens (integrase-inhibitor-based without booster, like Biktarvy) are an option to discuss with your HIV team.
Ready to find out if at-home ketamine fits your situation?
We’ll note that you’re on Prezista (Darunavir) at intake. The eligibility check takes 5 minutes and gives you an honest answer about whether at-home ketamine fits your specific situation.
FL and NJ residents only. Benjamin Soffer, DO — Tovani Health.
Sources
The verdict and clinical guidance on this page are based on the following peer-reviewed literature and FDA prescribing information.
- Ketamine: A Review of Clinical Pharmacokinetics and Pharmacodynamics in Anesthetic and Pain Therapy. Peltoniemi MA, Hagelberg NM, Olkkola KT, Saari TI. Clinical Pharmacokinetics. 2016. PMID: 27028535
Clinically reviewed
Reviewed by Benjamin Soffer, DO on May 22, 2026. Dr. Soffer is a board-certified physician (American Board of Internal Medicine) licensed in Florida and New Jersey, prescribing at-home ketamine therapy through Tovani Health.
This page is general information about how this medication interacts with at-home ketamine therapy at Tovani Health. It is not a substitute for medical advice from your prescribing physician about your specific situation. Always discuss medication changes with the doctor who prescribed them.