Antimicrobials
Lopinavir/ritonavir (Kaletra)

Lopinavir/ritonavir (Kaletra)

Dosing

400-100 mg PO bid for 10-14 days

Due to limited supply, ID may consider a shorter course

Neonates > 14 d PNA and > 42 weeks CGAInfants and children:Dosed by lopinavir component:

  • 16 mg/kg BID

Typical duration is 10-14 days; due to limited supply, ID may consider a shorter course.

Note: contains ethanol and propylene glycol- short term use in infants and children is acceptable, however use is not considered safe in term newborns < 14 days of age; or preterm infants < 42 weeks CGADosed by lopinavir component:

  • <15 kg: 12 mg/kg BID

  • 15 to 40 kg: 10 mg/kg BID

  • 40 kg: Lopinavir 400 mg-ritonavir 100 mg PO bid

Typical duration is 10-14 days; due to limited supply, ID may consider a shorter course.

General Information

Limited supply of tablets and oral solution available

Tablets cannot be crushed.

Oral solution should be given with food. Oral solution contains ethanol and propylene glycol and is incompatible with polyurethane feeding tubes but can be safely used with polyvinyl or silicone feeding tubes.

Liver enzymes and lipase at baseline

Major

  • Rare, high consequence - QT prolongation and torsade de pointes

  • Common, low consequence: Dermatologic, diarrhea, vomiting & abdominal pain

  • Uncommon, high consequence: Pancreatitis

Please consult your pharmacist, and/or see http://covid19-druginteractions.org

80 mg/mL - 20 mg/mL oral solution

200 mg - 50 mg tablet

  • Initiate as soon as possible (a general principle in antiviral intervention)

  • Usual precautions and drug-drug interaction assessment, side-effects monitoring

  • Consult Infectious Diseases in person or by phone for consideration of any directed COVID-19 therapy

SARS: 1 non-randomized study reported add-on lopinavir/ritonavir (n=41) was associated with lower rates of death and ARDS (2.4% vs 28.8%) compared with corticosteroid-ribavirin alone. Follow-up analysis (n=75) reported benefit limited to early initiation (median 5.5 days from onset). Reduced HCW infection in MERS prophylaxis.

COVID-19 RCT: insignificant trends on illness duration (-1 day), and mortality (16.7% vs 25.0%) reduction vs SOC; late initiation (median 13 days)

References: Arabi YM, et al. Am J Respir Crit Care Med. 2018;197(6):757-767. Zumla A, et al. Lancet. 2015;386(9997):995-1007. Park SY, et al. J Hosp Infect. 2019;101(1):42-46. Chu CM, et al. Thorax. 2004;59(3):252-6. Arabi YM, et al. Clin Infect Dis. 2019 Jun 25. pii: ciz544. Loutfy MR, et al. JAMA. 2003;290(24):3222-8. Cao B, et al. NEJM Mar 18.