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Brand name: Kaletra
Common name:
lopinavir/ritonavir
Class: HIV
protease inhibitor (PI)
Standard dose: Three
soft-gelatin capsules (133.3 mg lopinavir and 33.3 mg
ritonavir each) twice a day, preferably with food; liquid
formula available. Take missed dose as soon as possible,
but do not double dose.
Wholesale cost: $8,125/yr.,
$677/month
Patience assistance number:
1 (800) 637–2400, www.kaletra.com
AIDS Treatment Information
Service: 1 (800) HIV–0440
(448–0440)
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Potential side
effects:
Rash, loose stools,
diarrhea, nausea, headache, muscle weakness, and increased
cholesterol, triglycerides (fats in the blood) and AST/ALT
(liver function tests, a sign of liver damage). These
were not fasting samples, needed for the most accurate
results. Seen with all older protease inhibitors (except
Agenerase) are high
blood levels of cholesterol and triglycerides (fats)
and perhaps associated heart disease, lipodystrophy
(body fat changes, including thinning of the face, arms
and legs, with or without fat accumulation in the stomach,
breasts and sometimes the upper back), worsening or
new cases of diabetes (symptoms include increased thirst
and hunger, frequent urination, unexplained weight loss,
fatigue, and dry itchy skin; see your doctor promptly)
and increased bleeding in hemophiliacs.
Potential drug
interactions:
Dosage of methadone
may need to be increased when taken with Kaletra. Dose
increase to 4 capsules twice a day with food recommended
when using with Sustiva
or Viramune in people
who previously took HIV drugs, especially protease inhibitors.
May lower levels of Retrovir
and Ziagen. Do not use
Zocor or Mevacor; suggested alternatives are Lipitor,
Lescol, Baycol, and Pravachol (looks best on paper for
protease inhibitors). Alternatives should still be used
with caution because of potential for liver toxicity.
Protease inhibitors increase blood levels of Viagra,
and Viagra dose should be started at 25 mg (half the
normal dose) and increased as needed and tolerated.
It’s recommended that people do not exceed 25 mg in
a 48 hour period because of potential for fatal reaction.
Phenobarbital, phenytoin (Dilantin and others) or carbamazepine
(Tegretol and others) may lower blood levels of Kaletra.
Reduces effectiveness of birth control pills; use alternative
contraceptive. Oral solution contains alcohol, so do
not use with Antabuse or Flagyl. Do not take with flecainide,
propatenone, Hismanol, Seldane, rifampin, ergot derivatives
(such as Cafetrate, Cafergot, Wigraine and Methergine,
in any form—serious interactions seen with dilation
during gynecological exams), D.H.E. 45, St. John’s Wort,
pimozide, Versed and Halcion. (Also dihydropuridine
calcium channel blockers.) Videx should be given an
hour before (or two hours after) Kaletra is taken with
food. Rifabutin dose must be lowered.
Tips:
Doctors and patients
report that this protease inhibitor is very tolerable.
Great viral load results out to 72 weeks (significant)
in people on their first HIV regimen. Good results also
seen in heavily treatment-experienced children and adults,
even those with protease inhibitor resistance. However,
drug-experienced people also used a non-nuke, which
may mean that three classes of HIV drugs are needed
for them, and which limits future options. Then again,
some people don’t have many options. Expected to successfully
control HIV that no longer responds to other meds due
to drug resistance, but cross-resistance has already
been seen. Can have Norvir’s
yucky taste and taste aversion—one guy said his beer
tasted like soap. There is hope for once a day dosing.
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