Ritonavir: Difference between revisions
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==Background== | ==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. | 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. |
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
- Protease inhibitor boosting
- HIV post-exposure prophylaxis
- 100 mg PO QID
- Part of multi-drug regimen
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
- 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
- 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
- ↑ 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