Consumer Drug Information

ritonavir

Generic Name: ritonavir (rit OH na vir)
Brand names: Norvir, Norvir Soft Gelatin

What is ritonavir?

Ritonavir is an antiviral medication in a group of HIV medicines called protease (PRO-tee-ayz) inhibitors. Ritonavir prevents human immunodeficiency virus (HIV) cells from multiplying in your body.

Ritonavir is used to treat HIV, which causes acquired immunodeficiency syndrome (AIDS). Ritonavir is not a cure for HIV or AIDS.

Ritonavir may also be used for other purposes not listed in this medication guide.

What is the most important information I should know about ritonavir?

Do not take ritonavir with alfuzosin (Uroxatral), amiodarone (Cordarone, Pacerone), bepridil (Vascor), flecainide (Tambocor), propafenone (Rythmol), quinidine (Quinaglute, Quinidex), voriconazole (Vfend), cisapride (Propulsid), pimozide (Orap), midazolam (Versed), triazolam (Halcion), or an ergot medicine such as Ergomar, Cafergot, Wigraine, D.H.E. 45, Migranal, Methergine. These drugs can cause life-threatening side effects if you use them while you are taking ritonavir.

There are many other medicines that can interact with ritonavir. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

HIV/AIDS is usually treated with a combination of different drugs. To best treat your condition, use all of your medications as directed by your doctor. Do not change your doses or medication schedule without advice from your doctor. Every person with HIV or AIDS should remain under the care of a doctor.

Avoid having unprotected sex or sharing needles, razors, or toothbrushes. Taking this medication will not prevent you from passing HIV to other people. Talk with your doctor about safe methods of preventing HIV transmission during sex. Sharing drug or medicine needles is never safe, even for a healthy person.

What should I discuss with my healthcare provider before taking ritonavir?

Do not take this medication if you are allergic to ritonavir.

Do not take ritonavir with any of the following medications:

alfuzosin (Uroxatral);
amiodarone (Cordarone, Pacerone);
cisapride (Propulsid);
flecainide (Tambocor);
midazolam (Versed) or triazolam (Halcion);
pimozide (Orap);
propafenone (Rythmol);
quinidine (Cardioquin, Quinidex, Quinaglute);
voriconazole (Vfend); or
ergot medicines such as ergotamine (Ergomar, Cafergot), dihydroergotamine (D.H.E. 45, Migranal Nasal Spray), ergonovine (Ergotrate), or methylergonovine (Methergine).

These drugs can cause life-threatening side effects if you use them while you are taking ritonavir.

If you have any of these other conditions, you may need a dose adjustment or special tests to safely take ritonavir:

liver disease;
diabetes;
a bleeding disorder such as hemophilia; or
high cholesterol or triglycerides.

FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby, but HIV can be passed to the baby if the mother is not properly treated during pregnancy. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Take all of your HIV medicines as directed to control your infection while you are pregnant. Ritonavir can make birth control pills or patches less effective. Ask your doctor about using a non-hormone method of birth control (such as a condom, diaphragm, spermicide) to prevent pregnancy while taking ritonavir. You should not breast-feed while you are using ritonavir. Women with HIV or AIDS should not breast-feed at all. Even if your baby is born without HIV, you may still pass the virus to the baby in your breast milk.

How should I take ritonavir?

Take ritonavir exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Ritonavir works best if you take it with food.

Measure the liquid form (oral solution) of ritonavir with a special dose-measuring spoon or cup, not a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Liquid ritonavir can be mixed with chocolate milk or a nutrition drink such as Ensure. Drink the mixture within 1 hour after mixing.

It is important to use ritonavir regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

HIV/AIDS is usually treated with a combination of different drugs. To best treat your condition, use all of your medications as directed by your doctor. Be sure to read the medication guide or patient instructions provided with each of your medications. Do not change your doses or medication schedule without advice from your doctor. Every person with HIV or AIDS should remain under the care of a doctor.

To be sure this medication is helping your condition, your blood will need to be tested on a regular basis. Your liver function may also need to be tested. Do not miss any scheduled visits to your doctor.

Store ritonavir capsules in the refrigerator or at room temperature, away from heat or moisture. If you store the capsules at room temperature you must use them within 30 days. Store ritonavir liquid at room temperature with the cap tightly closed. Do not refrigerate.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at the next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medication, or if a child has accidentally swallowed it. An overdose of ritonavir oral liquid could be fatal to a child.

