Lopinavir/ritonavir dosage

Bonafe SM, Costa DA, Vaz MJ, Senise JF, Pott-Junior H, Machado RH, et al. A randomized controlled trial to assess safety, tolerabiUty, and antepartum viral load with increased lopinavir/ritonavir dosage in pregnancy. AIDS Patient Care STDS 2013 27(ll) 589-95. 

Therapy-naive patients-The recommended dosage is 400/100 mg of lopinavir/ritonavir (3 capsules or 5 mL taken with food, or 2 tablets taken with or without food) twice daily or 800/200 mg of lopinavir/ritonavir (6 capsules or 10 ml taken with food, or 4 tablets with or without food) once daily. 

Children (6 months to 12 years of age) The recommended dosage of lopinavir/ritonavir oral solution is 12/3 mg/kg for those weighing 7 to less than 15 kg and 10/2.5 mg/kg for those 15 to 40 kg (approximately equivalent to 230/57.5 mg/m ) twice daily with food, up to a maximum dose of 400/100 mg in children greater than 40 kg (5 mL or 3 capsules, or 2 tablets) twice daily. It is preferred that the prescriber calculate the appropriate milligram dose for each individual child 12 years of age and younger and determine the corresponding volume of solution or number of capsules or tablets. 

Lopinavir/Ritonavir Pediatric Dosage Without Efavirenz or Nevirapine... 

HIV infection (in combination with other antiretrovirals) PO 800 mg (two 400-mg capsules) q8h. Dosage adjustments when given concomitantly Delavirdine, itraconazole, ketoconazok Reduce dose to 600 mg q8h. Efavirenz-. Increase dose to 1,000 mg q8h. Lopinavir/ritonavir Reduce dose to 600 mg twice a day. Nevirapine-. Increase dose to 1,000 mgqSh. Rifabutin-. Reduce rifabutin by lA and increase indinavir to 1,000 mg q8h. Ritonavir 100-200 mg twice a day and indinavir 800 mg twice a day or ritonavir 400 mg twice a day and indinavir 400 mg twice a day. 

HIV infection in combination with other antiretrovirals PO (Fortovase) 1,200 mg 3 times a day or 1,000 mg twice a day in combination with ritonavir 100 mg twice a day. PO (Invirase) 1,000 mg (5X200 mg or 2X500 mg) twice a day in combination with ritonavir 100 mg twice a day. Dosage adjustments when given in combination therapy Delavirdine Fortovase 800 mg 3 times a day Lopinavir/ritonavir-. Fortovase 800 mg twice a day Nelfinavir. Fortovase 800 mg 3 times a day or 1,200 mg twice a day. Ritonavir. Fortovase or Invirase 1,000 mg twice a day... 

An optimum dosage for concurrent use has not been established. A dose increase of lopinavir/ritonavir oral solution to 533/133 mg twice daily (dose rounded to 6.5 mL) or 600/150 mg twice daily may be needed if amprenavir is given. Avoid once daily regimens. ... 

Rifabutin bioavailability is increased by amprenavir, atazanavir, fosamprenavir/ritonavir, indinavir, lopinavir/ritonavir, nelfinavir, tipranavir/ritonavir, and especially ritonavir, with an increased risk of toxicity. Rifabutin modestiy decreases the bioavailability of indinavir, neifinavir, and particuiarly saquinavir (with an increased risk of therapeutic faiiure), but has no effect on amprenavir, atazanavir, and ritonavir-boosted fosamprenavir. The combination of rifabutin with protease inhibitors may be used, but dosage adjustments of rifabutin or both drugs are often necessary. 

Drug-drug interactious Lopinavir - - ritonavir The steady-state pharmacokinetics of rifabutin and its active metabolite 25-desacetyl-rifabutin have been examined before and after the addition of lopinavir - -ritonavir in 10 patients with HIV infection and active tuberculosis [79 ]. Samples were collected at 2-4 weeks after starting rifabutin 300 mg thrice weekly without lopinavir -I- ritonavir, 2 weeks after the addition of lopinavir -I- ritonavir 400/100 mg bd to rifabutin 150 mg thrice weekly, and (if rifabutin plasma concentrations were below the target range) 2 weeks after an increase in rifabutin dosage to 300 mg thrice weekly with lopinavir + ritonavir. Lopinavir - -ritonavir reduced the Cmax of total rifabutin and most unbound rifabutin C ax values were below the tuberculosis MIC. For most patients, the AUC was low or lower than associated with treatment failure or relapse and with acquired rifampicin resistance. The authors concluded that the recommended doses of rifabutin for use with lopinavir -I- ritonavir may be inadequate in many patients and recommended monitoring of plasma concentrations. 

Lopinavir + ritonavir The interaction of rifampicin with lopinavir -I- ritonavir has been assessed in 34 patients, of whom 23 took a non-adjusted dose of lopinavir + ritonavir (400/100 mg bd or 800/200 mg/ day), six took a slightly adjusted dose (500/ 125 or 533/133 mg bd), and five took a recommended dose (400/400 or 800/200 mg bd) [85 ]. Seven prematmely stopped taking the combination within 4 weeks because of acute adverse events (4/23, 1/6, and 2/5 in the three respective dosage groups). Combined use of lopinavir -I- ritonavir and rifampicin is challenging, as it implies a balance between suboptimal efficacy and toxicity. 

Pharmaeokinetie studies have suggested that ritonavir and lopinavir/riton-avir ean modestly reduee warfarin levels. Clinieal information on an inter-aetion between eoumarins and protease inhibitors is limited to the ease reports eited, whieh either show an inerease in warfarin effeets (ritonavir or saquinavir) or a deerease in warfarin or aeenoeoumarol effeets (indinavir, nelfmavir, or ritonavir). These eases show it would be prudent to monitor the prothrombin times and INRs of any patient if any HIV protease inhibitor is added, being alert for the need to modify the eoumarin dosage. 

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