Ritocom Dosage/Direction for Use

Lopinavir and Ritonavir tablets may be taken with or without food. The tablets should be swallowed whole and not chewed, broken, or crushed.
Adult Patients: Therapy-Naïve Patients: Lopinavir and Ritonavir tablets 400/100 mg (given as two 200/50 mg tablets) twice daily taken with or without food.
Lopinavir and Ritonavir tablets 800/200 mg (given as four 200/50 mg tablets) once daily taken with or without food.
Therapy-Experienced Patients: Once daily administration of lopinavir and ritonavir tablet is not recommended in therapy-experienced patients.
Lopinavir and Ritonavir tablets 400/100 mg (given as two 200/50 mg tablets) twice daily taken with or without food.
Concomitant Therapy: Efavirenz, nevirapine, (fos)amprenavir or nelfinavir (see Pharmacology: Pharmacokinetics under Actions and Established and Other Potentially Significant Drug Interactions under Interactions): Lopinavir and Ritonavir tablets should not be administered as a once daily regimen in combination with efavirenz, nevirapine, (fos)amprenavir or nelfinavir.
A dose increase is recommended for all patients who use lopinavir and ritonavir tablets. The recommended dose of lopinavir and ritonavir tablets is 500/125 mg (such as two 200/50 tablets and one 100/25 mg tablet) twice daily in combination with efavirenz, nevirapine, (fos)amprenavir or nelfinavir.
Pediatric Patients: Lopinavir and Ritonavir tablets and oral solution should not be administered once daily in pediatric patients < 18 years of age.
Healthcare professionals should pay special attention to accurate calculation of the dose of lopinavir and ritonavir tablets, transcription of the medication order, dispensing information and dosing instructions to minimize the risk for medication errors, overdose, (see Overdosage) and underdose.
Prescribers should calculate the appropriate dose of lopinavir and ritonavir tablets for each individual child based on body weight (kg) or body surface area (BSA) and should not exceed the recommended adult dose.
Body surface area (BSA) can be calculated as follows: See Equation 1.

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The lopinavir and ritonavir dose can be calculated based on weight or BSA: Based on Weight: See Equation 2.

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Based on BSA: See Equation 3.

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Before prescribing lopinavir and ritonavir 100/25 mg tablets, children should be assessed for the ability to swallow intact tablets. If a child is unable to reliably swallow a lopinavir and ritonavir tablet, the lopinavir and ritonavir 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 lopinavir and ritonavir 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, (fos)amprenavir, or nelfinavir, it is recommended that lopinavir and ritonavir tablets not be administered in combination with these drugs in patients < 6 months of age.
6 Months to 18 Years: Without Concomitant Efavirenz, Nevirapine, (Fos) amprenavir or Nelfinavir: In children 6 months to 18 years of age, the recommended dosage of lopinavir/ritonavir using lopinavir and ritonavir oral solution without concomitant efavirenz, nevirapine, (fos)amprenavir, or nelfinavir is 230/57.5 mg/m² given twice daily, not to exceed the recommended adult dose. 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.
Table 9 provides the dosing recommendations for pediatric patients 6 months to 18 years of age based on body weight or body surface area for lopinavir and ritonavir tablets. (See Table 9.)

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Concomitant Therapy: Efavirenz, Nevirapine, (Fos) amprenavir, or Nelfinavir: A dose increase of lopinavir and ritonavir tablets to 300/75 mg/m² is needed when co-administered with efavirenz, nevirapine, (fos)amprenavir, or nelfinavir in children (both treatment-naïve and treatment-experienced) 6 months to 18 years of age, not to exceed the recommended adult dose. If weight-based dosing is preferred, the recommended dosage for patients <15 kg is 13/3.25 mg/kg given twice daily and the dosage for patients >15 kg to 45 kg is 11/2.75 mg/kg given twice daily.
Table 10 provides the dosing recommendations for pediatric patients 6 months to 18 years of age based on body weight or body surface area for lopinavir and ritonavir tablets when given in combination with efavirenz, nevirapine, (fos)amprenavir, or nelfinavir. (See Table 10.)

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