Ritonavir

What is Ritonavir

Ritonavir is an antiretroviral protease inhibitor used for the treatment of HIV infection.

Ritonavir is most often used as a pharmacokinetic enhancer or boosting agent in combination with another protease inhibitor for the treatment of HIV infection.

It is rarely used as the primary protease inhibitor in combination therapy.

Ritonavir has high affinity for the cytochrome P450 isoenzymes, especially CYP3A4, and may be involved in many drug-drug interactions.

Brand Name

Norvir

Indications

• human immunodeficiency virus (HIV)
• human immunodeficiency virus (HIV) infection
• human immunodeficiency virus (HIV) prophylaxis

Side Effects

1. abdominal pain
2. acne vulgaris
3. anaphylactoid reactions
4. anemia
5. angioedema
6. arthralgia
7. asthenia
8. AV block
9. back pain
10. bleeding
11. blurred vision
12. breast enlargement
13. bronchospasm
14. bundle-branch block
15. confusion
16. cough
17. Cushingoid features
18. dehydration
19. diabetes mellitus
20. diabetic ketoacidosis
21. diarrhea
22. dizziness
23. dysgeusia
24. dyspepsia
25. edema
26. elevated hepatic enzymes
27. fatigue
28. flatulence
29. flushing
30. gastroesophageal reflux
31. GI bleeding
32. gout
33. gynecomastia
34. hematoma
35. hepatitis
36. hyperamylasemia
37. hyperbilirubinemia
38. hypercholesterolemia
39. hyperglycemia
40. hyperlipidemia
41. hypertension
42. hypertriglyceridemia
43. hyperuricemia
44. hypotension
45. increased urinary frequency
46. jaundice
47. lipodystrophy
48. maculopapular rash
49. myalgia
50. myopathy
51. nausea
52. neutropenia
53. orthostatic hypotension
54. pancreatitis
55. paresthesias
56. peripheral edema
57. peripheral neuropathy
58. PR prolongation
59. pruritus
60. QT prolongation
61. rash
62. seizures
63. Stevens-Johnson syndrome
64. syncope
65. throat irritation
66. thrombocytopenia
67. toxic epidermal necrolysis
68. urticaria
69. vomiting

Monitoring Parameters

• blood glucose
• CBC with differential
• CD4+ T cell count
• hepatitis B serology
• LFTs
• plasma hepatitis C RNA
• plasma HIV RNA
• pregnancy testing
• serum bilirubin (total and direct)
• serum cholesterol
• serum lipid profile
• urinalysis

Contraindications

• autoimmune disease
• AV block
• breast-feeding
• cardiac disease
• cardiomyopathy
• congenital heart disease
• coronary artery disease
• diabetes mellitus
• diabetic ketoacidosis
• Graves’ disease
• Guillain-Barre syndrome
• hemophilia
• hepatic disease
• hepatitis
• hepatitis B and HIV coinfection
• hepatitis C and HIV coinfection
• human immunodeficiency virus (HIV) infection resistance
• hypercholesterolemia
• hyperglycemia
• hyperlipidemia
• hypertriglyceridemia
• immune reconstitution syndrome
• infants
• jaundice
• neonates
• pancreatitis
• pregnancy
• premature neonates
• ritonavir coadministration with other drugs

