Ritonavir Oral Route

Ritonavir, also known as the trade name Norvir, is a capsule, tablet or solution prescribed to HIV patients to treat the infection caused by the virus, slowing down the immune system destruction that it causes without curing the virus or preventing AIDS.

Overview

What is Ritonavir?

Ritonavir is a protease inhibitor type of drug, known to target the reproductive actions of the human immunodeficiency virus (HIV) and is commonly used in a combination drug therapy of other protease inhibitors. It is not an active antiviral, however it does possess properties that make it an effective pharmacokinetic booster of various protease inhibitors that are. Ritonavir is typically found with the drugs Ombitasvir, Dasabuvir and Paritaprevir in a combination drug pack.

Sold under the name Norvir, Ritonavir was approved for use in 1999. It is approved for adults and children over one month of age. No medication exists thus far that has been proven to cure HIV or AIDS including this one; Ritonavir is also not effective for use in stopping the spread of HIV. Cautions provided to you by your health care professional regarding the spread of HIV/AIDS should be followed at all times.

How does Ritonavir work?

HIV-1 protease is the name of an enzyme that the HIV virus requires to live and build new viruses. Drugs that are protease inhibitors, such as Ritonavir, bind themselves to this enzyme and stop their activity, preventing them from producing more of themselves and therefore spreading the virus. As a pharmacokinetic booster of other protease inhibitor drugs, Ritonavir increases the level of these drugs, thus providing a more effective combatant against the virus.

What is human immunodeficiency virus?

Human immunodeficiency virus, also known as HIV, is the virus that eventually causes AIDS which is known as acquired immunodeficiency syndrome. Patients with AIDS have a severely failed immune system, allowing a take-over by infections, cancers and other medical crisis conditions, which eventually end their life. Infection with HIV occurs with the transfer of bodily fluids including blood, semen, vaginal fluids and breast milk.

Vital cells are infected by HIV, leading to lower than healthy levels of these cells, eventually causing the body to become more susceptible to infection over time. Some people are initially unaware that they are infected with the HIV virus and can pass it on inadvertently. Early symptoms include:

  • Fever
  • Malaise
  • Arthralgia
  • Loss of appetite
  • Rash
  • Myalgia
  • Fever and rash
  • Pharngitis
  • Ulcers in the mouth
  • Loss of weight

If you exhibit any of these symptoms, it is advised that you get tested for HIV promptly as the earlier you are treated for the virus, the better chance you have of long term survival. If you have been diagnosed with HIV, your physician will advise you on preventive measures to keep from spreading it to others.

Conditions Treated

  • Human immunodeficiency virus, HIV

Type of Medicine

  • Protease inhibitor

Side Effects

Ritonavir, in its effort to prohibit a necessary enzyme from forming more of the HIV virus found in the body, may affect other processes and functions and cause unwanted effects. Not all of these effects are experienced by patients, but those who do show signs of them should seek medical attention. If you have any of these symptoms, contact your health care provider urgently?

  • Faintness, dizziness or lightheadedness
  • Overly warm or hot feeling
  • Flushed, red skin on the neck and face
  • Sweating
  • Headache
  • Confusion
  • Itchy, dry skin
  • Breath that smells like fruit
  • Dehydration
  • Hungry
  • Thirsty
  • More urine than typical, either frequency or amount
  • Vomiting
  • Nausea
  • Loss of weight
  • Chills
  • Bloating
  • Constipated
  • Spasms or seizures
  • Cough
  • Urine appears dark
  • Amount of urine decreased either quantity or frequency
  • Labored breathing
  • Mouth is dry causing thirst
  • Rapid heart rate
  • Elevated body temperature
  • Skin has welts, hives or itches
  • Upset stomach
  • Swollen blotches on lips, tongue, eyes, face, legs, feet, throat or sex organs
  • No appetite
  • No control over bladder function
  • Loud breathing
  • Abdominal pains, back pains
  • Shallow breathing or panting
  • Blacking out suddenly
  • Eyes appear sunken
  • Chest tightness
  • Weak, tired, fatigued
  • Skin is wrinkled or yellow

As your body gets used to having Ritonavir in its system, you may find that the following side effects, while strong at first, go away by themselves over time. However, you should check with your physician if the following symptoms become prolonged or are severe in nature:

