Ritonavir Uses

sponsored
Is this medication very expensive?

What is Ritonavir?

Ritonavir is used alone or in combination with other medicines for the treatment of the infection caused by the human immunodeficiency virus (HIV). HIV is the virus that causes acquired immune deficiency syndrome (AIDS).

Ritonavir will not cure HIV infection or prevent AIDS. It helps keep HIV from reproducing and appears to slow down the destruction of the immune system. This may help delay problems that are usually related to AIDS or HIV disease from occurring. Ritonavir will not keep you from spreading HIV to other people. People who receive Ritonavir may continue to have other problems related to AIDS or HIV disease.

Ritonavir is available only with your doctor's prescription.

Ritonavir indications

infoAn indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol. A patient should be aware of the indications of medications used for common conditions because they can be taken over the counter in the pharmacy meaning without prescription by the Physician.
sponsored

Ritonavir is indicated in combination with other antiretroviral agents for the treatment of HIV-1 infection.

How should I use Ritonavir?

Use Ritonavir solution as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • An extra patient leaflet is available with Ritonavir solution. Talk to your pharmacist if you have questions about this information.
  • Take Ritonavir solution by mouth with food.
  • Shake well before each use.
  • Use a measuring device marked for medicine dosing. Ask your pharmacist for help if you are unsure of how to measure your dose.
  • To improve the taste of Ritonavir solution, you may mix it with 8 ounces of certain liquids (eg, chocolate milk, Ensure, or Advera) as directed in the patient leaflet. If you mix Ritonavir solution with these fluids, be sure to take it within 1 hour of mixing. As your doctor, nurse, or pharmacist if you have any questions about this information.
  • Continue to take Ritonavir solution even if you feel well. Do not miss any doses.
  • If you miss a dose of Ritonavir solution, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. It is important not to miss doses of Ritonavir solution. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use Ritonavir solution.

Uses of Ritonavir in details

infoThere are specific as well as general uses of a drug or medicine. A medicine can be used to prevent a disease, treat a disease over a period or cure a disease. It can also be used to treat the particular symptom of the disease. The drug use depends on the form the patient takes it. It may be more useful in injection form or sometimes in tablet form. The drug can be used for a single troubling symptom or a life-threatening condition. While some medications can be stopped after few days, some drugs need to be continued for prolonged period to get the benefit from it.
sponsored

Ritonavir is used along with other medication for treating human immunodeficiency virus (HIV 1) infection. It does not completely cure HIV or acquired immunodeficiency syndrome (AIDS).

Ritonavir description

An HIV protease inhibitor that works by interfering with the reproductive cycle of HIV. [PubChem]

Ritonavir dosage

General Dosing and Administration Recommendations

  • Ritonavir must be used in combination with other antiretroviral agents.
  • Ritonavir Tablets are administered orally. Ritonavir Tablets should be swallowed whole, and not chewed, broken or crushed. Take Ritonavir Tablets with meals.

Recommended Adult Dosage

Recommended Dosage for Treatment of HIV-1:

The recommended dosage of Ritonavir Tablets is 600 mg twice daily by mouth to be taken with meals. Use of a dose titration schedule may help to reduce treatment-emergent adverse events while maintaining appropriate Ritonavir plasma levels. Ritonavir Tablets should be started at no less than 300 mg twice daily and increased at 2 to 3 day intervals by 100 mg twice daily. The maximum dose of 600 mg twice daily should not be exceeded upon completion of the titration.

Recommended Pediatric Dosage

Ritonavir Tablets must be used in combination with other antiretroviral agents. The recommended dosage of Ritonavir Tablets in pediatric patients older than 1 month is 350 to 400 mg per m2 twice daily by mouth to be taken with meals and should not exceed 600 mg twice daily. Ritonavir Tablets should be started at 250 mg per m2 twice daily and increased at 2 to 3 day intervals by 50 mg per m2 twice daily. If patients do not tolerate 400 mg per m2 twice daily due to adverse events, the highest tolerated dose may be used for maintenance therapy in combination with other antiretroviral agents, however, alternative therapy should be considered.

Body surface area (BSA) can be calculated as follows1:

Dose Modification due to Drug Interaction

Dose reduction of Ritonavir is necessary when used with other protease inhibitors: atazanavir, darunavir, fosamprenavir, saquinavir, and tipranavir.

Prescribers should consult the full prescribing information and clinical study information of these protease inhibitors if they are co-administered with a reduced dose of Ritonavir.