Interactions

• Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
• Abemaciclib
• Acalabrutinib
• Acarbose
• Acebutolol
• Acetaminophen
• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Dichloralphenazone; Isometheptene
• Acetaminophen; Diphenhydramine
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Propoxyphene
• Acetaminophen; Pseudoephedrine
• Acetaminophen; Tramadol
• Adefovir
• Ado-Trastuzumab emtansine
• Afatinib
• Aldesleukin, IL-2
• Alfentanil
• Alfuzosin
• Aliskiren
• Aliskiren; Amlodipine
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Aliskiren; Hydrochlorothiazide, HCTZ
• Aliskiren; Valsartan
• Almotriptan
• Alogliptin
• Alogliptin; Metformin
• Alogliptin; Pioglitazone
• Alosetron
• Alpha-glucosidase Inhibitors
• Alprazolam
• Amiodarone
• Amitriptyline
• Amitriptyline; Chlordiazepoxide
• Amlodipine
• Amlodipine; Atorvastatin
• Amlodipine; Benazepril
• Amlodipine; Celecoxib
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amlodipine; Olmesartan
• Amlodipine; Telmisartan
• Amlodipine; Valsartan
• Amobarbital
• Amoxapine
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Amphetamine
• Amphetamine; Dextroamphetamine
• Amphetamines
• Apalutamide
• Apixaban
• Aprepitant, Fosaprepitant
• Arformoterol
• Aripiprazole
• Armodafinil
• Artemether; Lumefantrine
• Aspirin, ASA; Butalbital; Caffeine
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Citric Acid; Sodium Bicarbonate
• Aspirin, ASA; Omeprazole
• Aspirin, ASA; Oxycodone
• Atazanavir
• Atazanavir; Cobicistat
• Atenolol
• Atenolol; Chlorthalidone
• Atorvastatin
• Atorvastatin; Ezetimibe
• Atovaquone
• Atovaquone; Proguanil
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Avanafil
• Avapritinib
• Avatrombopag
• Axitinib
• Azelastine; Fluticasone
• Barbiturates
• Bedaquiline
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Belladonna; Opium
• Bendroflumethiazide; Nadolol
• Benzhydrocodone; Acetaminophen
• Benzphetamine
• Bepridil
• Betamethasone
• Betaxolol
• Betrixaban
• Bicalutamide
• Bismuth Subcitrate Potassium; Metronidazole; Tetracycline
• Bismuth Subsalicylate; Metronidazole; Tetracycline
• Bisoprolol
• Bisoprolol; Hydrochlorothiazide, HCTZ
• Boceprevir
• Bortezomib
• Bosentan
• Bosutinib
• Brentuximab vedotin
• Brexpiprazole
• Brigatinib
• Brimonidine; Timolol
• Bromocriptine
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Budesonide
• Budesonide; Formoterol
• Bupivacaine
• Bupivacaine Liposomal
• Bupivacaine; Lidocaine
• Buprenorphine
• Buprenorphine; Naloxone
• Bupropion
• Bupropion; Naltrexone
• Buspirone
• Butabarbital
• Cabazitaxel
• Cabozantinib
• Caffeine; Ergotamine
• Calcifediol
• Canagliflozin
• Canagliflozin; Metformin
• Cannabidiol
• Capmatinib
• Carbamazepine
• Carbetapentane; Chlorpheniramine
• Carbetapentane; Chlorpheniramine; Phenylephrine
• Carbetapentane; Diphenhydramine; Phenylephrine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Cariprazine
• Carteolol
• Carvedilol
• Ceritinib
• Cetirizine
• Cetirizine; Pseudoephedrine
• Cevimeline
• Chloramphenicol
• Chlordiazepoxide
• Chlordiazepoxide; Clidinium
• Chlorpheniramine
• Chlorpheniramine; Codeine
• Chlorpheniramine; Dextromethorphan
