Lopinavir with ritonavir slows the progress of HIV infection. It is one of a number of medicines that you will need to take regularly.
It has been associated with some side-effects. Your doctor will discuss these with you before you start treatment.
About lopinavir with ritonavir
|Type of medicine||A protease inhibitor (PI) antiretroviral medicine|
|Used for||Human immunodeficiency virus (HIV) infection in adults and in children from 14 days old|
|Also called||Kaletra® (lopinavir with ritonavir)|
|Available as||Tablets and oral liquid medicine. There are two strengths of tablet - the adult strength is 200 mg/50 mg and the child strength is 100 mg/25 mg|
Kaletra® contains two ingredients - lopinavir and ritonavir. These are both antiretroviral medicines prescribed for human immunodeficiency virus (HIV) infection. Lopinavir is the main active ingredient and ritonavir helps to boost the amount of lopinavir which gets into your bloodstream. Kaletra® slows the progress of HIV infection, but it is not a cure. HIV destroys cells in the body, called CD4 T cells. These cells are a type of white blood cell and are important because they are involved in protecting your body from infection. If left untreated, the HIV infection weakens your immune system so that your body cannot defend itself against bacteria, viruses and other germs. Kaletra® slows down the progress of HIV infection by reducing the amount of virus in your body. It does this by stopping the production of a protein that the virus needs to copy (replicate) itself.
Lopinavir and ritonavir belong to a group of antiretroviral medicines known as protease inhibitors (PIs). They are given alongside a number of other antiretroviral medicines, as part of a combination therapy. Taking three or more antiretroviral medicines at the same time is more effective than taking one alone. Taking a combination of different medicines also reduces the risk that the virus will become resistant to any individual medicine.
Antiretroviral medicines will be prescribed for you by a doctor who is a specialist. It is vital to take your antiretroviral medicines exactly as prescribed in order to maintain success and to help to prevent the virus from becoming resistant to the medicines. These medicines are usually taken for life.
Before taking lopinavir with ritonavir
Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking lopinavir with ritonavir it is important that your doctor knows:
- If you are pregnant, trying for a baby or breastfeeding.
- If you have diabetes (diabetes mellitus).
- If you have a heart problem or have been told you have a heart rhythm disorder.
- If you have liver inflammation (called hepatitis), or any other liver problem.
- If you have a problem with the way your kidneys work.
- If you have inflammation of the pancreas (pancreatitis).
- If you are being treated for low levels of thyroid hormone (hypothyroidism).
- If you have either haemophilia or porphyria, which are both rare inherited blood disorders.
- If you are taking any other medicines. This includes any medicines which are available to buy without a prescription, as well as herbal and complementary medicines.
- If you have ever had an allergic reaction to a medicine.
How to take lopinavir with ritonavir
- Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about Kaletra®, and it will also provide you with a full list of the side-effects which you could experience from taking it.
- Take Kaletra® exactly as your doctor tells you to - the directions will be printed on the label of the pack to remind you about what the doctor said to you. The usual dose for an adult is two tablets taken twice a day (12 hours apart), although some people can be asked to take four tablets once daily. If you have any difficulties swallowing tablets, let your doctor know about this as the liquid medicine could be more suitable for you.
- Depending upon their age, children can be prescribed tablets or liquid medicine. The dose will depend upon their weight and height. If you (or your child) have been given liquid medicine to take, your doctor will advise you about how much you should take for each dose, and how to measure it out correctly using the dosing syringe provided in the pack. Wash the syringe with water after each use.
- Tablets should be swallowed with a drink of water. Do not crush or break the tablet before you swallow - it should be swallowed whole. You can take Kaletra® tablets either with or without food.
- If you are taking liquid medicine, you should always take your doses with a meal. This is because food in your stomach helps the liquid medicine to be absorbed better by your body.
- Try to take your doses at the same times of day each day, as this will help you to remember to take the tablets/medicine regularly.
- If you forget to take a dose, take it as soon as you remember unless:
- You usually take your doses twice a day and you are more than 6 hours late; in which case do not take the missed dose but do take your next dose when it is due.
- You usually take your doses once a day and you are more than 12 hours late; in which case do not take the missed dose but do take your next dose when it is due.
Getting the most from your treatment
- Keep your regular appointments with your doctor so that your progress can be monitored. You will need to have regular blood tests.
- It is important that you continue to take antiretroviral treatment regularly. This will help to prevent the HIV from becoming resistant to the medicines you are taking. Even if you miss only a small number of doses, the virus can become resistant to treatment.