  • Excess stomach acid
  • Gas
  • Skin burns, itches, feels numb, prickles or tingles
  • Sense of taste is altered
  •  Diarrhea
  • Dizzy spells
  • Overall unwell feeling
  • Acid reflux
  • Weak muscles
  • Drowsy or sleepy
  • Body aches
  • Congested sinuses
  • Dementia or delusions
  • Trouble moving
  • Depression
  • Dry, sore throat
  • Paranoia
  • Desolation
  • Stomach fullness
  • Hoarse voice
  • More frequent urination at night
  • Irritable mood
  • Loss of appetite
  • No interest in pleasure
  • Mental alterations affecting mood
  • Pain or stiffness in muscles
  • Joint pain
  • Nose runs
  • Throat irritated
  • Neck glands are swollen
  • Mind wanders
  • Difficulty swallowing
  • Vocal changes
  • Gaining weight in certain areas such as neck, breast, upper back, waist or face

Some patients may not have any side effects at all; others may not be able to take this medication because the side effects are too severe. Ever patient is different and therefore it is very important that you review and understand the brochure that comes with your prescription medication and ask any questions of your doctor or pharmacist about things you are unsure of.

Dosage

As every patient is different and so are their symptoms, your dose and frequency of Ritonavir may be different than what is listed here. Follow your doctor’s prescribed dosing amount and schedule; if you have questions, contact the doctor’s office or your pharmacist. Take tablets and capsules whole, without chewing, crushing or breaking them in any way. Take care that you do not run out of this medicine and do not, under any circumstances, stop taking this medicine. Your doctor will advise you to take Ritonavir with food to avoid an upset stomach.

Ritonavir has the best chance of being effective if it is in your system on a constant basis. With this in mind, your doses have been carefully prescribed for you and should be followed. The dosage information below is of a general nature - your prescription may be different.

Adults will typically be prescribed 600 milligrams to be taken twice per day. For children who are older than one month, their physician will base the dosage on their age and physical size, but typically it will be between 350 and 400 milligrams per square meter of body size twice daily, never exceeding more than two 600 milligram doses per day. Children younger than one month are not recommended candidates for this drug, but may be prescribed doses depending on their condition, which is up to their health care professional to decide.

Ritonavir also comes in an oral liquid form, which should be measured using the cup or syringe provided, taking care to be accurate for safety reasons. Do not use household utensils such as teaspoons as they differ and cannot guarantee that they hold the correct amount. Shake the bottle well and measure the liquid into milk or other drinks to disguise the taste, keeping in mind that the drink should be finished within one hour of stirring the medication in.

Take care not to miss any doses of Ritonavir, but if you do, skipping a dose is preferred over doubling it up, depending on when you notice the missing dose. When in doubt, check with your team of health care professionals for the best course of action for a missing dose.

Interactions

Ritonavir is frequently prescribed as part of a combination therapy drug treatment program. These drugs are designed to work together to fight the symptoms and effects of the HIV virus. However, not all drugs interact well with Ritonavir and, in fact, can prove harmful if taken at the same time or reduce the effect Ritonavir is intended to have in fighting the virus. Therefore, it is important that any other prescription drugs or over-the-counter, herbal, vitamin or holistic drugs that you take are disclosed to your doctor. If you are on the following prescription drugs, be aware that they are not recommended to be taken with Ritonavir in any way:

  • Amifampridine
  • Alfuzosin
  • Amisulpride
  • Amiodarone
  • Bepridil
  • Astemizole
  • Cisapride
  • Carbamazepine
  • Conivaptan
  • Colchicine
  • Dihydroergotamine
  • Crizotinib
  • Efavirenz
  • Dronedarone
  • Eletriptan
  • Elbasvir
  • Eplerenone
  • Encainide
  • Ergonovine
  •  Ergoloid Mesylates
  • Ethinyl Estradiol
  • Ergotamine
  • Flibanserin
  • Flecainide
  • Fosphenytoin
  • Fluconazole
  • Isavuconazonium Sulfate
  • Grazoprevir
  • Lomitapide
  • Ivabradine
  • Lurasidone
  • Lovastatin
  • Mesoridazine
  • Maraviroc
  • Methysergide
  • Methylergonovine
  • Naloxegol
  • Midazolam
  • Nimodipine
  • Nelfinavir
  • Phenytoin
  • Phenobarbital
  • Piperaquine
  • Pimozide
  • Propafenone
  • Primidone
  • Ranolazine
  • Quinidine
  • Riociguat
  • Rifampin
  • Sildenafil
  • Romidepsin
  • Simvastatin
  • Silodosin
  • St. John's Wort
  • Sparfloxacin
  • Thioridazine
  • Triazolam
  • Tolvaptan
  • Terfenadine
  • Venetoclax
  • Ziprasidone
  • Voriconazole