What should I avoid while taking ritonavir?

If you also take didanosine, take it 2 hours before or after you take ritonavir.

Ritonavir oral liquid contains alcohol. Avoid drinking alcoholic beverages while using this medicine, and do not take disulfiram (Antabuse) or you could have an alcohol reaction. Avoid having unprotected sex or sharing needles, razors, or toothbrushes. Taking this medication will not prevent you from passing HIV to other people. Talk with your doctor about safe methods of preventing HIV transmission during sex. Sharing drug or medicine needles is never safe, even for a healthy person.

Ritonavir side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop taking ritonavir and call your doctor at once if you have any of these serious side effects:

slow heart rate, feeling like you might pass out;
fever, sore throat, and headache with a severe blistering, peeling, and red skin rash;
increased urination or extreme thirst;
easy bruising or bleeding;
signs of a new infection, such as fever or chills, cough, or flu symptoms;
severe pain in your upper stomach spreading to your back, nausea and vomiting, fast heart rate; or
low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes).

Less serious side effects may include:

mild nausea, vomiting, diarrhea, stomach pain;
numbness or tingling, especially around your mouth;
headache, mood changes; or
changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Ritonavir Dosing Information

Usual Adult Dose for HIV Infection:

As a pharmacokinetic booster for other protease inhibitors: 100 to 400 mg/day orally in 1 or 2 divided doses

FDA-approved dose:
Initial dose: 300 mg orally twice a day
Maintenance dose: Increase by 100 mg twice daily every 2 to 3 days to the full dose of 600 mg orally twice a day

Usual Pediatric Dose for HIV Infection:

1 month to 12 years:
Initial dose: 250 mg/m2 orally twice a day
Maintenance dose: Increase by 50 mg/m2 twice daily every 2 to 3 days to the full dose of 350 to 450 mg/m2 orally twice a day; if 450 mg/m2 twice daily is intolerable, the highest tolerated dose in combination with other antiretrovirals may be used although a different protease inhibitor should be considered
Maximum: 600 mg/dose

13 years or older:
Initial dose: 300 mg orally twice a day
Maintenance dose: Increase by 100 mg twice daily every 2 to 3 days to the full dose of 600 mg orally twice a day

What other drugs will affect ritonavir?

Many drugs can interact with ritonavir. Below is just a partial list. Tell your doctor if you are using:

ADHD medication;
atovaquone (Malarone, Mepron) or quinine (Qualaquin);
dronabinol (Marinol);
St. John's wort;
theophylline (Elixophyllin, Theo-24, Uniphyl);
steroid medication (prednisone, Advair, Flonase, Flovent, DexPak, Dexasone, Cortastat, and others);
an antibiotic(such as Biaxin, Mycobutin, Rifadin, Rimactane, Rifater);
an antifungal medication (such as Nizoral or Sporanox);
an antidepressant (Elavil, Vanatrip, Wellbutrin, Norpramin, nefazodone, Paxil, Zoloft, Desyrel, and others);
heart or blood pressure medication (Lopressor, Toprol, Blocadren, Norpace, Mexitil, digitalis, Lanoxin, Cartia, Cardizem, Plendil, Nifedical, Procardia, Calan, Covera, Isoptin, Verelan, and others);
cholesterol-lowering medicine (such as Lipitor, Zocor, Crestor);
medicines used to prevent organ transplant rejection;
any other HIV/AIDS medicines (especially Reyataz, Prezista, Rescriptor, Lexiva, Crixivan, Invirase, or Aptivus);
insulin or diabetes medication you take by mouth;
medicine to treat a psychiatric disorder;
erectile dysfunction medication (Viagra, Cialis, Levitra;
pain medication (such as Demerol, Darvon, Darvocet, Ultram, Ultracet);
a sedative (such as BuSpar, Tranxene, Prosom, Dalmane); or
seizure medications (such as Carbatrol, Tegretol, Lamictal, Klonopin, Depakote, Zarontin, Dilantin).

This list is not complete and there are many other medicines that can interact with ritonavir. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor. Keep a list with you of all the medicines you use and show this list to any doctor or other healthcare provider who treats you.

Where can I get more information?

Your pharmacist can provide more information about ritonavir.

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.