Difference between revisions of "Ritonavir"

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==Background==
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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.
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==Administration==
 
==Administration==
 
*Type: [[Antiviral]]
 
*Type: [[Antiviral]]
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==Adult Dosing==
 
==Adult Dosing==
 
*HIV Treatment
 
*HIV Treatment
*HIV post-exposure prophylaxis
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**Protease inhibitor boosting
*
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***100-400 mg/day QD-BID
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**Sole protease inhibitor
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***600 mg PO BID
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***Start with 300 mg PO BID, increased by 200 mg/day every 2-3 days
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*[[HIV post-exposure prophylaxis]]
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**100 mg PO QID
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**Part of multi-drug regimen
  
 
==Pediatric Dosing==
 
==Pediatric Dosing==
 
*HIV Treatment
 
*HIV Treatment
*HIV post-exposure prophylaxis
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**Can be given in >1 month old, dosing varies based on other concominant treatments
*
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*[[HIV post-exposure prophylaxis]]
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**Can be given in >3 years old,  dosing varies based on other concominant treatments
  
 
==Special Populations==
 
==Special Populations==
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==Mechanism of Action==
 
==Mechanism of Action==
 
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*Binds to active site of HIV protease, preventing maturation of the virus
  
 
==Comments==
 
==Comments==
 
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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==
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*[[Lopinavir]]
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*[[HIV]]
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*[[HIV post-exposure prophylaxis]]
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*[[Coronavirus]]
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*[[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