Ritonavir interactions

See also:
What other drugs will affect Ritonavir?

sponsored

Ritonavir has been found to be an inhibitor of cytochrome P450 3A (CYP3A) both in vitro and in vivo (Table 2). Agents that are extensively metabolized by CYP3A and have high first pass metabolism appear to be the most susceptible to large increases in AUC (>3-fold) when co-administered with Ritonavir. Ritonavir also inhibits CYP2D6 to a lesser extent. Co-administration of substrates of CYP2D6 with Ritonavir could result in increases (up to 2-fold) in the AUC of the other agent, possibly requiring a proportional dosage reduction. Ritonavir also appears to induce CYP3A as well as other enzymes, including glucuronosyl transferase, CYP1A2, and possibly CYP2C9.

Drugs that are contraindicated specifically due to the expected magnitude of interaction and potential for serious adverse events are listed both in CONTRAINDICATIONS Table 3 and under Contraindicated Drugs in Table 4.

Those drug interactions that have been established based on drug interaction studies are listed with the pharmacokinetic results in CLINICAL PHARMACOLOGY, Table 2. The clinical recommendations based on the results of these studies are listed in Table 4 Established Drug Interactions: Alteration in Dose or Regimen Recommended Based on Drug Interaction Studies.

A systematic review of over 200 medications prescribed to HIV-infected patients was performed to identify potential drug interactions with Ritonavir. 2 There are a number of agents in which CYP3A or CYP2D6 partially contribute to the metabolism of the agent. In these cases, the magnitude of the interaction and therapeutic consequences cannot be predicted with any certainty.

When co-administering Ritonavir with calcium channel blockers, immunosuppressants, some HMG-CoA reductase inhibitors, some steroids, or other substrates of CYP3A, or most antidepressants, certain antiarrhythmics, and some narcotic analgesics which are partially mediated by CYP2D6 metabolism, it is possible that substantial increases in concentrations of these other agents may occur, possibly requiring a dosage reduction (>50%); examples are listed in Table 4 Predicted Drug Interactions: Use With Caution, Dose Decrease May be Needed.

When co-administering Ritonavir with any agent having a narrow therapeutic margin, such as anticoagulants, anticonvulsants, and antiarrhythmics, special attention is warranted. With some agents, the metabolism may be induced, resulting in decreased concentrations.

Table 4Drug Interactions With NORVIRCONTRAINDICATED DRUGS(Same as Table 3)
DRUGS THAT ARE CONTRAINDICATED WIT NORVIR USE

Ritonavir side effects

See also:
What are the possible side effects of Ritonavir?

sponsored

The following adverse reactions are discussed in greater detail in other sections of the labeling.

  • Drug Interactions
  • Hepatotoxicity
  • Pancreatitis
  • Allergic Reactions/Hypersensitivity

When co-administering Ritonavir with other protease inhibitors, see the full prescribing information for that protease inhibitor including adverse reactions.

Clinical Trial Experience

Because clinical trials are conducted under widely varying conditions, adverse reactions rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.

Adverse Reactions in Adults

The safety of Ritonavir alone and in combination with other antiretroviral agents was studied in 1,755 adult patients. Table 2 lists treatment-emergent Adverse Reactions (with possible or probable relationship to study drug) occurring in greater than or equal to 1% of adult patients receiving Ritonavir in combined Phase II/IV studies.

The most frequently reported adverse drug reactions among patients receiving Ritonavir alone or in combination with other antiretroviral drugs were gastrointestinal (including diarrhea, nausea, vomiting, abdominal pain (upper and lower)), neurological disturbances (including paresthesia and oral paresthesia), rash, and fatigue/asthenia.

