Lopinavir + Ritonavir

By Medically reviewed by hellodoktor

Generic Name: Lopinavir + Ritonavir Brand Name(s): Lopinavir + Ritonavir.

Uses

What is Lopinavir + Ritonavir used for?

This combination product contains two medications: lopinavir and ritonavir. This product is used with other HIV medications to help control HIV infection. It helps to decrease the amount of HIV in your body so your immune system can work better. This lowers your chance of getting HIV complications (such as new infections, cancer) and improves your quality of life. Both lopinavir and ritonavir belong to a class of drugs known as HIV protease inhibitors. Ritonavir increases (“boosts”) the levels of lopinavir. This helps lopinavir work better.

Lopinavir/ritonavir is not a cure for HIV infection. To decrease your risk of spreading HIV disease to others, do all of the following: (1) continue to take all HIV medications exactly as prescribed by your doctor, (2) always use an effective barrier method (latex or polyurethane condoms/dental dams) during all sexual activity, and (3) do not share personal items (such as needles/syringes, toothbrushes, and razors) that may have contacted blood or other body fluids. Consult your doctor or pharmacist for more details.

How should I take Lopinavir + Ritonavir?

Take this medication by mouth with or without food as directed by your doctor, usually once or twice daily. Swallow the tablets whole. Do not crush, break or chew the tablets.

The dosage is based on your medical condition, response to treatment, and other medications you may be taking. Be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

For children, the dosage is also based on age, weight, and height. Once-daily dosing of this medication is not recommended for children younger than 18 years of age.

If you are taking didanosine in addition to this product, you can take it at the same time as this product, but take them both without food.

It is very important to continue taking this medication (and other HIV medications) exactly as prescribed by your doctor. Do not skip any doses.

This medication works best when the amount of drug in your body is kept at a constant level. Therefore, take this drug at evenly spaced intervals. To help you remember, take it at the same time(s) each day.

Do not take more or less of this drug than prescribed or stop taking it (or other HIV medicines) even for a short time unless directed to do so by your doctor. Doing so may cause the amount of virus to increase, make the infection more difficult to treat (resistant), or worsen side effects.

How do I store Lopinavir + Ritonavir?

Lopinavir + Ritonavir is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Lopinavir + Ritonavir in the bathroom or the freezer. There may be different brands of Lopinavir + Ritonavir that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Lopinavir + Ritonavir down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Lopinavir + Ritonavir?

Before taking this product, tell your doctor or pharmacist if you are allergic to either lopinavir or ritonavir; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver disease, diabetes, pancreatitis, high blood fat levels (cholesterol/triglycerides), heart problems (coronary artery disease, heart attack), bleeding problems (such as hemophilia), previous infection with certain diseases (such as hepatitis B infection, hepatitis C infection, tuberculosis).

Lopinavir/ritonavir may cause a condition that affects the heart rhythm (QT prolongation). QT prolongation can rarely cause serious (rarely fatal) fast/irregular heartbeat and other symptoms (such as severe dizziness, fainting) that need medical attention right away.

The risk of QT prolongation may be increased if you have certain medical conditions or are taking other drugs that may cause QT prolongation. Before using lopinavir/ritonavir, tell your doctor or pharmacist of all the drugs you take and if you have any of the following conditions: certain heart problems (heart failure, slow heartbeat, QT prolongation in the EKG), family history of certain heart problems (QT prolongation in the EKG, sudden cardiac death).

Low levels of potassium or magnesium in the blood may also increase your risk of QT prolongation. This risk may increase if you use certain drugs (such as diuretics/”water pills”) or if you have conditions such as severe sweating, diarrhea, or vomiting. Talk to your doctor about using lopinavir/ritonavir safely.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Older adults may be more sensitive to the side effects of this drug, especially QT prolongation.

Tell your doctor if you are pregnant before using this medication. Treatment can lower the risk of passing HIV infection to your baby. Discuss the risks and benefits with your doctor.

It is unknown if this medication passes into breast milk. Because breast milk can transmit HIV, do not breast-feed.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Lopinavir + Ritonavir during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Lopinavir + Ritonavir. Lopinavir + Ritonavir is pregnancy risk category N according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Side effects

What side effects can occur from Lopinavir + Ritonavir?

