ritonavir Nursing Considerations & Management

Drug Name

Generic Name :  ritonavir

Brand Name: Norvir

Classification:  Antiretroviral

Pregnancy Category B 

Dosage & Route

Available forms :Capsules—100 mg; oral solution—80 mg/mL

ADULTS
  • 600 mg PO bid with food.
PEDIATRIC PATIENTS
  • Start at 250 mg/m2 PO bid and increase by 50 mg/m2 twice daily at 2–3 day intervals, to maximum of 400 mg/m2 PO bid; do not exceed 600 mg bid. Use in combination with other antiretrovirals.
Therapeutic actions
  • Ritonavir, a selectively competitive reversible inhibitor of HIV protease, interferes with the formation of essential proteins and enzymes. Afterwhich, the formation of immature and non-infectious viruses follows. It also interferes with the production of infectious HIV and limits further infectious spread of the virus.
Indications
  • Treatment of HIV infection in combination with other antiretrovirals
Adverse effects
  • Syncope, orthostatic hypotension; dry mouth, mouth ulcers, throat irritation, cough; dyspepsia, nausea, vomiting, diarrhoea, taste disturbance, seizures, anxiety, sweating, fever, asthenia, fatigue, headache, dizziness, paraesthesia, myalgia, skin rashes, pruritus, renal insufficiency, anaemia, raised WBC, raised prothrombin time, lipodystrophy, pancreatitis, electrolyte imbalance.
  • Potentially Fatal: Hypersensitivity, anaphylaxis and Stevens-Johnson syndrome.
Contraindications
  • Hypersensitivity; lactation; severe hepatic impairment.
Nursing considerations

CLINICAL ALERT! Name confusion has been reported between Retrovir (zidovudine) and ritonavir; use caution.

Assessment
  • History: Allergy to ritonavir, hepatic dysfunction, pregnancy, lactation
  • Physical: T; orientation, reflexes; BP, P, peripheral perfusion; R, adventitious sounds; bowel sounds; skin color, perfusion; LFTs
Interventions
  • Capsules and oral solution should be stored in refrigerator; solution may be refrigerated or left at room temperature if used within 30 days; protect from light and extreme heat.
  • Administer with meals or food to increase absorption.
  • BLACK BOX WARNING: Carefully screen drug history to avoid potentially dangerous drug interactions.
Teaching points
  • Take this drug with meals or food; store capsules in refrigerator. Taste of solution may be improved if mixed with chocolate milk, Ensure, or Advera 1 hour before taking. Do not drink grapefruit juice while using this drug.
  • Take the full course of therapy as prescribed; do not take double doses if one is missed; do not change dosage without consulting your health care provider. Always take in combination with your other HIV drugs.
  • This drug does not cure HIV infection; long-term effects are not yet known; continue to take precautions as the risk of transmission is not reduced by this drug.
  • Do not take any other drugs, prescription or over-the-counter, without consulting your health care provider; this drug interacts with many other drugs and serious problems can occur.
  • You may experience these side effects: Nausea, vomiting, loss of appetite, diarrhea, abdominal pain, headache, dizziness, numbness, tingling.
  • Report severe diarrhea, severe nausea, personality changes, changes in color of urine or stool, fever, chills.
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