Lopinavir /Ritonavir Ranbaxy (Lopinavir, Ritonavir)

Lopinavir/ritonavir is used as part of antiretroviral therapy targeting the HIV-1 protease pathway.

• HIV-1 infection: reduces viral replication and improves immune function when combined with other antiretrovirals.
• Prevention of mother‑to‑child transmission: lowers the risk of vertical HIV transmission when administered to pregnant women as part of a combination regimen.
• Post‑exposure prophylaxis: incorporated into recommended regimens for occupational or accidental exposure to HIV.

• Lopinavir binds to the active site of HIV‑1 protease, blocking the cleavage of viral polyprotein precursors and preventing maturation of infectious virions. Ritonavir inhibits CYP3A enzymes, markedly slowing lopinavir metabolism and increasing its plasma concentration, thereby enhancing antiviral efficacy.

Lopinavir/ritonavir may cause a range of adverse reactions, most of which are dose‑related or related to the pharmacokinetic boosting effect of ritonavir.

Common Side Effects

• Diarrhea: frequent loose stools, often mild to moderate.
• Nausea and vomiting: gastrointestinal discomfort occurring after dosing.
• Headache: transient mild to moderate pain.
• Elevated triglycerides: increase in blood lipid levels.

Serious or Rare Side Effects

• Hepatotoxicity: signs of liver injury such as jaundice or elevated transaminases.
• Pancreatitis: severe abdominal pain with elevated pancreatic enzymes.
• Severe allergic reactions: rash, angioedema, or anaphylaxis.
• QT interval prolongation: cardiac rhythm disturbances detectable on ECG.
• Lipodystrophy: abnormal fat redistribution, especially in the abdomen and dorsocervical region.

When prescribing lopinavir/ritonavir, clinicians should consider several safety measures.

• Liver function monitoring: assess baseline enzymes and repeat during therapy.
• Lipid profile assessment: check triglycerides and cholesterol periodically.
• Hypersensitivity avoidance: discontinue if any allergic reaction occurs.
• Pregnancy counseling: use only if benefits outweigh potential risks; category B.
• Hepatic impairment dose adjustment: consider reduced dosing in moderate to severe liver disease.
• Store at below 25°C: keep in the original pack, protect from moisture and direct sunlight.

Lopinavir/ritonavir interacts with many drugs metabolized by CYP3A4, requiring careful review of concomitant medications.

Major Interactions (Avoid)

• Strong CYP3A inducers (e.g., rifampin, carbamazepine, St. John's wort): markedly reduce lopinavir exposure.
• Antiarrhythmic agents (e.g., amiodarone, quinidine): increase risk of cardiac conduction abnormalities.
• Certain sedatives (e.g., midazolam, triazolam): may cause excessive sedation or respiratory depression.

Moderate Interactions (Monitor Closely)

• Statins (simvastatin, lovastatin): increased risk of myopathy; consider dose reduction or alternative lipid‑lowering agents.
• Oral anticoagulants (warfarin): monitor INR more frequently.
• Hormonal contraceptives: efficacy may be reduced; advise additional non‑hormonal contraception.