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Ritonavir liquid
Owing to a worldwide shortage of ritonavir (Norvir) capsules, people who are currently taking ritonavir will be receiving their medicine in a liquid form from the beginning of September. The liquid is called ritonavir oral solution. Both preparations are equally effective and have similar potential side-effects and drug interactions.
Some people prefer to take the liquid as it means having fewer capsules to swallow – but some do find the taste (and often the ‘aftertaste’) bitter. The following suggestions may help to mask this taste and ease the change from capsules to liquid.
If you have any difficulties with this change, don’t stop your medication – talk to your clinic doctor, nurse or hospital pharmacist, about your options.
Tips for taking ritonavir liquid
- Try any of the following suggestions – or if you have thought of your own ways to make the liquid more palatable, check them out with your HIV pharmacist or doctor. Different things work for different people, so if you’re having difficulty at first, persevere with some alternatives.
- Remember, don’t mix ritonavir liquid directly with water or water-based drinks (e.g. squash or fruit juice) because it may form a precipitate (go cloudy or lumpy) and don’t freeze the liquid.
- Try mixing ritonavir liquid with up to 250ml (half a pint) of a milk-based nutritional supplement (e.g. Build Up, Ensure, Ensure Plus, Scandi Shake) or a milk shake (make sure you drink it within one hour of adding the ritonavir). Chocolate flavour seems to be best at disguising the taste. You can also try drinking the mixture through a straw to bypass most of the tastebuds. Alternatively, drink half a glass of supplement/milk shake, then take the ritonavir, then drink the rest of the supplement. For best results, chill the drink in the fridge first.
- Try freezing a small carton of fruit juice drink or water-based nutritional supplement (e.g. Enlive, Provide) by placing it in the freezer for about four hours, until it looks like crushed ice. Drink half of it, followed by the ritonavir, then finish off the icy drink. Alternatively, suck an ice cube or ice lolly before taking the dose.
- Try drinking mango juice or eating a peanut butter sandwich, chocolate spread or salty crisps before and after taking the ritonavir.
- Try eating a piece of fruit, strong flavoured yoghurt, a strong peppermint or chewing gum after the ritonavir.
- Try a ‘ritonavir slammer’ – salt, ritonavir, then suck a piece of lime.
- You can use an oral syringe (from your pharmacy) to squirt the liquid to the back of your mouth, so avoiding most of the tastebuds.
Other information about ritonavir liquid
Ritonavir liquid should be kept at room temperature. (If it’s hot – above 25oC – keep it in the coolest area of the house, but not a fridge). Ritonavir liquid is most stable between 20 and 25oC. Shake the bottle vigorously before taking the dose. If the liquid is cloudy or contains crystals, take the dose as usual but contact your pharmacy.
There is more alcohol in the liquid than the capsules, and this may interact with metronidazole (Flagyl), an antibiotic used to treat genitourinary infections, or disulfiram (Antabuse). 5ml of liquid contains about a quarter of a unit of alcohol.
400mg ritonavir (4 capsules) = 5ml ritonavir liquid; 500mg (5 capsules) = 6.25ml; 600mg (6 capsules) = 7.5ml. Measure the dose carefully using the dosing cup provided, an oral syringe, or a 5ml spoon. Do not use a kitchen teaspoon. The measure must be clean and dry before use.
Further information
Abbott, the manufacturers of ritonavir have produced a letter for all patients and have set up a freephone helpline (0800 018 3340) and website (http://www.norvir.com). Don’t forget to read the manufacturer’s information for patients on ritonavir liquid and to discuss this Factsheet with your doctor. The information in this Factsheet is based on current knowledge and practice and does not necessarily reflect the views of Abbott Laboratories.