Table 2. Treatment-Emergent Adverse Reactions (With Possible or Probable Relationship to Study Drug) Occurring in greater than or equal to 1% of Adult Patients Receiving Ritonavir in Combined Phase II/IV Studies (N = 1,755)
Adverse Reactions n %
Eye disorders
Blurred vision 113 6.4
Gastrointestinal disorders
Abdominal Pain (upper and lower)* 464 26.4
Diarrhea including severe with electrolyte imbalance* 1,192 67.9
Dyspepsia 201 11.5
Flatulence 142 8.1
Gastrointestinal hemorrhage* 41 2.3
Gastroesophageal reflux disease (GERD) 19 1.1
Nausea 1,007 57.4
Vomiting* 559 31.9
General disorders and administration site conditions
Fatigue including asthenia* 811 46.2
Hepatobiliary disorders
Blood bilirubin increased (including jaundice)* 25 1.4
Hepatitis (including increased AST, ALT, GGT)* 153 8.7
Immune system disorders
Hypersensitivity including urticaria and face edema* 114 8.2
Metabolism and nutrition disorders
Edema and peripheral edema* 110 6.3
Gout* 24 1.4
Hypercholesterolemia* 52 3.0
Hypertriglyceridemia* 158 9.0
Lipodystrophy acquired* 51 2.9
Musculoskeletal and connective tissue disorders
Arthralgia and back pain* 326 18.6
Myopathy/creatine phosphokinase increased* 66 3.8
Myalgia 156 8.9
Nervous system disorders
Dizziness* 274 15.6
Dysgeusia* 285 16.2
Paresthesia (including oral paresthesia)* 889 50.7
Peripheral neuropathy 178 10.1
Syncope* 58 3.3
Psychiatric disorders
Confusion* 52 3.0
Disturbance in attention 44 2.5
Renal and urinary disorders
Increased urination* 74 4.2
Respiratory, thoracic and mediastinal disorders
Coughing* 380 21.7
Oropharyngeal Pain* 279 15.9
Skin and subcutaneous tissue disorders
Acne* 67 3.8
Pruritus* 214 12.2
Rash (includes erythematous and maculopapular)* 475 27.1
Vascular disorders
Flushing, feeling hot* 232 13.2
Hypertension* 58 3.3
Hypotension including orthostatic hypotension* 30 1.7
Peripheral coldness* 21 1.2
* Represents a medical concept including several similar MedDRA PTs

Laboratory Abnormalities in Adults

Table 3 shows the percentage of adult patients who developed marked laboratory abnormalities.

Table 3. Percentage of Adult Patients, by Study and Treatment Group, with Chemistry and Hematology Abnormalities Occurring in greater than 3% of Patients Receiving Ritonavir
Study 245

Naive Patients

Study 247

Advanced Patients

Study 462 PI-Naive Patients
Variable Limit Ritonavir plus ZDV Ritonavir ZDV Ritonavir Placebo Ritonavir plus Saquinavir
Chemistry High
Cholesterol > 240 mg/dL 30.7 44.8 9.3 36.5 8.0 65.2
CPK > 1000 IU/L 9.6 12.1 11.0 9.1 6.3 9.9
GGT > 300 IU/L 1.8 5.2 1.7 19.6 11.3 9.2
SGOT (AST) > 180 IU/L 5.3 9.5 2.5 6.4 7.0 7.8
SGPT (ALT) > 215 IU/L 5.3 7.8 3.4 8.5 4.4 9.2
Triglycerides > 800 mg/dL 9.6 17.2 3.4 33.6 9.4 23.4
Triglycerides > 1500 mg/dL 1.8 2.6 - 12.6 0.4 11.3
Triglycerides Fasting > 1500 mg/dL 1.5 1.3 - 9.9 0.3 -
Uric Acid > 12 mg/dL - - - 3.8 0.2 1.4
Hematology Low
Hematocrit < 30% 2.6 - 0.8 17.3 22.0 0.7
Hemoglobin < 8.0 g/dL 0.9 - - 3.8 3.9 -
Neutrophils ≤ 0.5 x 109/L - - - 6.0 8.3 -
RBC < 3.0 x 1012/L 1.8 - 5.9 18.6 24.4 -
WBC < 2.5 x 109/L - 0.9 6.8 36.9 59.4 3.5
- Indicates no events reported.

Adverse Reactions in Pediatric Patients

Ritonavir has been studied in 265 pediatric patients greater than 1 month to 21 years of age. The adverse event profile observed during pediatric clinical trials was similar to that for adult patients.

Vomiting, diarrhea, and skin rash/allergy were the only drug-related clinical adverse events of moderate to severe intensity observed in greater than or equal to 2% of pediatric patients enrolled in Ritonavir clinical trials.

Laboratory Abnormalities in Pediatric Patients

The following Grade 3-4 laboratory abnormalities occurred in greater than 3% of pediatric patients who received treatment with Ritonavir either alone or in combination with reverse transcriptase inhibitors: neutropenia (9%), hyperamylasemia (7%), thrombocytopenia (5%), anemia (4%), and elevated AST (3%).

Postmarketing Experience

The following adverse events (not previously mentioned in the labeling) have been reported during post-marketing use of Ritonavir. Because these reactions are reported voluntarily from a population of unknown size, it is not possible to reliably estimate their frequency or establish a causal relationship to Ritonavir exposure.