- If you develop any infection soon after you start this treatment, let your doctor know. As a result of taking this medicine, your immune system may start fighting an infection which was present before you started the treatment, but which you may not have been aware of.
- Follow carefully any advice your doctor gives to you about making lifestyle changes to reduce any risk of damage to your heart and blood vessels. These can include stopping smoking, eating healthily and taking regular exercise.
- Some people taking antiretroviral medicines develop changes to the way body fat is distributed in the body. This can result in changes to body image. Your doctor will discuss the possibility of this with you.
- Although treatment with antiretroviral medicines may reduce the risk of you passing HIV to others through sexual contact, it does not stop it. It is important that you use condoms.
- It is not uncommon for people with HIV to feel low or even depressed, especially soon after the diagnosis has been made and treatment has been started. If you have any feelings of depression, or any distressing thoughts about harming yourself then you should speak with your doctor straightaway.
- Some people who have taken antiretroviral medicines (particularly over a long time) have developed a condition called osteonecrosis. This is a bone disease where bone tissue dies because there is a reduced blood supply to it. It leads to joint pains and stiffness, and can cause difficulties in movement. If you notice any of these symptoms, speak with your doctor.
- If you buy any medicines, check with a pharmacist that they are suitable to take with your other medicines. This is because some remedies interfere with antiretroviral medicines and stop them from working properly. In particular, do not take the herbal remedy St John's wort.
- If you have diabetes you may need to check your blood sugar (glucose) more frequently, as this medicine can affect the levels of sugar in your blood. Your doctor will advise you about this.
- If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking.
- Treatment for HIV is usually lifelong. Continue to take this medicine regularly for as long as your doctor tells you to, even if you feel well. This is to keep your immune system healthy.
Can lopinavir with ritonavir cause problems?
Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with Kaletra®. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.
|Very common Kaletra® side-effects (these affect more than 1 in 10 people)||What can I do if I experience this?|
|Infections such as nose and throat infections||If these become troublesome, speak with your doctor|
|Diarrhoea||Drink plenty of water to replace lost fluids|
|Feeling sick (nausea)||Stick to simple meals - avoid fatty or spicy food|
|Common Kaletra® side-effects (these affect fewer than 1 in 10 people)||What can I do if I experience this?|
|Being sick (vomiting), tummy (abdominal) pain, indigestion, wind||Stick to simple meals - avoid fatty or spicy food. If it is severe, speak with your doctor straightaway (see below)|
|Headache, muscle aches and pains||Ask your doctor or pharmacist to recommend a suitable painkiller|
|Feeling dizzy or weak||Do not drive and do not use tools or machines while affected. If this continues, speak with your doctor|
|Reduced appetite and loss of weight, tingling feelings, allergic-type skin rash and itching, feeling anxious, difficulties sleeping, increased blood pressure, night sweats, erectile dysfunction, menstrual disorders, piles, chest infections and skin infections||If any of these become troublesome, speak with your doctor|
|Changes to some blood tests||Your doctor will check for this|
Important: some people taking Kaletra® have developed inflammation of the pancreas (pancreatitis) - the most common signs of this are persistent stomach pain, feeling sick (nausea) or being sick (vomiting), high temperature (fever), and feeling generally unwell. Let your doctor know straightaway if you develop these symptoms.
If you experience any other symptoms which you think may be due to the medicine, speak with your doctor or pharmacist for further advice.
How to store lopinavir with ritonavir
- Keep all medicines out of the reach and sight of children.
- Store Kaletra® tablets in a cool, dry place, away from direct heat and light.
- Store Kaletra® Oral Solution in a refrigerator until it is needed. Once a bottle has been opened it may be kept out of the fridge providing it is in a cool place. It will keep for six weeks after being opened - after this time, make sure you have a fresh supply.
- It is a good idea to write on the label the date you removed the bottle from the refrigerator
Important information about all medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital at once. Take the container with you, even if it is empty.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.
Further reading and references
Manufacturer's PIL, Kaletra® 200 mg/50 mg film-coated tablets; AbbVie Limited, The electronic Medicines Compendium. Dated July 2019.
Manufacturer's PIL, Kaletra® 80 mg/20 mg Oral Solution; AbbVie Limited, The electronic Medicines Compendium. Dated July 2019.
British National Formulary, 77th Edition (Mar 2019); British Medical Association and Royal Pharmaceutical Society of Great Britain, London.