Diarrhea, nausea, vomiting, stomach upset, gas, headache, and trouble sleeping may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

As your immune system gets stronger, it can begin to fight off infections you already had, possibly causing disease symptoms to come back. You could also have symptoms if your immune system becomes overactive. This reaction may happen at any time (soon after starting HIV treatment or many months later). Get medical help right away if you have any serious symptoms, including: unexplained weight loss, severe tiredness, muscle aches/weakness that doesn’t go away, headaches that are severe or don’t go away, joint pain, numbness/tingling of the hands/feet/arms/legs, vision changes, signs of infection (such as fever, chills, swollen lymph nodes, trouble breathing, cough, non-healing skin sores), signs of an overactive thyroid (such as irritability, nervousness, heat intolerance, fast/pounding/irregular heartbeat, bulging eyes, unusual growth in the neck/thyroid known as a goiter), signs of a certain nerve problem known as Guillain-Barre syndrome (such as trouble breathing/swallowing/moving your eyes, drooping face, paralysis, trouble speaking).

Tell your doctor right away if you have any serious side effects, including: increased thirst, increased urination, confusion, persistent nausea/vomiting, stomach/abdominal pain, yellowing eyes/skin, dark urine.

Get medical help right away if you have any very serious side effects, including: symptoms of a heart attack (such as chest/jaw/left arm pain, shortness of breath, unusual sweating), severe dizziness, fainting, slow/fast/irregular heartbeat.

Changes in body fat may occur while you are taking this medication (such as increased fat in the upper back and stomach areas, decreased fat in the arms and legs). The cause and long-term effects of these changes are unknown. Discuss the risks and benefits of treatment with your doctor, as well as the possible use of exercise to reduce this side effect.

This medication may cause an increase in blood fat levels (cholesterol and triglycerides). Cholesterol and triglyceride testing should be done before and occasionally during treatment with this medication. Consult your doctor or pharmacist for more information.

A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.

Not everyone experiences these side effects. There may be some side effects not listed above. If you have any concerns about a side-effect, please consult your doctor or pharmacist.

Interactions

What drugs may interact with Lopinavir + Ritonavir?

Lopinavir/ritonavir interacts with many medications. Some products that may interact with this drug include: cobicistat, certain HIV medications (such as fosamprenavir, tipranavir), orlistat.

Other medications can affect the removal of lopinavir/ritonavir from your body, which may affect how lopinavir/ritonavir works. Examples include boceprevir, rifampin, St. John’s wort, among others.

Lopinavir/ritonavir can speed up or slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include certain alpha blockers (such as alfuzosin, tamsulosin), certain inhaled drugs to treat breathing problems (such as fluticasone, salmeterol), cisapride, drugs to treat erectile dysfunction-ED or pulmonary hypertension (such as sildenafil, tadalafil), ergot drugs (such as ergotamine, dihydroergotamine), pimozide, rivaroxaban, simeprevir, telaprevir, certain sedatives (such as midazolam, triazolam), certain statins (such as lovastatin, simvastatin), among others.

This medication may decrease the effectiveness of hormonal birth control such as pills, patch, or ring. This could cause pregnancy. Talk to your doctor about additional or alternative reliable forms of birth control, and always use an effective barrier method (latex or polyurethane condoms/dental dams) during all sexual activity to decrease the risk of spreading HIV to others. Tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your hormonal birth control is not working well.

Lopinavir + Ritonavir may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Lopinavir + Ritonavir?

Lopinavir + Ritonavir may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Lopinavir + Ritonavir?

Lopinavir + Ritonavir may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Lopinavir + Ritonavir.

What is the dose of Lopinavir + Ritonavir for an adult?

Usual Adult Dose for HIV Infection

Once-daily dosing regimen: Lopinavir 800 mg-ritonavir 200 mg orally once a day

Twice-daily dosing regimen: Lopinavir 400 mg-ritonavir 100 mg orally twice a day

Twice-daily dosing regimen in combination with efavirenz, nelfinavir, or nevirapine:

-Tablets: Lopinavir 500 mg-ritonavir 125 mg orally twice a day

-Oral solution: Lopinavir 520 mg-ritonavir 130 mg orally twice a day

-Capsules: Lopinavir 533 mg-ritonavir 133 mg orally twice a day

Comments:

-Patients with less than 3 lopinavir resistance-associated substitutions can use the once-daily or twice-daily dosing regimen.

-Once-daily dosing regimen is not recommended for patients with 3 or more lopinavir resistance-associated substitutions including L10F/I/R/V, K20M/N/R, L24I, L33F, M36I, I47V, G48V, I54L/T/V, V82A/C/F/S/T, and I84V; twice-daily dosing regimen must be used.

-Once-daily dosing regimen should not be used with concomitant carbamazepine, efavirenz, nelfinavir, nevirapine, phenobarbital, or phenytoin.

-Twice-daily dosing regimen is recommended for pregnant women with no documented lopinavir-associated resistance substitutions; insufficient data to recommend dosing in those with any documented lopinavir-associated resistance substitutions.