Body as a Whole

Dehydration, usually associated with gastrointestinal symptoms, and sometimes resulting in hypotension, syncope, or renal insufficiency has been reported. Syncope, orthostatic hypotension, and renal insufficiency have also been reported without known dehydration.

Co-administration of Ritonavir with ergotamine or dihydroergotamine has been associated with acute ergot toxicity characterized by vasospasm and ischemia of the extremities and other tissues including the central nervous system.

Cardiovascular System

First-degree AV block, second-degree AV block, third-degree AV block, right bundle branch block have been reported.

Cardiac and neurologic events have been reported when Ritonavir has been co-administered with disopyramide, mexiletine, nefazodone, fluoxetine, and beta blockers. The possibility of drug interaction cannot be excluded.

Endocrine System

Cushing's syndrome and adrenal suppression have been reported when Ritonavir has been co-administered with fluticasone propionate or budesonide.

Nervous System

There have been postmarketing reports of seizure. Also, see Cardiovascular System.

Skin and subcutaneous tissue disorders

Toxic epidermal necrolysis (TEN) has been reported.

Ritonavir contraindications

See also:
What is the most important information I should know about Ritonavir?

  • When co-administering Ritonavir with other protease inhibitors, see the full prescribing information for that protease inhibitor including contraindication information.
  • Ritonavir is contraindicated in patients with known hypersensitivity (e.g., toxic epidermal necrolysis (TEN) or Stevens-Johnson syndrome) to Ritonavir or any of its ingredients.
  • Ritonavir is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening reactions.
  • Ritonavir is contraindicated with drugs that are potent CYP3A inducers where significantly reduced lopinavir plasma concentrations may be associated with the potential for loss of virologic response and possible resistance and cross-resistance.
Table 1. Drugs that are Contraindicated with Ritonavir
Drug Class Drugs Within Class That Are Contraindicated With Ritonavir** Clinical Comments
Alpha1-adrenoreceptor antagonist Alfuzosin HCL Potential for hypotension.
Antianginal Ranolazine Potential for serious and/or life-threatening reactions.
Antiarrhythmic Amiodarone, dronedarone, flecainide, propafenone, quinidine Potential for cardiac arrhythmias.
Antifungal Voriconazole Voriconazole is contraindicated with Ritonavir doses of 400 mg every 12 hours or greater due to the potential for loss of antifungal response.
Anti-gout Colchicinea Potential for serious and/or life-threatening reactions in patients with renal and/or hepatic impairment.
Antipsychotics Lurasidone

Pimozide

Potential for serious and/or life-threatening reactions.

Potential for serious and/or life‑threatening reactions such as cardiac arrhythmias.

Ergot Derivatives Dihydroergotamine, ergotamine, methylergonovine Potential for acute ergot toxicity characterized by vasospasm and ischemia of the extremities and other tissues including the central nervous system.
GI Motility Agent Cisapride Potential for cardiac arrhythmias.
Herbal Products St. John's Wort (hypericum perforatum) May lead to loss of virologic response and possible resistance to Ritonavir or to the class of protease inhibitors.
HMG-CoA Reductase Inhibitors Lovastatin, simvastatin Potential for myopathy including rhabdomyolysis.
PDE5 inhibitor Sildenafilb (Revatio®) when used for the treatment of pulmonary arterial hypertension (PAH) Potential for sildenafil-associated adverse events, including visual abnormalities, hypotension, prolonged erection, and syncope.
Sedative/hypnotics

Oral midazolamc, triazolam

Prolonged or increased sedation or respiratory depression.
a see Drug Interactions (7), Table 4 for colchicine doses in patients with normal hepatic and renal function.

b see Drug Interactions (7), Table 4 for co-administration of sildenafil in patients with erectile dysfunction.

c see Drug Interactions (7), Table 4 for parenterally administered midazolam.



