RITONAVIR = RTV oral

Therapeutic action

• Antiretroviral, HIV protease inhibitor

Indications

• Booster for protease inhibitors (atazanavir, darunavir, lopinavir, etc.) in HIV infection. Ritonavir should not be used alone.

Forms and strengths

• 25 mg and 100 mg tablets

Dosage

Dosage depends on the administration schedule of the boosted protease inhibitor. The daily dose is administered once daily or in 2 divided doses.

• Child 14 to < 25 kg:
  • 50 mg (two 25 mg tablets) 2 times daily, or
  • 100 mg (four 25 mg tablets or one 100 mg tablet) once daily
• Child ≥ 25 kg and adult: 100 mg (one 100 mg tablet) once or 2 times daily

Duration

• Depending on the efficacy and tolerance of the boosted protease inhibitor and ritonavir.

Contra-indications, adverse effects, precautions

• Do not administer to patients with severe hepatic impairment.
• Administer with caution and monitor use in patients with haemophilia (increased bleeding) or mild to moderate hepatic impairment.
• The adverse effects of ritonavir as a booster are also dependent on the boosted protease inhibitor.
• May cause:
  • gastrointestinal disturbances, fatigue, headache, dizziness, paraesthesia, joint and muscle pain, taste disturbances, hyperglycaemia, hyperlipidaemia, lipodystrophy, conduction disorders;
  • pancreatitis, hepatic disorders, skin rash sometimes severe; in this event, stop treatment immediately.
• Ritonavir reduces the efficacy of implants and oral contraceptives.: use injectable medroxyprogesterone or an intrauterine device. Only when combined with atazanavir, an oral contraceptive containing at least 30 micrograms of ethinylestradiol per tablet may also be used.
• Pregnancy: no contra-indication

Remarks

• Take with meals.
• Tablets are not recommended in children < 14 kg. 
• Also comes in fixed-dose combinations with other protease inhibitors (atazanavir, darunavir, lopinavir, etc.). Preferably use these formulations when available.

Storage