[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [HIV protease inhibitors (PIs)](https://durgical.com/en/pharmacology/classes/hiv-protease-inhibitors/) › Darunavir

[Pharmacology](https://durgical.com/en/pharmacology/) · [HIV protease inhibitors (PIs)](https://durgical.com/en/pharmacology/classes/hiv-protease-inhibitors/)

# Darunavir

A protease inhibitor with a high genetic barrier. Given boosted with ritonavir (or cobicistat) and with food; the preferred PI for second line.

Updated 2026-11-01

- Class: [HIV protease inhibitors (PIs)](https://durgical.com/en/pharmacology/classes/hiv-protease-inhibitors/)
- Enzyme: HIV-1 protease
- ATC code: J05AE10
- WHO Model List of Essential Medicines

Also called: DRV

✂**HIV-1 protease**Darunavir

ⓘ The figure shows darunavir in the active site of HIV-1 protease, between the two catalytic aspartic acids.

**Target in 3D:** HIV-1 protease. PDB structure 1T3R (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/1T3R) · Drag to rotate · pinch to zoom

## Mechanism of action

It binds tightly but reversibly to the active site of HIV aspartyl protease and also hinders the two halves from pairing into a dimer; the virus needs several mutations to resist it. Without active protease, the Gag and Gag-Pol polyproteins are not cut and virions come out immature.

- It binds the HIV protease active site
- Gag and Gag-Pol polyproteins stay uncut
- New virions come out immature and non-infectious

## Pharmacokinetics

**Absorption**
Oral bioavailability 37% alone and 82% with ritonavir; taken with food

**Metabolism**
Liver, by CYP3A; ritonavir slows that metabolism

## Indications

- HIV-1 infection, boosted and combined with other antiretrovirals [HIV infection and AIDS →](https://durgical.com/en/conditions/hiv-infection-and-aids/)

## Adverse effects

### Common

- Diarrhoea, nausea, vomiting, abdominal pain
- Headache
- Rash
- Raised lipids

### Serious (rare, important)

- Hepatotoxicity
- Severe skin reactions (Stevens-Johnson, toxic epidermal necrolysis, DRESS)

## Contraindications

- Narrow-margin drugs highly dependent on CYP3A (for example simvastatin, lovastatin, certain sedatives and antiarrhythmics)
- Strong inducers such as rifampicin or St John's wort

## Key interactions

**Rifampicin**
Greatly lowers darunavir: contraindicated

**Statins cleared by CYP3A**
Risk of myopathy and rhabdomyolysis

## What is monitored

- Liver tests
- Lipids and glucose
- Skin
- Viral load and CD4

## Administration and safety

- By mouth, with food and with its booster
- It has a sulfonamide group: ask about sulfa allergy
- Keep a full list of medicines and herbal products and review it with pharmacy before any new drug

## Nursing care

- Confirm it is given with the ordered booster
- Teach to take it with food
- Watch for rash and signs of hepatitis
- Review interactions before any new drug

## Pregnancy and breastfeeding

Antiretroviral treatment in pregnancy protects the mother and lowers HIV transmission to the baby; the treating team chooses the regimen.

## Memory aid

'Darunavir is DURABLE': high genetic barrier, always boosted and with food.

## Test yourself

Think of the answer, then tap the question to see it.

## Why does darunavir withstand mutations better than other PIs?

It binds the active site very tightly and also prevents protease dimerisation; at least three associated mutations are needed to lose its effect.

## What does ritonavir do to darunavir bioavailability?

It raises it greatly (from 37% to 82%) by inhibiting CYP3A metabolism.

## Which chemical group in darunavir prompts an allergy question?

The sulfonamide: it is used with caution in sulfa allergy.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/darunavir/)

## Related drugs

- [Ritonavir](https://durgical.com/en/pharmacology/ritonavir/)
- [Atazanavir](https://durgical.com/en/pharmacology/atazanavir/)
- [Lopinavir/ritonavir](https://durgical.com/en/pharmacology/lopinavir-ritonavir/)

## Related conditions

- [HIV infection and AIDS](https://durgical.com/en/conditions/hiv-infection-and-aids/)

[← Back to the class: HIV protease inhibitors (PIs)](https://durgical.com/en/pharmacology/classes/hiv-protease-inhibitors/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - DARUNAVIR tablet, film coated](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=56daf67e-7501-4cd5-be22-566d7997d42e) (DailyMed (U.S. National Library of Medicine), 2025); [Darunavir: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a607042.html) (MedlinePlus (U.S. National Library of Medicine), 2025); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=J05AE10) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/) (World Health Organization, 2025).

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Representative model, for educational purposes only.

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