Ritonavir: Difference between revisions

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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
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