The following medications should not be used in combination with Ritonavir, but such a therapy may be necessary for your health. Your health care provider may choose to alter the dosage of one or both drugs if you are taking:

  • Anagrelide
  • Afatinib
  • Ado-Trastuzumab Emtansine
  • Aprepitant
  • Apixaban
  • Arsenic Trioxide
  • Aripiprazole
  • Avanafil
  • Artemether
  • Bedaquiline
  • Axitinib
  • Bosentan
  • Boceprevir
  • Brexpiprazole
  • Bosutinib
  • Budesonide
  • Bromocriptine
  • Buserelin
  • Bupropion
  • Cabozantinib
  • Cabazitaxel
  • Cariprazine
  • Calcifediol
  • Cilostazol
  • Ceritinib
  • Cobicistat
  • Clarithromycin
  • Cyclophosphamide
  • Cobimetinib
  • Dabigatran Etexilate
  • Cyclosporine
  • Daclatasvir
  • Dabrafenib
  • Deferasirox
  • Dasatinib
  • Delamanid
  • Degarelix
  • Dexamethasone
  • Deslorelin
  • Docetaxel
  • Digoxin
  • Donepezil
  • Domperidone
  • Doxorubicin Hydrochloride Liposome
  • Doxorubicin
  • Enzalutamide
  • Eluxadoline
  • Escitalopram
  • Erlotinib
  • Etravirine
  • Eszopiclone
  • Fentanyl
  • Everolimus
  • Fluticasone
  • Fluoxetine
  • Fusidic Acid
  • Fosaprepitant
  • Gonadorelin
  • Garlic
  • Histrelin
  • Goserelin
  • Hydroxychloroquine
  • Hydrocodone
  • Ibrutinib
  • Hydroxyzine
  • Ifosfamide
  • Idelalisib
  • Irinotecan
  • Iloperidone
  • Ivacaftor
  • Irinotecan Liposome
  • Ketoconazole
  • Ixabepilone
  • Lapatinib
  • Lacosamide
  • Levofloxacin
  • Leuprolide
  • Macitentan
  • Levomilnacipran
  • Metformin
  • Manidipine
  • Metronidazole
  • Methylenedioxymethamphetamine
  • Morphine
  • Mifepristone
  • Moxifloxacin
  • Morphine Sulfate Liposome
  • Nifedipine
  • Nafarelin
  • Olaparib
  • Nilotinib
  • Ondansetron
  • Omeprazole
  • Oxycodone
  • Orlistat
  • Panobinostat
  • Palbociclib
  • Pazopanib
  • Pasireotide
  • Pitolisant
  • Pimavanserin
  • Ponatinib
  • Pixantrone
  • Prednisolone
  • Pravastatin
  • Quetiapine
  • Prednison
  • Reboxetine
  • Quinine
  • Retapamulin
  • Regorafenib
  • Rifapentine
  • Rifabutin
  • Rosuvastatin
  • Rivaroxaban
  • Salmeterol
  • Ruxolitinib
  • Sevoflurane
  • Sertraline
  • Sonidegib
  • Simeprevir
  • Sulpiride
  • Sotalol
  • Suvorexant
  • Sunitinib
  • Tadalafil
  • Tacrolimus
  • Tamsulosin
  • Tamoxifen
  • Ticagrelor
  • Temsirolimus
  • Toremifene
  • Topotecan
  • Triamcinolone
  • Trabectedin
  • Vandetanib
  • Triptorelin
  • Venlafaxine
  • Vemurafenib
  • Vilazodone
  • Vilanterol
  • Vincristine
  • Vinflunine
  • Vincristine Sulfate Liposome
  • Vinblastine
  • Vorapaxar
  • Zuclopenthixol
  • Zolpidem

