| Generic (& other names) | Brand name | Classification |
| ritonavir | Norvir | protease inhibitor |
| Dosage, usual for adults | 600 mg orally two times a day (preferably every 12 hours) |
| Dosage strength / form | 100 mg capsule
600 mg/7.5 ml oral solution
|
| Capsules per full dose | 6 capsules each dose; 12 capsules total per day.
|
| Volume per full dose | 7.5 ml each dose; 15 ml oral solution total per day. |
| Storage | - Store capsules in the refrigerator at all times and protect from light. Ritonavir should not be kept outside a refrigerator longer than 24 hours and should be kept from sunlight and heat.
- Refrigeration by the user of the oral solution is recommended but not required if used within 30 days. Store in original container. Avoid exposure to excessive heat.
- If you use the oral solution in a mixture: mix one dose at a time and the mixture must be taken within one hour of mixing.
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| Enhancing drug levels |
- Take about every 12 hours and don't skip doses.
- The package insert specifies it can be taken with food or without food, HOWEVER:
- Food. The drug is usually tolerated better with food.
- There is some drug level benefit by eating a meal when taking ritonavir. The package insert states: relative to fasting conditions, the extent of absorption of ritonavir from the capsule formulation was 15% higher when administered with a meal (771 calories, 46% fat, 18% protein, and 37% carbohydrate). See below for sample meal ideas loosly based on this macronutrient profile. (Macronutrient = calories, protein, fat, and carbohydrate.)
- Taste. The taste of the oral solution may be improved by mixing it with chocolate milk or a liquid nutritional supplement or protein shake. Mix one dose at a time and the mixture must be taken within one hour of mixing. Some people have reported that chocolate helps cover the taste of ritonavir and reduce nausea.
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| Reducing drug levels | Missing dosages will reduce the effectiveness of the drug and increase the possibility of developing drug resistance. |
| Possible meal / med schedule |
| Breakfast- 7 AM | Lunch - 12 PM | Supper - 6 PM |
| ritonavir with breakfast | lunch | ritonavir with supper |
1 1/2 cups whole milk
1 cup oatmeal, prepared w/ milk
1 tablespoon brown sugar
1 pat butter
2 English muffins
2 pats of butter
1 tablespoon jam
1 banana
1 cup orange juice | 1 cup whole milk
3 ounce hamburger
1 hamburger bun
1 ounce cheddar cheese
1 tablespoon mayonnaise
1 orange
1 cup apple juice | 1 cup whole milk
3 ounces chicken breast roasted
2 tablespoons barbecue sauce
1 baked potato
1 pat butter
1 tablespoon sour cream
1/2 cup steamed broccoli
1/2 cup steamed carrots
1 pat butter
1 slice whole grain bread
1 pat butter
3 small cookies |
| Totals |
1041 calories
29 g protein
29 g fat
123 g carbohydrate | 922 calories
41 g protein
49 g fat
82 g carbohydrate | 990 calories
47 g protein
41 g fat
106 g carbohydrate |
7 AM : Breakfast & ritonavir
10 AM : Snack
12 noon : Lunch
4 PM : Snack
6 PM : Supper & ritonavir
10 PM : Snack
|
|
| Fluids |
- Recommendation. There is not a specific recommendation for increased fluid intake with ritonavir. However, people living with HIV do have increased need in general for more fluid. Intake goals of safe drinking water are 10-12 cups (8 oz/cup) of water for men and 9-11 cups of water for women.
- Safe water is water that has been brought to a rapid boil for 1 minute, is distilled, has gone through a filter meeting NSF standard 53 for cyst reduction. Bottled water, unless it meets these guidelines, or water from a vending machine does not necessarily guarantee safe water.
- Coffee!. Be aware that caffeine in coffee and other foods can speed up the gastrointestinal tract, creating looser stools with a potential fluid loss from both excretion and urination. Also, many people experience a reduction of appetite after caffeine containing foods. Watch that you donÌt skip meals or snacks when you have the opportunity to eat.
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| Common reactions that may affect nutritional status |
| Specifically |
- Fatigue, weakness, diarrhea, nausea, vomiting, loss of appetite, abdominal pain and headaches. Nasal symptoms, like a runny nose or cold symptoms may occur. It also can cause an abnormal sensation around the mouth, such as, burning, prickling or a sensation as if there are small insects crawling (called circumoral parasthesia).
- Often, these symptoms can be minimized when starting the medication by slowly increasing (ramping up) the dose over the first two weeks. Your primary care provider and registered dietitian can help you manage these problems.
- Cholesterol and triglyceride levels may become elevated with ritonavir. Watch your labs and discuss this with your primary care provider. Why these levels are high, what the implications are, and how to reduce them are under investigation.
- Watch for any symptoms of high blood sugar (high blood glucose)
- Watch for any elevation in liver enzymes (SGOT, SGPT)
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| Generally, any reactions effecting (or may effect) nutrition
| Tell your primary care provider if and when anything abnormal occurs to determine what is its actual cause and what to do about it. Work with your primary care provider and your registered dietitian to manage and reduce their effects on your nutritional health. |
| Tips to taking meds on time | - Write down your own regular meal and medication schedule (see worksheet)
- Figure out a daily routine of eating and taking meds that work for you. Practice your routine each day.
- If you can't keep to your routine talk to a health care professional or even a friend about where it gets hard. Make adjustments and try again.
- Make eating and taking meds your priority.
- Use a timer to remind you when to take your meds and when to eat.
- Use a pill box with compartments
- Use a daily check list or journal to track that you have taken each med and snack.
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- Eat to live
- Buy lots of portable snacks that don't spoil easily
- Keep food easy to reach: at the side of your bed, by the phone, by your TV or computer.
- Put a snack in your pack anytime you leave home: to work, appointments, errands, socializing
- Communicate your needs to anyone with a demand on your time. Say, for example: I need to eat first.
- Set up meals with friends during times you can eat.
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