Active ingredient matches for Ritonavir:

Ritonavir


Unit description / dosage (Manufacturer)Price, USD
Capsule; Oral; Ritonavir 100 mg
Norvir 100 mg softgel cap$ 10.29
Norvir 100 mg tablet$ 10.29

List of Ritonavir substitutes (brand and generic names):

RINAVO tab 100 mg x 30's (Mylan)$ 19.05
Ritomax 100mg CAP / 90 (Alkem (Cytomed))$ 39.29
100 mg x 90's (Alkem (Cytomed))$ 39.29
RITOMAX 100MG CAPSULE 1 packet / 60 capsules each (Alkem (Cytomed))$ 42.04
RITOMAX 100MG TABLET 1 strip / 30 tablets each (Alkem (Cytomed))$ 13.74
RITOMAX cap 100 mg x 90's (Alkem (Cytomed))$ 39.29
Ritomax 100mg Capsule (Alkem (Cytomed))$ 0.70
Ritomax 100mg Tablet (Alkem (Cytomed))$ 0.46
RITOMUNE Capsule/ Tablet / 100mg / 60 units (Cipla)$ 39.29
100 mg x 60's (Cipla)$ 28.57
Ritomune 100mg TAB / 60 (Cipla)$ 28.57
RITOMUNE 100MG CAPSULE 1 packet / 60 capsules each (Cipla)$ 28.57
RITOMUNE 100MG CAPSULE 1 strip / 30 capsules each (Cipla)$ 27.21
RITOMUNE 100MG TABLET 1 packet / 60 tablets each (Cipla)$ 28.57
RITOMUNE film-coated tab 100 mg x 60's (Cipla)$ 28.57
Ritomune 100mg Capsule (Cipla)$ 0.48
Ritomune 100mg Tablet (Cipla)$ 0.48
RITOVIR Capsule/ Tablet / 100mg / 80 units (Hetero HC (GenX))$ 51.59
Ritovir 100mg CAP / 30 (Hetero HC (GenX))$ 14.29
100 mg x 30's (Hetero HC (GenX))$ 14.29
RITOVIR 100MG CAPSULE 1 strip / 30 capsules each (Hetero HC (GenX))$ 13.74
RITOVIR 100MG CAPSULE 1 packet / 60 capsules each (Hetero HC (GenX))$ 30.00
RITOVIR 100MG CAPSULE 1 packet / 80 capsules each (Hetero HC (GenX))$ 106.26
RITOVIR film-coated tab 100 mg x 30's (Hetero HC (GenX))$ 14.29
V Letra 133.3+33.3 Tablet (Super Speciality (Ranbaxy Laboratories Ltd))$ 0.79
V LETRA 33.3MG/133.3MG CAPSULE 1 packet / 60 capsules each (Super Speciality (Ranbaxy Laboratories Ltd))$ 46.03
V LETRA 33.3MG/133.3MG CAPSULE 1 packet / 90 capsules each (Super Speciality (Ranbaxy Laboratories Ltd))$ 35.96
V Letra 33.3 mg/133.3 mg Capsule (Super Speciality (Ranbaxy Laboratories Ltd))$ 0.77
Virataz R 300+100 Tablet (Genx (Hetero Healthcare Ltd))$ 1.59
VIRATAZ R 300MG/100MG TABLET 1 strip / 30 tablets each (Genx (Hetero Healthcare Ltd))$ 47.62
Virataz R 300 mg/100 mg Tablet (Genx (Hetero Healthcare Ltd))$ 1.59
VIRITON 100MG TABLET 1 packet / 60 tablets each (Ranbaxy Laboratories Ltd)$ 30.00

References

  1. DailyMed. "OMBITASVIR; PARITAPREVIR; RITONAVIR: DailyMed provides trustworthy information about marketed drugs in the United States. DailyMed is the official provider of FDA label information (package inserts).". https://dailymed.nlm.nih.gov/dailyme... (accessed September 17, 2018).
  2. PubChem. "ritonavir". https://pubchem.ncbi.nlm.nih.gov/com... (accessed September 17, 2018).
  3. DrugBank. "ritonavir". http://www.drugbank.ca/drugs/DB00503 (accessed September 17, 2018).

Reviews

The results of a survey conducted on ndrugs.com for Ritonavir are given in detail below. The results of the survey conducted are based on the impressions and views of the website users and consumers taking Ritonavir. We implore you to kindly base your medical condition or therapeutic choices on the result or test conducted by a physician or licensed medical practitioners.

User reports

Consumer reported useful

No survey data has been collected yet


Consumer reported price estimates

No survey data has been collected yet


Consumer reported time for results

No survey data has been collected yet


Consumer reported age

No survey data has been collected yet


Consumer reviews


There are no reviews yet. Be the first to write one!


Your name: 
Email: 
Spam protection:  < Type 16 here

Information checked by Dr. Sachin Kumar, MD Pharmacology

| Privacy Policy
This site does not supply any medicines. It contains prices for information purposes only.
© 2003 - 2019 ndrugs.com All Rights Reserved