-Once-daily dosing regimen is not recommended in pregnancy.

-Pregnant women should not use the oral solution.

-No dose adjustment needed during postpartum period.

Use: In combination with other antiretroviral agents, for the treatment of HIV-1 infection

Usual Adult Dose for Nonoccupational Exposure

US CDC recommendations: Lopinavir 400 mg-ritonavir 100 mg orally twice a day

Duration of therapy: 28 days

Comments:

-This drug should be used with zidovudine plus (lamivudine or emtricitabine); recommended as the preferred protease inhibitor-based regimen for nonoccupational postexposure prophylaxis of HIV infection.

-Prophylaxis should be started as soon as possible, within 72 hours of exposure.

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

Caution recommended.

What is the dose of Lopinavir + Ritonavir for a child?

Usual Pediatric Dose for HIV Infection

ORAL SOLUTION:

14 days to 6 months: 16 mg/kg or 300 mg/m2 (lopinavir component) orally twice a day

6 months to 18 years:

Based on BSA: 230 mg/m2 (lopinavir component) orally twice a day

Maximum dose: Lopinavir 400 mg-ritonavir 100 mg orally twice a day

Based on weight:

Less than 15 kg: 12 mg/kg (lopinavir component) orally twice a day

15 to 40 kg: 10 mg/kg (lopinavir component) orally twice a day

Greater than 40 kg: Lopinavir 400 mg-ritonavir 100 mg orally twice a day

-Concomitant efavirenz, nelfinavir, or nevirapine:

Based on BSA: 300 mg/m2 (lopinavir component) orally twice a day

Maximum dose: Lopinavir 520 mg-ritonavir 130 mg orally twice a day

Based on weight:

Less than 15 kg: 13 mg/kg (lopinavir component) orally twice a day

Greater than 15 to 45 kg: 11 mg/kg (lopinavir component) orally twice a day

Greater than 45 kg: Lopinavir 520 mg-ritonavir 130 mg orally twice a day

TABLETS:

6 months to 18 years:

15 to 25 kg or BSA 0.6 to less than 0.9 m2: Lopinavir 200 mg-ritonavir 50 mg orally twice a day

Greater than 25 to 35 kg or BSA 0.9 to less than 1.4 m2: Lopinavir 300 mg-ritonavir 75 mg orally twice a day

Greater than 35 kg or BSA at least 1.4 m2: Lopinavir 400 mg-ritonavir 100 mg orally twice a day

-Concomitant efavirenz, nelfinavir, or nevirapine:

15 to 20 kg or BSA 0.6 to less than 0.8 m2: Lopinavir 200 mg-ritonavir 50 mg orally twice a day

Greater than 20 to 30 kg or BSA 0.8 to less than 1.2 m2: Lopinavir 300 mg-ritonavir 75 mg orally twice a day

Greater than 30 to 45 kg or BSA 1.2 to less than 1.7 m2: Lopinavir 400 mg-ritonavir 100 mg orally twice a day

Greater than 45 kg or BSA at least 1.7 m2: Lopinavir 500 mg-ritonavir 125 mg orally twice a day

CAPSULES:

Children less than 12 years weighing greater than 40 kg and children greater than 12 years: Lopinavir 400 mg-ritonavir 100 mg orally twice a day

-Concomitant efavirenz, nelfinavir, or nevirapine:

Greater than 45 kg: Lopinavir 533 mg-ritonavir 133 mg orally twice a day

Comments:

-The oral solution should not be given to neonates before a postmenstrual age of 42 weeks and a postnatal age of at least 14 days has been reached.

-This drug should not be used with efavirenz, nelfinavir, or nevirapine in patients younger than 6 months.

-Pediatric dose should not exceed the usual adult dose.

-Once-daily dosing is not recommended for patients younger than 18 years.

-The oral solution is available for patients with BSA less than 0.6 m2 or those who are unable to reliably swallow tablets or capsules.

-Special attention should be given to accurate calculation of dose, transcription of medication order, dispensing information, and dosing instructions to reduce risk for medication errors and overdose; particularly important for infants and young children.

Use: In combination with other antiretroviral agents, for the treatment of HIV-1 infection

Precautions

Safety and efficacy have not been established in patients younger than 14 days.

How is Lopinavir + Ritonavir available?

Lopinavir + Ritonavir is available in the following dosage forms and strengths:

  • Oral tablet
  • Oral liquid
  • Oral capsule

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Lopinavir + Ritonavir, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

Hello Health Group does not provide medical advice, diagnosis or treatment.

Sources

Review Date: March 17, 2018 | Last Modified: September 12, 2019

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