-
Related books
PDR Drug Guide for Mental Health Professionals, 3rd Edition
by Physicians' Desk Reference (Paperback - Sep 30, 2007)
Excerpt:
... "Other drugs to be avoided during thioridazine therapy include fluvoxamine, Norvir, Paxil, pindolol, Prozac, Rescriptor, and Tagamet." ...
More about this bookEuropean Blue List: European Drug Registrations (Ring Bound Edition)
by Karl Feiden (Ring-bound - Mar 1, 1999)
Excerpt:
... "Nobi-vac Porcoli Norvir Novo-Seven Olansek Pentofel Puregon Rapilysin refludan rilutek Taxotere" ...
More about this bookThe Top 100 Drug Interactions: A Guide to Patient Management, 2005 Editon
by Philip D. Hansten and John R. Horn (Paperback - Jan 3, 2004)
Excerpt:
... "Quinupristin (Synercid) ritonavir (Norvir) saquinavir (Invirase) Telithromycin (Ketek) COMMENTS:" ...
More about this bookThe Top 100 Drug Interactions: A Guide to Patient Management, Year 2008
by Philip D. Hansten and John R. Horn (Perfect Paperback - Jan 31, 2008)
Excerpt:
... "('rixivan) nelfinavir (Viracept) ritonavir (Norvir) saquinavir (Invirase) verapamil (Isoptin) COMMENTS:" ...
More about this bookImmune Restoration Handbook, Second Edition
by Mark Konlee and Conrad LeBeau (Paperback - Dec 2004)
Excerpt:
... "approved protease inhibitors prior to 2003 for treating AIDS, only Norvir (Ritonavir) has consistently remitted KS lesions, even in very advanced" ...
More about this bookThe PDR Pocket Guide to Prescription Drugs: Sixth Edition
by Thompson PDR (Mass Market Paperback - Dec 1, 2003)
Excerpt:
... "you are taking both agenerase and the HIV drug ritonavir (Norvir), you must be careful to avoid the heart medications flecainide" ...
More about this bookNursing Drug Interactions Handbook
by Springhouse (Paperback - Nov 1, 2008)
Excerpt:
... "bupropion WNHEW ritonavir Wellbutrin, Zyban Norvir Risk rating: 2 Severity: Moderate Onset: Delayed Likelihood:" ...
More about this bookPDR Drug Guide For Mental Health Professionals (Pdr Drug Guide for Mental Health Professionals)
(Paperback)
Excerpt:
... "aldomet and catapres indinavir (Crixivan) ketoconazole (Nizoral) phenytoin (Dilantin) ritonavir (Norvir) warfarin (Coumadin)" ...
More about this bookThe Top 100 Drug Interactions: A Guide to Patient Management, Year 2006
by Philip D. Hansten; John R. Horn (Paperback - Dec 1, 2005)
Excerpt:
... "Trimipramine(Surniontil) Propox~phene(Darvon) quinidine (Quinidex) ritonavir (Norvir) l'erhinafine (Lamisil) CosRirsrs: CYP2D6 inhibitors (" ...
More about this bookThe Essential Guide to Prescription Drugs 2005 : Everything You Need to Know for Safe Drug Use (The Essential Guide to Prescription Drugs)
by James J. Rybacki (Paperback - Nov 30, 2004)
Excerpt:
... "result in slow recovery from low blood sugar. ritonavir (Norvir) and perhaps other protease inhibitors may increase the metabolism of" ...
More about this bookA Woman's Guide to Living with HIV Infection (A Johns Hopkins Press Health Book)
by Rebecca A. Clark MD PhD, Robert T. Maupin Jr. MD FACOG, and Jill Hayes PhD (Hardcover - Mar 17, 2004)
Excerpt:
... "saquinavir Fortivase large tan capsule ritonavir Norvir large white capsule indinavir crixivan white capsule nelfinavir viracept oblong" ...
More about this bookThe PDR Pocket Guide to Prescription Drugs: 7th Edition
by Thompson PDR (Mass Market Paperback - Nov 29, 2005)
Excerpt:
... "Nizoral) Long-acting inhalers such as foradil and serevent ritonavir (Norvir) Water pills (diuretics) such as HydroDILIRIL and lasix Special information" ...
More about this book
medicine: norvir
norvir description
Ritonavir, with trade name Norvir (Abbott Laboratories), is an antiretroviral drug from the protease inhibitor class used to treat HIV infection and AIDS.
Ritonavir is frequently prescribed with HAART, not for its antiviral action, but as it inhibits the same host enzyme that metabolizes other protease inhibitors. This inhibition leads to higher plasma concentrations of these latter drugs, allowing the clinician to lower their dose and frequency and improving their clinical efficacy.
