Lopinavir/Ritonavir
A to Z Drug Facts
Lopinavir/Ritonavir |
Kaletra |
Class: Antiviral |
Action Inhibits HIV protease, the enzyme required to form functional proteins in HIV-infected patients. Ritonavir inhibits the cytochrome P450 (CYP) 3A-mediated metabolism of lopinavir, increasing lopinavir plasma concentrations.
Indications Treatment of HIV infections in combination with other antiviral agents.
Contraindications Concurrent administration with drugs that are highly dependent on CYP3A or CYP2D6 for clearance and for which elevated plasma levels are associated with serious or life-threatening reactions.
ADULTS: PO 400/100 mg of lopinavir/ritonavir bid. When combined with efavirenz or nevirapine, a dose of 533/133 mg of lopinavir/ritonavir bid should be considered. CHILDREN (6 MO to 12 YR) Dose based on lopinavir component of combination.
Without efavirenz or nevirapine
7 to < 15 KG CHILD: PO 12 mg/kg bid. 15 to 40 KG CHILD: PO 10 mg/kg bid. > 40 kg CHILD: PO Adult dose.
With efavirenz or nevirapine
7 to < 15 KG CHILD: PO 13 mg/kg bid. 15 to 50 KG CHILD: PO 11 mg/kg bid. > 50 KG CHILD: PO Adult dose.
Anticonvulsants (eg, carbamazepine, phenobarbital, phenytoin), corticosteroids (eg, dexamethasone), efavirenz, rifampin, St. John's wort, nevirapine: Effects of lopinavir/ritonavir may be decreased. Antiarrhythmic agents (eg, amiodarone, bepridil, flecainide, lidocaine [systemic], propafenone, quinidine), ergot derivatives (eg, dihydroergotamine, ergonovine, ergotamine, methylergonovine), midazolam, pimozide, triazolam: Contraindicated because of potentially serious or life-threatening reactions. Clarithromycin, dihydropyridine calcium channel blockers (eg, felodipine, nifedipine, nicardipine), HMG-CoA reductase inhibitors (eg, atorvastatin, cerivastatin, lovastatin, simvastatin), immunosuppressants (eg, cyclosporine, sirolimus, tacrolimus, rapamycin), itraconazole, ketoconazole, rifabutin, sildenafil: Lopinavir/ritonavir may increase the effects of these agents. Atovaquone, methadone, oral contraceptives (eg, ethinyl estradiol): Lopinavir/ritonavir may decrease the efficacy of these agents. Disulfiram, metronidazole: Disulfiram-like reaction may occur due to alcohol present in lopinavir/ritonavir oral solution.
Lab Test Interferences None well documented.
CV: Deep vein thrombosis; hypertension; palpitation; thrombophlebitis; vasculitis. CNS: Headache; insomnia; abnormal dreams; agitation; amnesia; anxiety; ataxia; confusion; depression; dizziness; dyskinesia; emotional lability; encephalopathy; hypertonia; decreased libido; nervousness; neuropathy; paresthesia; peripheral neuritis; somnolence; abnormal thinking; tremor. DERM: Rash; acne; alopecia; dry skin; exfoliative dermatitis; furunculosis; maculopapular rash; nail disorder; pruritus; benign neoplasm; skin discoloration; sweating. EENT: Dry mouth; sinusitis; abnormal vision; otitis media; taste perversion; tinnitus. GI: Abdominal pain; abnormal stools; diarrhea; nausea; vomiting; anorexia; constipation; dyspepsia; dysphagia; enterocolitis; eructation; esophagitis; fecal incontinence; flatulence; gastritis; gastroenteritis; GI hemorrhage; colitis; increased appetite; pancreatitis; sialadenitis; stomatitis; ulcerative stomatitis. GU: Abnormal ejaculation; gynecomastia; hypogonadism; kidney calculus; urine abnormalities. HEMA: Anemia; leukopenia. HEPA: Cholecystitis. META: Hypothyroidism; Cushing syndrome; avitaminosis; dehydration; edema; decreased glucose tolerance; lactic acidosis; weight loss. RESP: Bronchitis; dyspnea; pulmonary edema. OTHER: Asthenia; pain; lymphadenopathy; arthralgia; arthrosis; myalgia; back pain; chest pain; substernal pain; chills; facial edema; fever; flu-like symptoms; malaise; viral infection.
Pregnancy: Category C. Lactation: HIV-infected mothers should not breastfeed their infants. Children < 6 mo: Safety and efficacy not established. Elderly: Select dose with caution, reflecting greater frequency of decreased hepatic, renal, or cardiac function and comorbidity. Hepatic function impairment: Use with caution, decreased lopinavir/ritonavir clearance may occur. Pancreatitis: Fatalities have been associated with use.
PATIENT CARE CONSIDERATIONS |
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Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts