Lopinavir and Ritonavir (patient information)

# Why this medication is prescribed
The combination of lopinavir and ritonavir is used with other antiviral medications to treat human immunodeficiency virus (HIV) in patients with acquired immunodeficiency syndrome (AIDS). Lopinavir is in a class of medications called protease (pro' tee ace) inhibitors. It works by slowing the spread of HIV in the body. In this combination, ritonavir is used to increase the amount of lopinavir in the body so it can work better. Lopinavir and ritonavir is not a cure and may not decrease the number of HIV-related illnesses. Lopinavir and ritonavir does not prevent the spread of HIV to other people.

# How this medication should be used
The combination of lopinavir and ritonavir comes as a capsule and a solution (liquid) to take by mouth. It is usually taken twice a day with food. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take lopinavir and ritonavir exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Continue to take lopinavir and ritonavir even if you feel well. Do not stop taking lopinavir and ritonavir without talking to your doctor.

# Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

# Special precautions
Before taking lopinavir and ritonavir:
- tell your doctor and pharmacist if you are allergic to lopinavir, ritonavir (Norvir), or any other medications.
- do not take lopinavir and ritonavir if you are taking astemizole (Hismanal), cisapride (Propulsid), dihydroergotamine (D.H.E. 45, Migranal), ergonovine (Ergotrate Maleate), ergotamine (Cafatine, Cafergot, Cafetrate, others), flecainide (Tambocor), methylergonovine (Methergine), midazolam (Versed), pimozide (Orap), propafenone (Rythmol), terfenadine (Seldane), or triazolam (Halcion).
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, and nutritional supplements you are taking. Be sure to mention any of the following: anticoagulants (blood thinners) such as warfarin (Coumadin); antifungals such as itraconazole (Sporanox) and ketoconazole (Nizoral); atovaquone (Mepron); calcium-channel blockers such as felodipine (Plendil), nicardipine (Cardene), and nifedipine (Adalat, Procardia); cholesterol-lowering medications such as atorvastatin (Lipitor), lovastatin (Mevacor), and simvastatin (Zocor); clarithromycin (Biaxin); disulfiram (Antabuse); medications for irregular heartbeats such as amiodarone (Cordarone, Pacerone), bepridil (Vascor), and quinidine (Quinidex); medications for seizures such as carbamazepine (Tegretol), phenobarbital (Luminal, Solfoton), and phenytoin (Dilantin); medications that suppress the immune system such as cyclosporine (Neoral, Sandimmune), Rapamune (sirolimus), and tacrolimus (Prograf); methadone (Dolophine); metronidazole (Flagyl); oral steroids such as dexamethasone (Decadron, Dexone); other antiviral medications such as amprenavir (Agenerase), delavirdine (Rescriptor), efavirenz (Sustiva), indinavir (Crixivan), nevirapine (Viramune), ritonavir (Norvir), and saquinavir (Fortovase, Invirase); rifabutin (Mycobutin); rifampin (Rifadin, Rimactane); and sildenafil (Viagra). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- if you are taking didanosine, take it 1 hour before or 2 hours after lopinavir and ritonavir.
- tell your doctor what herbal products you are taking, especially products containing St. John's wort.
- tell your doctor if you have ever had pancreas disease and if you have or have ever had diabetes, liver disease, or hemophilia.
- you should know that lopinavir and ritonavir may decrease the effectiveness of oral contraceptives (birth control pills). Talk to your doctor about using another form of birth control.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking lopinavir and ritonavir, call your doctor. You should not breast-feed while taking lopinavir and ritonavir.
- you should know that lopinavir and ritonavir solution contains alcohol and may make you drowsy. Do not drive a car or operate machinery until you know how this medication affects you.
- remember that alcohol can add to the drowsiness caused by this medication.
- you should be aware that your body fat may increase or move to different areas of your body, such as your breasts and your upper back.

# Special dietary instructions
Unless your doctor tells you otherwise, continue your normal diet.

# What to do if you forget a dose
Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

# Side effects

## Minor side effects
Lopinavir and ritonavir may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- diarrhea
- weakness
- heartburn
- headache
- difficulty falling asleep or staying asleep
- rash

## Severe side effects
Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:
- upset stomach
- vomiting
- stomach pain
- unusual bleeding or bruising
- extreme tiredness
- loss of appetite
- pain in the upper right part of the stomach
- yellowing of the skin or eyes
- flu-like symptoms
Lopinavir and ritonavir may cause high blood sugar. If you experience any of the following symptoms, call your doctor immediately:
- thirst
- dry mouth
- tiredness
- flushing
- dry skin
- frequent urination
- loss of appetite
- trouble breathing
Lopinavir and ritonavir may cause increases in levels of cholesterol and other fats (triglycerides) in the blood.
Lopinavir and ritonavir may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# Storage conditions needed for this medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. If you store lopinavir and ritonavir capsules or solution in the refrigerator, they can be used until the expiration date printed on the label. If you store them at room temperature, the capsules or solution should be used within 2 months. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

# Other information
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to lopinavir and ritonavir.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Kaletra