Finally, these medications could put your health at risk with unwanted effects, but you may need to take both drugs, with adjustment to dosage. If you are on the following medications, make sure your doctor is aware of them and be alert for unusual symptoms:

  • Amitriptyline
  • Acenocoumarol
  • Cerivastatin
  • Amprenavir
  • Dalfopristin
  • Clonazepam
  • Desipramine
  • Delavirdine
  • Didanosine
  • Desogestrel
  • Disopyramide
  • Dienogest
  • Dutasteride
  • Drospirenone
  • Estradiol Valerate
  • Estradiol Cypionate
  • Etonogestrel
  • Ethynodiol Diacetate
  • Imipramine
  • Fosamprenavir
  • Itraconazole
  • Indinavir
  • Levonorgestrel
  • Lamotrigine
  • Medroxyprogesterone Acetate
  • Levothyroxine
  • Mestranol
  • Meperidine
  • Methamphetamine
  • Methadone
  • Nefazodone
  • Mexiletine
  • Norethindrone
  • Norelgestromin
  • Norgestrel
  • Norgestimate
  • Paroxetine
  • Olanzapine
  • Quinupristin
  • Prasugrel
  • Tenofovir Disoproxil Fumarate
  • Risperidone
  • Trazodone
  • Warfarin
  • Valproic Acid
  • Theophylline

Your doctor, in the interest of preventing Ritonavir from upsetting your stomach, may recommend that you take this medication with food. If you find that doesn’t work for you or does the opposite, you may be experiencing an unwanted interaction. Discuss food and diet with your health care provider while also inquiring about the use of tobacco products and the consumption of alcohol while on this medication.

Diseases such as those listed below can be made worse or have adverse affects with the use of Ritonavir. Make sure to communicate your medical history to your health care provider so that your health can be monitored during treatment.

Tell your physician if you have:

  • High blood sugar
  • Diabetes mellitus
  • Cardiac problems or heart disease
  • High cholesterol
  • Problems with liver function or liver disease
  • Inflammation of the pancreas
  • Hemophilia

Warnings

Reactions to other medications that have been determined to be allergic in nature should be disclosed to your health care provider to prevent you from experiencing the same with Ritonavir. Additionally, if you have allergies to preservatives, colorings, foods or animals, be sure to disclose these to your doctor.

With regards to age related recommendations, studies have not provided any appropriate data with regard to the use of Ritonavir in children who are not yet one month in age. It has not, therefore, been determined that this drug is safe or even effective on this age group and should only be prescribed with caution.

As older patients are more inclined to have kidney, liver and heart problems that are related to their age, caution should be used when prescribing Ritonavir to this age group, though the effectiveness is expected to be similar to that experienced in adults.

Pregnant women or those planning to become pregnant while being treated with Ritonavir should be aware that there are no studies that have determined that it is safe to take this medication. It is best that a discussion is had with your health care provider to determine what is safe for you and your unborn child before beginning this drug therapy.

Women who are breastfeeding can pass on amounts of Ritonavir to their babies. It is recommended that women stop breastfeeding if it is necessary for them to take this drug.

You must make absolutely certain that your doctor knows all of the medications that you take for your own safety. Ritonavir has adverse reactions with a wide variety of drugs including herbal and vitamin supplements as well as over-the-counter and other prescription drugs. To be safe and ensure your course of treatment is effective, disclose all pharmaceuticals to your health care provider.

All of your doctors, dentists, nurses and pharmacy professionals should be made aware that you take Ritonavir so that others can also be aware of your safety and the need to monitor your symptoms and side effects. Some of your side effects can be life-threatening, so the more people close to you that are aware of your drug treatment, the safer you will be.

Blood sugar has been shown to be affected with use of Ritonavir including new cases of diabetes. Your doctor will instruct you on how to check your blood sugar level and with what frequency and what to do if it becomes elevated.

Your physician will also require you to have blood work monitored on a regular basis. Be sure to keep these appointments, following all health instructions given to you at that time.