History
Ritonavir is manufactured as Norvir by Abbott Laboratories. Research that led to the drug's development was financed by a $3,500,000 federal grant through the National Institutes of Health (NIH) and over $200,000,000 by Abbott Labs. Most of the $200,000,000 figure cited by Abbott paid for clinical trials-despite NIH offering to pay for them-because Abbott was concerned about "public interest" responses to the high prices they projected Norvir would command. The Food and Drug Administration (FDA) approved ritonavir on March 1, 1996, making it the seventh approved antiretroviral drug in the United States. In 2003, Abbott raised the price of a Norvir course from USD $1.71 per day to $8.57 per day, leading to claims of price gouging by patients' groups and some members of Congress. Consumer group Essential Inventions petitioned the NIH to override the Norvir patent, but the NIH announced on August 4, 2004 that it would not invoke its legal right to allow generic production of Norvir, citing potential adverse effects on the pharmaceutical market.
Method of action
Ritonavir (center) bound to the active site of HIV protease.Ritonavir was originally developed as an inhibitor of HIV protease.It's one of the most complex inhibitors. It is now rarely used for its own antiviral activity, but remains widely used as a booster of other protease inhibitors. More specifically, ritonavir is used to inhibit a particular liver enzyme that normally metabolizes protease inhibitors, cytochrome P450-3A4 (CYP3A4). The drug's molecular structure inhibits CYP3A4, so a low dose can be used to enhance other protease inhibitors. This discovery, which has drastically reduced the adverse effects and improved the efficacy of PI's and HAART, was first communicated in an article published in the AIDS Journal in 1997 by the University of Liverpool. This effect does come with a price: it also affects the efficacy of numerous other medications, making it difficult to know how to administer them concurrently. In addition it can cause a large number of side-effects on its own.
Drug interactions
Concomitant therapy of ritonavir with a variety of medications may result in serious and sometimes fatal drug interactions . These interactions can occur with strong inhibitors, strong or moderate inducers or substrates of hepatic cytochrome P450 CYP3A4 isoform.
The list of clinically significant interactions of ritonavir includes but is not limited to following drugs:
amiodarone - decreased metabolism, possible toxicitymidazolam and triazolam - contraindicated
cisapride - decreased metabolism, possible prolongation of Q-T interval and life-threatening arrythmias
disulfiram (with ritonavir oral preparation) - decreased metabolism of ritonavir
eplerenone
etravirine
flecainide - decreased metabolism, possible toxicity
mdma
meperidine - build-up of toxic concentrations of a metabolite possible
nilotinib
nisoldipine
pimozide
quinidine
ranolazine
salmeterol
St John's wort
statins - decreased metabolism, without dosage modification increased risk of rhabomyolisis
thioridazine
topotecan
voriconazole - ritonavir increases metabolism of voriconazole
Side effects
The most common side effects of ritonavir therapy are:
asthenia, malaisediarrhoea
nausea and vomiting
abdominal pain
dizziness
insomnia
sweating
taste abonormality
metabolichypercholesterolemia
hypertriglyceridemia
elevated transaminases
elevated CPK
One of ritonavir's side effects is hyperglycemia. It appears that ritonavir directly inhibits the GLUT4 insulin-regulated transporter, keeping glucose from entering fat and muscle cells. This can lead to insulin resistance and cause problems for Type I diabetics.
Conformational polymorphism
This section is in need of attention from an expert on the subject. WikiProject Pharmacology or the Pharmacology Portal may be able to help recruit one. (September 2009)Norvir was originally dispensed as an ordinary capsule, which did not require refrigeration. This original capsule exhibited strong conformational polymorphism. This threatened existing supplies of ritonavir as the lower energy polymorph caused the therapeutically effective polymorph to convert to the lower energy polymorph on contact. This lower energy polymorph, which was not therapeutically effective, entered production lines and effectively halted production processes. After this discovery in the late 1990s, Abbot withdrew the original capsules from the market, and recommended patients switch to Norvir suspension while researchers worked to solve the problem. The capsules have been replaced with refrigerated gelcaps, to solve the crystallization problem of the original capsules. Norvir suspension is still available, but its flavor has been described as "cherry motor oil".
Tags
Keywords related to norvir
trimeprazine tartrate theostat 80 dehydroepiandrosterone intron a dyclonine nedaplatin luxiq femara methandrostenolone tranilast sterane noritate prussian blue rolicyclidine levoxyl norgesic piromidic acid romazicon olsalazine dosulepin hydrochloride terconazole peridex 11 deoxycorticosterone lorazepam butacaine fencamfamin agrylin desomorphine dihydroergotamine lidocaine mestanolone vecuronium bromide cetrotide cinobac dial ilosone psilocybine tylenol oxetine tirofiban tetrabenazine bimatoprost flumazenil dimiracetam nonabine