BNF for Children 2011-2012

BNFC 2011–2012 5.3.1 HIV infection 317Side-effects see notes and Cautions above; alsoelectrolyte disturbances; less commonly dysphagia,appetite changes, weight changes, cholecystitis,hypertension, myocardial infarction, palpitation,thrombophlebitis, vasculitis, chest pain, oedema,dyspnoea, cough, agitation, anxiety, amnesia, ataxia,hypertonia, confusion, depression, abnormal dreams,extrapyramidal effects, neuropathy, influenza-likesyndrome, Cushing’s syndrome, hypothyroidism,menorrhagia, amenorrhoea, sexual dysfunction,breast enlargement, dehydration, nephritis, hypercalciuria,lactic acidosis, arthralgia, hyperuricaemia,abnormal vision, otitis media, tinnitus, dry mouth,sialadenitis, mouth ulceration, peridontitis, acne, alopecia,dry skin, sweating, skin discoloration, nail disorders;rarely prolonged PR intervalIndication and doseSee preparationsKaletra c (Abbott) ATablets, pale yellow, f/c, lopinavir 100 mg, ritonavir25 mg, net price 60-tab pack = £76.85. Label: 25DoseHIV infection in combination with other antiretroviraldrugs. By mouthChild 2–18 years with body-weight under 40 kgBody surface area 0.5–0.9 m 2 2 tablets twice dailyBody surface area 0.9–1.4 m 2 3 tablets twice dailyTablets, yellow, f/c, lopinavir 200 mg, ritonavir 50 mg,net price 120-tab pack = £307.39. Label: 25DoseHIV infection in combination with other antiretroviraldrugs. By mouthChild 2–18 years with body surface area greater than1.4 m 2 or body-weight 40 kg and over 2 tablets twicedailyOral solution, lopinavir 400 mg, ritonavir 100 mg/5 mL, net price 5 60-mL packs = £307.39. Label: 21Excipients include propylene glycol 153 mg/mL (see Excipients, p. 2),alcohol 42%DoseHIV infection in combination with other antiretroviraldrugs. By mouthChild 2–18 years 2.9 mL/m 2 (max. 5 mL) twice dailywith foodCounselling Oral solution tastes bitterNELFINAVIRCautions see notes above; interactions: Appendix 1(nelfinavir)Contra-indications see notes aboveHepatic impairment see notes above; also manufactureradvises cautionRenal impairment manufacturer advises cautionPregnancy manufacturer advises use only if potentialbenefit outweighs risk—no information availableBreast-feeding see p. 310Side-effects see notes above; also reported, feverLicensed use not licensed for use in children under 3yearsIndication and doseHIV infection in combination with other antiretroviraldrugsFor dose, consult Guidelines (see notes above)Viracept c (Roche) ATablets, blue, f/c, nelfinavir (as mesilate) 250 mg, netprice 300-tab pack = £257.32. Label: 21RITONAVIRCautions see notes above; concomitant use with drugsthat prolong PR interval; cardiac conduction disorders,structural heart disease; pancreatitis (see below);interactions: Appendix 1 (ritonavir)Pancreatitis Signs and symptoms suggestive of pancreatitis(including raised serum lipase) should be evaluated—discontinueif pancreatitis diagnosedContra-indications see notes aboveHepatic impairment see notes above; also avoid indecompensated liver disease; in severe impairmentwithout decompensation, use ‘booster’ doses withcaution (avoid treatment doses)Pregnancy manufacturer advises use only if potentialbenefit outweighs risk—toxicity in animal studiesBreast-feeding see p. 310Side-effects see notes and Cautions above; alsodiarrhoea (may impair absorption—close monitoringrequired), vasodilatation, cough, throat irritation,anxiety, perioral and peripheral paraesthesia, hyperaesthesia,fever, decreased blood-thyroxine concentration,electrolyte disturbances, raised uric acid, drymouth, mouth ulcers, and sweating; less commonlyincreased prothrombin time and dehydration; syncope,postural hypotension, seizures, menorrhagia,and renal failure also reportedIndication and doseLow-dose ritonavir to increase the effect ofatazanavir. By mouthChild 6–18 yearsBody-weight 15–20 kg 80–100 mg once dailyBody-weight over 20 kg 100 mg once dailyLow-dose ritonavir to increase the effect ofdarunavir. By mouthChild 6–18 yearsBody-weight 20–30 kg 50 mg twice dailyBody-weight 30–40 kg 60 mg twice dailyBody-weight over 40 kg 100 mg twice dailyLow-dose ritonavir to increase the effect offosamprenavir. By mouthChild 6–18 yearsBody-weight 25–33 kg 3 mg/kg twice dailyBody-weight over 33 kg 100 mg twice dailyLow-dose ritonavir to increase the effect ofsaquinavir. By mouthChild 16–18 years 100 mg twice daily5 Infections