• Chlorpheniramine; Dextromethorphan; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Phenylephrine
• Chlorpheniramine; Pseudoephedrine
• Ciclesonide
• Cidofovir
• Cilostazol
• Cimetidine
• Cinacalcet
• Cisapride
• Citalopram
• Clarithromycin
• Clevidipine
• Clindamycin
• Clobazam
• Clofarabine
• Clomipramine
• Clonazepam
• Clopidogrel
• Clorazepate
• Clozapine
• Cobicistat
• Cobimetinib
• Cocaine
• Codeine
• Codeine; Guaifenesin
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• Colchicine
• Colchicine; Probenecid
• Conivaptan
• Conjugated Estrogens
• Conjugated Estrogens; Bazedoxifene
• Conjugated Estrogens; Medroxyprogesterone
• Copanlisib
• Crizotinib
• Cyclophosphamide
• Cyclosporine
• Dabigatran
• Dabrafenib
• Daclatasvir
• Dapagliflozin
• Dapagliflozin; Metformin
• Dapagliflozin; Saxagliptin
• Dapsone
• Darifenacin
• Darolutamide
• Darunavir; Cobicistat
• Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
• Dasatinib
• Deferasirox
• Deflazacort
• Delavirdine
• Desipramine
• Dexamethasone
• Dexlansoprazole
• Dexmedetomidine
• Dextroamphetamine
• Dextromethorphan; Diphenhydramine; Phenylephrine
• Dextromethorphan; Quinidine
• Diazepam
• Diclofenac
• Diclofenac; Misoprostol
• Dienogest; Estradiol valerate
• Digoxin
• Dihydrocodeine; Guaifenesin; Pseudoephedrine
• Dihydroergotamine
• Diltiazem
• Diphenhydramine
• Diphenhydramine; Hydrocodone; Phenylephrine
• Diphenhydramine; Ibuprofen
• Diphenhydramine; Naproxen
• Diphenhydramine; Phenylephrine
• Disopyramide
• Disulfiram
• Docetaxel
• Dofetilide
• Donepezil
• Donepezil; Memantine
• Doravirine
• Doravirine; Lamivudine; Tenofovir disoproxil fumarate
• Dorzolamide; Timolol
• Doxazosin
• Doxepin
• Doxercalciferol
• Doxorubicin
• Doxorubicin Liposomal
• Dronabinol
• Dronedarone
• Drospirenone; Estradiol
• Drospirenone; Ethinyl Estradiol
• Drospirenone; Ethinyl Estradiol; Levomefolate
• Dutasteride
• Dutasteride; Tamsulosin
• Duvelisib
• Echinacea
• Edoxaban
• Efavirenz
• Efavirenz; Emtricitabine; Tenofovir
• Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
• Elagolix
• Elagolix; Estradiol; Norethindrone acetate
• Elbasvir; Grazoprevir
• Eletriptan
• Elexacaftor; tezacaftor; ivacaftor
• Eliglustat
• Eltrombopag
• Eluxadoline
• Elvitegravir
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
• Empagliflozin
• Empagliflozin; Linagliptin
• Empagliflozin; Linagliptin; Metformin
• Empagliflozin; Metformin
• Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
• Emtricitabine; Tenofovir disoproxil fumarate
• Enalapril; Felodipine
• Encainide
• Encorafenib
• Enfortumab vedotin
• Entrectinib
• Enzalutamide
• Eplerenone
• Erdafitinib
• Ergoloid Mesylates
• Ergonovine
• Ergot alkaloids
• Ergotamine
• Erlotinib
• Ertugliflozin; Metformin
• Erythromycin
• Erythromycin; Sulfisoxazole
• Eslicarbazepine
• Esmolol
• Esomeprazole
• Esomeprazole; Naproxen
• Estazolam
• Esterified Estrogens
• Esterified Estrogens; Methyltestosterone
• Estradiol
• Estradiol Cypionate; Medroxyprogesterone
• Estradiol; Levonorgestrel
• Estradiol; Norethindrone
• Estradiol; Norgestimate
• Estradiol; Progesterone
• Estropipate
• Eszopiclone
• Ethanol
• Ethinyl Estradiol
• Ethinyl Estradiol; Desogestrel
• Ethinyl Estradiol; Ethynodiol Diacetate
• Ethinyl Estradiol; Etonogestrel
