Difference between revisions of "Ritonavir"

(Created page with "==Administration== *Type: *Dosage Forms: *Routes of Administration: *Common Trade Names: ==Adult Dosing== ==Pediatric Dosing== ==Special Populations== ===Drug pregnan...")
 
(Removed redirect to Lopinavir)
(Tag: Removed redirect)
 
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==Background==
 +
Ritonavir is usually given in combination with [[lopinavir]] for both treatment of [[HIV]] and [[HIV post-exposure prophylaxis]]. It is currently being studied in the use of [[COVID-19]] as well.
 +
 
==Administration==
 
==Administration==
*Type:  
+
*Type: [[Antiviral]]
*Dosage Forms:
+
*Dosage Forms: 100 mg
*Routes of Administration:
+
*Routes of Administration: PO
*Common Trade Names:  
+
*Common Trade Names: Norvir
  
 
==Adult Dosing==
 
==Adult Dosing==
 +
*HIV Treatment
 +
**Protease inhibitor boosting
 +
***100-400 mg/day QD-BID
 +
**Sole protease inhibitor
 +
***600 mg PO BID
 +
***Start with 300 mg PO BID, increased by 200 mg/day every 2-3 days
  
 +
*[[HIV post-exposure prophylaxis]]
 +
**100 mg PO QID
 +
**Part of multi-drug regimen
  
 
==Pediatric Dosing==
 
==Pediatric Dosing==
 
+
*HIV Treatment
 +
**Can be given in >1 month old, dosing varies based on other concominant treatments
 +
*[[HIV post-exposure prophylaxis]]
 +
**Can be given in >3 years old,  dosing varies based on other concominant treatments
  
 
==Special Populations==
 
==Special Populations==
 
===[[Drug pregnancy categories|Pregnancy Rating]]===
 
===[[Drug pregnancy categories|Pregnancy Rating]]===
*
+
*HIV: Benefits outweight risk during pregnancy. Avoid oral solution due to alcohol content.
  
 
===Lactation risk===
 
===Lactation risk===
*
+
*Avoid breastfeeding
  
 
===Renal Dosing===
 
===Renal Dosing===
*Adult:
+
*Adult: No adjustment
*Pediatric:
+
*Pediatric: Not defined, but likely no adjustment as in adults
  
 
===Hepatic Dosing===
 
===Hepatic Dosing===
 
*Adult:
 
*Adult:
 +
**Mild-moderate impairment: no adjustment
 +
**Severe impairment: not defined
 
*Pediatric:
 
*Pediatric:
 
+
**Mild-moderate impairment: no adjustment
 +
**Severe impairment: not defined
 
==Contraindications==
 
==Contraindications==
 
*Allergy to class/drug
 
*Allergy to class/drug
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==Adverse Reactions==
 
==Adverse Reactions==
 
===Serious===
 
===Serious===
 
+
*Hepatotoxicity
 +
*[[Pancreatitis]]
 +
*GI bleed
 +
*Hypersensitivity reaction
 +
*[[Anaphylaxis]]
 +
*[[Toxic epidermal necrolysis]]
 +
*[[Stevens-Johnson syndrome]]
 +
*PR prolongation/AV block
 +
*Hypercholesterolemia/hypertriglyceridemia
 +
*[[Diabetes mellitus]]/hyperglycemia
 +
*[[Immune reconstitution syndrome]]
 +
*Autoimmune disorders
 +
*[[Hypertension]]
 +
*[[Syncope]]
 +
*Orthostatic hypotension
 +
*Myopathy
 +
*[[Thrombocytopenia]]
  
 
===Common===
 
===Common===
 
+
*Nausea/vomiting
 +
*Diarrhea
 +
*Paresthesia
 +
*Fatigue
 +
*Rash
 +
*Abdominal pain
 +
*Cough
 +
*Dysgeusia
 +
*Oropharyngeal pain
 +
*Dizziness
 +
*AST, ALT, CK elevation
 +
*Edema
 +
*Acne
 +
*Lipodystrophy
  
 
==Pharmacology==
 
==Pharmacology==
*Half-life:  
+
*Half-life: 3-5 hours
*Metabolism:  
+
*Metabolism: Liver (CYP450)
*Excretion:  
+
*Excretion: Fecal
  
 
==Mechanism of Action==
 
==Mechanism of Action==
 
+
*Binds to active site of HIV protease, preventing maturation of the virus
  
 
==Comments==
 
==Comments==
 
+
A trial of [[lopinavir]]/[[ritonavir]] is currently being done to study use in [[COVID-19]]. So far, studies have not shown significant benefit in time to clinical improvement. Mortality at 28 days is lower but not statistically significant.<ref>Cao B, Wang Y, Wen D, et al. A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19 [published online ahead of print, 2020 Mar 18]. N Engl J Med. 2020;10.1056/NEJMoa2001282. doi:10.1056/NEJMoa2001282</ref>
  
 
==See Also==
 
==See Also==
 +
*[[Lopinavir]]
 +
*[[HIV]]
 +
*[[HIV post-exposure prophylaxis]]
 +
*[[Coronavirus]]
 +
*[[COVID-19]]
  
  

Latest revision as of 19:07, 22 March 2020

Background

Ritonavir is usually given in combination with lopinavir for both treatment of HIV and HIV post-exposure prophylaxis. It is currently being studied in the use of COVID-19 as well.

Administration

  • Type: Antiviral
  • Dosage Forms: 100 mg
  • Routes of Administration: PO
  • Common Trade Names: Norvir

Adult Dosing

  • HIV Treatment
    • Protease inhibitor boosting
      • 100-400 mg/day QD-BID
    • Sole protease inhibitor
      • 600 mg PO BID
      • Start with 300 mg PO BID, increased by 200 mg/day every 2-3 days

Pediatric Dosing

  • HIV Treatment
    • Can be given in >1 month old, dosing varies based on other concominant treatments
  • HIV post-exposure prophylaxis
    • Can be given in >3 years old, dosing varies based on other concominant treatments

Special Populations

Pregnancy Rating

  • HIV: Benefits outweight risk during pregnancy. Avoid oral solution due to alcohol content.

Lactation risk

  • Avoid breastfeeding

Renal Dosing

  • Adult: No adjustment
  • Pediatric: Not defined, but likely no adjustment as in adults

Hepatic Dosing

  • Adult:
    • Mild-moderate impairment: no adjustment
    • Severe impairment: not defined
  • Pediatric:
    • Mild-moderate impairment: no adjustment
    • Severe impairment: not defined

Contraindications

  • Allergy to class/drug

Adverse Reactions

Serious

Common

  • Nausea/vomiting
  • Diarrhea
  • Paresthesia
  • Fatigue
  • Rash
  • Abdominal pain
  • Cough
  • Dysgeusia
  • Oropharyngeal pain
  • Dizziness
  • AST, ALT, CK elevation
  • Edema
  • Acne
  • Lipodystrophy

Pharmacology

  • Half-life: 3-5 hours
  • Metabolism: Liver (CYP450)
  • Excretion: Fecal

Mechanism of Action

  • Binds to active site of HIV protease, preventing maturation of the virus

Comments

A trial of lopinavir/ritonavir is currently being done to study use in COVID-19. So far, studies have not shown significant benefit in time to clinical improvement. Mortality at 28 days is lower but not statistically significant.[1]

See Also


References

  1. Cao B, Wang Y, Wen D, et al. A Trial of Lopinavir-Ritonavir in Adults Hospitalized with Severe Covid-19 [published online ahead of print, 2020 Mar 18]. N Engl J Med. 2020;10.1056/NEJMoa2001282. doi:10.1056/NEJMoa2001282