Children

Ritonavir (Norvir) is approved for use in children aged over two years in Europe and over one month in the United States . Body surface area is used for dosing in children at a recommended twice daily dose of 350mg/m2 twice daily, not exceeding 600mg twice daily. The starting dose is 250mg/m2, increasing by 50mg/m2 every two to three days until the final dose is reached.

Triple drug combinations including ritonavir are effective in children, with similar side-effect profiles to adults, even in those with prior treatment exposure.1 2 3 4 5 The approval of ritonavir for children aged as young as one month was based on good results of a combination of ritonavir, AZT (zidovudine, Retrovir) and 3TC (lamivudine, Epivir) in 50 HIV-positive children.6

The liquid formulation of ritonavir is bitter. If children cannot stand the taste, it can be disguised by being given after peanut butter and followed with chocolate sauce or cheese. Alternatively, it can be mixed into chocolate milk.

References

  1. Nachman SA et al. Nucleoside analogs plus ritonavir in stable antiretroviral therapy-experienced HIV-infected children: a randomized controlled trial. JAMA 283: 492-498, 2000
  2. Horneff G et al. Preliminary experiences with ritonavir in children with advanced HIV infection. Infection 27: 103-107, 1999
  3. Mueller BU A phase I / II study of the protease inhibitor ritonavir in children with human immunodeficiency virus infection. Pediatrics 101: 335-343, 1998
  4. Pelton SI et al. A one year experience: T cell responses and viral replication in children with advanced human immunodeficiency virus type 1 disease treated with combination therapy including ritonavir. Pediatr Infect Dis J 18: 650-652, 1999
  5. Johnson SR et al. Cushing syndrome with secondary arterial insufficiency from concomitant therapy with ritonavir and fluticasone. J Pediatr 148: 294-295, 2006
  6. Gould Chadwick E et al. Ritonavir-based highly active antiretroviral therapy in human immunodeficiency virus type 1-infected infants younger than 24 months of age. Pediatr Infect Dis J 24: 793-800, 2005
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