• Ethinyl Estradiol; Levonorgestrel
• Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
• Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
• Ethinyl Estradiol; Norelgestromin
• Ethinyl Estradiol; Norethindrone
• Ethinyl Estradiol; Norethindrone Acetate
• Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
• Ethinyl Estradiol; Norethindrone; Ferrous fumarate
• Ethinyl Estradiol; Norgestimate
• Ethinyl Estradiol; Norgestrel
• Ethosuximide
• Ethotoin
• Etonogestrel
• Etravirine
• Everolimus
• Ezetimibe; Simvastatin
• Fedratinib
• Felbamate
• Felodipine
• Fentanyl
• Fesoterodine
• Fexofenadine
• Fexofenadine; Pseudoephedrine
• Flecainide
• Flibanserin
• Fluconazole
• Fluoxetine
• Fluoxetine; Olanzapine
• Flurazepam
• Fluticasone
• Fluticasone; Salmeterol
• Fluticasone; Umeclidinium; Vilanterol
• Fluticasone; Vilanterol
• Fluvastatin
• Fluvoxamine
• food
• Formoterol; Mometasone
• Foscarnet
• Fosphenytoin
• Fostamatinib
• Galantamine
• Gefitinib
• Gilteritinib
• Glasdegib
• Glecaprevir; Pibrentasvir
• Glipizide; Metformin
• Glyburide; Metformin
• Granisetron
• grapefruit juice
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Guanfacine
• Halofantrine
• Haloperidol
• Homatropine; Hydrocodone
• Hydantoins
• Hydrochlorothiazide, HCTZ; Losartan
• Hydrochlorothiazide, HCTZ; Metoprolol
• Hydrochlorothiazide, HCTZ; Propranolol
• Hydrochlorothiazide, HCTZ; Valsartan
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydroxyprogesterone
• Ibrutinib
• Ibuprofen; Oxycodone
• Idelalisib
• Ifosfamide
• Iloperidone
• Imatinib
• Imipramine
• Incretin Mimetics
• Indacaterol
• Indacaterol; Glycopyrrolate
• Indinavir
• Insulins
• Interferon Alfa-2b; Ribavirin
• Interferons
• Irinotecan
• Irinotecan Liposomal
• Isavuconazonium
• Isoniazid, INH; Pyrazinamide, PZA; Rifampin
• Isoniazid, INH; Rifampin
• Isradipine
• Istradefylline
• Itraconazole
• Ivabradine
• Ivacaftor
• Ivosidenib
• Ixabepilone
• Ketamine
• Ketoconazole
• Labetalol
• Lacosamide
• Lamivudine, 3TC; Zidovudine, ZDV
• Lamivudine; Tenofovir Disoproxil Fumarate
• Lamotrigine
• Lansoprazole
• Lansoprazole; Naproxen
• Lanthanum Carbonate
• Lapatinib
• Larotrectinib
• Ledipasvir; Sofosbuvir
• Lefamulin
• Lemborexant
• Lesinurad
• Lesinurad; Allopurinol
• Letermovir
• Leuprolide; Norethindrone
• Levobupivacaine
• Levocetirizine
• Levomethadyl
• Levomilnacipran
• Levonorgestrel
• Levorphanol
• Lidocaine
• Lidocaine; Prilocaine
• Linagliptin
• Linagliptin; Metformin
• Lisdexamfetamine
• Lomitapide
• Loperamide
• Loperamide; Simethicone
• Lorlatinib
• Losartan
• Lovastatin
• Lovastatin; Niacin
• Lumacaftor; Ivacaftor
• Lumacaftor; Ivacaftor
• Lumateperone
• Lurasidone
• Macitentan
• Maprotiline
• Maraviroc
• Meclizine
• Medroxyprogesterone
• Mefloquine
• Meloxicam
• Meperidine
• Meperidine; Promethazine
• Mephobarbital
• Mestranol; Norethindrone
• Metformin
• Metformin; Pioglitazone
• Metformin; Repaglinide
• Metformin; Rosiglitazone
• Metformin; Saxagliptin
• Metformin; Sitagliptin
• Methadone
• Methamphetamine
• Methohexital
• Methylergonovine
• Methylprednisolone
• Methysergide
• Metoclopramide
• Metoprolol
• Metronidazole
• Mexiletine
• Midazolam
• Midostaurin
• Mifepristone
• Miglitol
• Mirabegron
• Mirtazapine
