Lopinavir ritonavir dosage and administration

# Dosage AND Administration
KALETRA tablets may be taken with or without food. The tablets should be swallowed whole and not chewed, broken, or crushed.
KALETRA oral solution must be taken with food.
Adult Patients
KALETRA tablets 400/100 mg (given as two 200/50 mg tablets) twice daily.
KALETRA oral solution 400/100 mg (5 mL) twice daily.
KALETRA tablets 800/200 mg (given as four 200/50 mg tablets) once daily in patients with less than three lopinavir resistance-associated substitutions.
KALETRA oral solution 800/200 mg (10 mL) once daily in patients with less than three lopinavir resistance-associated substitutions.
Once daily administration of KALETRA is not recommended for adult patients with three or more of the following lopinavir resistance-associated substitutions: L10F/I/R/V, K20M/N/R, L24I, L33F, M36I, I47V, G48V, I54L/T/V, V82A/C/F/S/T, and I84V .
KALETRA should not be administered once daily in combination with carbamazepine, phenobarbital, or phenytoin .
Concomitant Therapy: Efavirenz, Nevirapine, or Nelfinavir
KALETRA tablets and oral solution should not be administered as a once daily regimen in combination with efavirenz, nevirapine, or nelfinavir.
A dose increase is recommended for all patients who use KALETRA tablets. The recommended dose of KALETRA tablets is 500/125 mg (such as two 200/50 tablets and one 100/25 mg tablet) twice daily in combination with efavirenz, nevirapine, or nelfinavir.
A dose increase is recommended for all patients who use KALETRA oral solution. The recommended dose of KALETRA oral solution is 533/133 mg (6.5 mL) twice daily when used in combination with efavirenz, nevirapine, or nelfinavir.
Pediatric Patients
KALETRA tablets and oral solution should not be administered once daily in pediatric patients < 18 years of age.
KALETRA oral solution should not be administered to neonates before a postmenstrual age (first day of the mothers last menstrual period to birth plus the time elapsed after birth) of 42 weeks and a postnatal age of at least 14 days has been attained .
KALETRA oral solution contains 42.4% (v/v) alcohol and 15.3% (w/v) propylene glycol. Special attention should be given to accurate calculation of the dose of KALETRA, transcription of the medication order, dispensing information and dosing instructions to minimize the risk for medication errors, and overdose. This is especially important for infants and young children. Total amounts of alcohol and propylene glycol from all medicines that are to be given to pediatric patients 14 days to 6 months of age should be taken into account in order to avoid toxicity from these excipients .
Prescribers should calculate the appropriate dose of KALETRA for each individual child based on body weight (kg) or body surface area (BSA) to avoid underdosing or exceeding the recommended adult dose.
Body surface area (BSA) can be calculated as follows:
The KALETRA dose can be calculated based on weight or BSA:
Based on Weight:
Patient Weight (kg)  Prescribed lopinavir dose (mg/kg) = Administered lopinavir dose (mg)
Based on BSA:
Patient BSA (m2)  Prescribed lopinavir dose (mg/m2) = Administered lopinavir dose (mg)
If KALETRA oral solution is used, the volume (mL) of KALETRA solution can be determined as follows:
Volume of KALETRA solution (mL) = Administered lopinavir dose (mg)  80 (mg/mL)
The dose of the oral solution should be administered using a calibrated dosing syringe.
Before prescribing KALETRA 100/25 mg tablets, children should be assessed for the ability to swallow intact tablets. If a child is unable to reliably swallow a KALETRA tablet, the KALETRA oral solution formulation should be prescribed.
14 Days to 6 Months:
In pediatric patients 14 days to 6 months of age, the recommended dosage of lopinavir/ritonavir using KALETRA oral solution is 16/4 mg/kg or 300/75 mg/m2 twice daily. Prescribers should calculate the appropriate dose based on body weight or body surface area.
Because no data exists for dosage when administered with efavirenz, nevirapine, or nelfinavir, it is recommended that KALETRA not be administered in combination with these drugs in patients < 6 months of age.
6 Months to 18 Years:
Without Concomitant Efavirenz, Nevirapine, or Nelfinavir
Dosing recommendations using oral solution
In children 6 months to 18 years of age, the recommended dosage of lopinavir/ritonavir using KALETRA oral solution without concomitant efavirenz, nevirapine, or nelfinavir is 230/57.5 mg/m2 given twice daily, not to exceed the recommended adult dose (400/100 mg  twice daily). If weight-based dosing is preferred, the recommended dosage of lopinavir/ritonavir for patients < 15 kg is 12/3 mg/kg given twice daily and the dosage for patients  15 kg to 40 kg is 10/2.5 mg/kg given twice daily.
Dosing recommendations using tablets
Table 1 provides the dosing recommendations for pediatric patients 6 months to 18 years of age based on body weight or body surface area for KALETRA tablets.
Concomitant Therapy: Efavirenz, Nevirapine, or Nelfinavir
Dosing recommendations using oral solution
A dose increase of KALETRA to 300/75 mg/m2 using KALETRA oral solution is needed when co-administered with efavirenz, nevirapine, or nelfinavir in children (both treatment-naive and treatment-experienced) 6 months to 18 years of age, not to exceed the recommended adult dose (533/133 mg  twice daily). If weight-based dosing is preferred, the recommended dosage for patients 15 kg to 45 kg is 11/2.75 mg/kg given twice daily.
Dosing recommendations using tablets
Table 2 provides the dosing recommendations for pediatric patients 6 months to 18 years of age based on body weight or body surface area for KALETRA tablets when given in combination with efavirenz, nevirapine, or nelfinavir.