Incidents of toxic epidermal necrolysis, also known as Stevens-Johnson syndrome, have occurred with use of Ritonavir. This condition is sometimes fatal; seek immediate medical care if you have swollen, peeling, blistered or red skin, irritated and bloodshot eyes, sores around the nose or mouth, in the throat or on the eyes.

The liver is a vital organ that can be affected by the use of Ritonavir, so special attention should be paid to symptoms indicating liver problems such as urine that is dark in color, fatigue, loss of appetite, abdominal pains, stools that are pale, vomiting or yellow tinge in eyes or on skin. Contact your doctor as soon as possible if you have any of these symptoms.

The pancreas is another organ that Ritonavir can have adverse affects on, which shows symptoms of abdominal pain, severe stomach upset and vomiting. If you have these or even terrible back pain, call for medical help immediately.

Some birth control pills do not have the same effectiveness with use of Ritonavir, so use other forms of birth control to avoid becoming pregnant while being treated with this drug, as it could cause fetal harm.

Rashes, itching, difficulty breathing, inability to swallow or swelling in mouth, face or hands could be signs of a condition called anaphylaxis, a life-threatening infection. Seek immediate medical attention if you experience these symptoms.

Ritonavir does not cure HIV, nor does it stop you from giving it to your partner during sex. Continue to practice safe sex even when under drug treatment therapy such as Ritonavir. Do not share or re-use blood exposed items such as syringes or needles.

HIV medications such as Ritonavir may expose previously undetected infections that were hiding from your previously low immune system. If you notice tuberculosis or pneumonia symptoms, notify your physician right away.

Storage

Store Ritonavir and other medications out of sight and reach of children. Keep it in the original container and do not allow it to come in contact with excessive heat, moisture or direct light. Do not allow Ritonavir to freeze.

Ritonavir capsules stored at room temperature must be used within 30 days and can be stored at room temperature or the refrigerator. Tablets and oral liquid forms of Ritonavir should be stored at room temperature and not refrigerated.

Any unused or expired doses of Ritonavir should be disposed of following the safety instructions provided to you in the leaflet that comes with your prescription.

Summary

Ritonavir is an oral medication that is prescribed alongside other drugs to treat patients with HIV. Ritonavir works by stopping the ability of the HIV or hepatitis C virus to clone itself and multiply, effectively reducing the amount of the virus in the body.

Patients on drug therapy regimens that include Ritonavir may experience side effects such as malaise, asthenia, nausea, vomiting, diarrhea, abdominal pain, sweating, sleeplessness, or abnormal taste sensations. Immediate medical assistance should be sought if patients experience symptoms involving skin reactions, liver problems or pancreas issues as these could be life-threatening conditions.

Patients who have a history of pancreatic or liver problems or cardiac issues or those who have blood sugar that is high or even diabetes should proceed with the use of Ritonavir with caution as these conditions could worsen dramatically. Ritonavir is not recommended for the treatment of HIV infection in children under one month old; nor is it recommended for treatment in women who are pregnant or breastfeeding.

Many different drugs and supplement products, including over the counter medications, have been known to adversely react with Ritonavir. All medications, whether they are prescription, over the counter, vitamin, herbal or holistic in nature should be discussed with your health care provider for effectiveness and safety while on treatment with Ritonavir.

Dosage depends on the patient’s physical characteristics as well as other factors and will be determined by your health care provider. Average doses are 600 milligrams to be taken twice daily for adults. Children older than one month are typically provided a dose of Ritonavir based on their body size, beginning with 350 to 400 milligrams per square meter of body size twice daily, adjusting as required. Liquid Ritonavir can be mixed with drinks like chocolate milk to make it taste better but should be taken within one hour of mixing. Dosage size, frequency and duration should not be changed nor should the recommended time of day to take Ritonavir, as these details are important to the effectiveness of the drug.

As a continuous level of Ritonavir in the body is desired for maximum effectiveness, your dosing schedule should be adhered to without fail. Should you miss a dose, it is preferable to wait to take your next dose, skipping the missed dose, rather than take too much Ritonavir. Consult your team of medical professionals should you have any questions about Ritonavir or your dosing schedule.

 

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Last Reviewed:
January 30, 2018
Last Updated:
January 27, 2018
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