• Mitomycin
• Mitotane
• Modafinil
• Mometasone
• Morphine
• Morphine; Naltrexone
• Moxifloxacin
• Nabilone
• Nadolol
• Nafcillin
• Naldemedine
• Naloxegol
• Nateglinide
• Nebivolol
• Nebivolol; Valsartan
• Nefazodone
• Nelfinavir
• Neratinib
• Netupitant, Fosnetupitant; Palonosetron
• Nevirapine
• Niacin; Simvastatin
• Nicardipine
• Nifedipine
• Nilotinib
• Nimodipine
• Nintedanib
• Nisoldipine
• Norethindrone
• Nortriptyline
• Olanzapine
• Olaparib
• Olodaterol
• Omeprazole
• Omeprazole; Amoxicillin; Rifabutin
• Omeprazole; Sodium Bicarbonate
• Ondansetron
• Oritavancin
• Orlistat
• Osilodrostat
• Ospemifene
• Oxcarbazepine
• Oxybutynin
• Oxycodone
• Oxymorphone
• Paclitaxel
• Palbociclib
• Panobinostat
• Paricalcitol
• Paroxetine
• Pazopanib
• Pemigatinib
• Penbutolol
• Pentobarbital
• Perampanel
• Pergolide
• Perindopril; Amlodipine
• Perphenazine; Amitriptyline
• Pexidartinib
• Phenobarbital
• Phentermine; Topiramate
• Phenytoin
• Pimavanserin
• Pimozide
• Pindolol
• Pirfenidone
• Polatuzumab Vedotin
• Pomalidomide
• Ponatinib
• Posaconazole
• Pramlintide
• Praziquantel
• Prednisolone
• Prednisone
• Primidone
• Propafenone
• Propofol
• Propoxyphene
• Propranolol
• Protriptyline
• Quazepam
• Quetiapine
• Quinidine
• Quinine
• Rabeprazole
• Ramelteon
• Ranolazine
• Red Yeast Rice
• Regorafenib
• Remifentanil
• Repaglinide
• Retapamulin
• Ribavirin
• Ribociclib
• Ribociclib; Letrozole
• Rifabutin
• Rifampin
• Rifapentine
• Rifaximin
• Riluzole
• Rimegepant
• Riociguat
• Ripretinib
• Risperidone
• Rivaroxaban
• Rocuronium
• Roflumilast
• Romidepsin
• Rosuvastatin
• Ruxolitinib
• Sacituzumab Govitecan
• Sacubitril; Valsartan
• Salmeterol
• Sapropterin
• Saxagliptin
• Secobarbital
• Segesterone Acetate; Ethinyl Estradiol
• Selegiline
• Selpercatinib
• Selumetinib
• Sibutramine
• Sildenafil
• Silodosin
• Simeprevir
• Simvastatin
• Simvastatin; Sitagliptin
• Siponimod
• Sirolimus
• Sitagliptin
• Sodium Bicarbonate
• Sodium Oxybate
• Solifenacin
• Somatropin, rh-GH
• Sonidegib
• Sotalol
• St. John’s Wort, Hypericum perforatum
• Sufentanil
• Sulfonylureas
• Sunitinib
• Suvorexant
• Tacrolimus
• Tadalafil
• Talazoparib
• Tamsulosin
• Tasimelteon
• Tazemetostat
• Telithromycin
• Telotristat Ethyl
• Temsirolimus
• Teniposide
• Tenofovir, PMPA
• Terbinafine
• Terfenadine
• Tesamorelin
• Testosterone
• Tezacaftor; Ivacaftor
• Theophylline, Aminophylline
• Thiazolidinediones
• Thiopental
• Thioridazine
• Thiotepa
• Tiagabine
• Ticagrelor
• Timolol
• Tinidazole
• Tiotropium; Olodaterol
• Tofacitinib
• Tolterodine
• Tolvaptan
• Topiramate
• Topotecan
• Toremifene
• Trabectedin
• Tramadol
• Trandolapril; Verapamil
• Trazodone
• Triamcinolone
• Triazolam
• Tricyclic antidepressants
• Trimetrexate
• Trimipramine
• Tucatinib
• Ubrogepant
• Ulipristal
• Upadacitinib
• Valbenazine
• Valproic Acid, Divalproex Sodium
• Valsartan
• Vardenafil
• Vemurafenib
• Venetoclax
• Verapamil
• Vilazodone
• Vinblastine
• Vincristine
• Vincristine Liposomal
• Vinorelbine
• Vorapaxar
• Voriconazole
• Vorinostat
• Voxelotor
• Warfarin
• Yohimbine
• Zafirlukast
• Zalcitabine, ddC
• Zaleplon
• Zanubrutinib
• Zidovudine, ZDV
• Zileuton
• Ziprasidone
• Zolmitriptan
• Zolpidem
• Zonisamide