Kaletra (Lopinavir/Ritonavir)

What Kaletra is and what it is used for

Your doctor has prescribed Kaletra to help control Human Immunodeficiency Virus (HIV) infection by slowing the spread of the virus in your body. Kaletra is an antiretroviral medication that belongs to a group of medications called protease inhibitors. It is used in adults and in children 2 years of age or older who are infected with HIV (the virus that causes acquired immunodeficiency syndrome, or AIDS). In Canada, HIV treatment is managed by a doctor or specialist, who will decide whether Kaletra is appropriate for you or your child. Kaletra should not be given to children younger than 2 years old unless their doctor specifically tells you to do so.

Kaletra is usually prescribed together with other antiviral medications. Your doctor will decide which medications are best for you.

Before you take Kaletra

Do not take Kaletra

Do not take Kaletra if you are allergic (hypersensitive) to lopinavir, ritonavir, or any of the other ingredients in Kaletra, or if you have severe liver problems.

Do not take Kaletra with any of the following medications

• Astemizole or terfenadine (commonly used to treat allergy symptoms; may be available without a prescription);
• Midazolam taken orally (by mouth) or triazolam (used to relieve anxiety and/or trouble sleeping);
• Pimozide (used to treat schizophrenia);
• Cisapride (used to relieve certain stomach problems);
• Ergotamine, dihydroergotamine, ergonovine, methylergonovine (used to treat headaches);
• Amiodarone (used to treat an abnormal heartbeat);
• Lovastatin or simvastatin (used to lower blood cholesterol);
• Vardenafil (used to treat erectile dysfunction);
• Sildenafil used to treat pulmonary arterial hypertension;
• Products that contain St. John's wort (Hypericum perforatum).

Read the list of medications under 'Taking other medications' for information on certain other medications that require special care. If you are currently taking any of the medications listed above, ask your doctor about switching to another medication while you are taking Kaletra.

Take special care with Kaletra

Important information

Kaletra is not a cure for HIV infection or AIDS. People taking Kaletra may still develop infections or other illnesses linked to HIV disease and AIDS, so it is important to stay under your doctor's care while taking this medication. Kaletra does not reduce the risk of passing HIV to others; appropriate precautions should be taken to prevent transmission through sexual contact (for example, using a condom) or blood contamination.

Tell your doctor if you have/had

Tell your doctor if you have haemophilia type A or B, as Kaletra may increase the risk of bleeding. Also tell your doctor if you have diabetes or a history of liver problems. Patients with liver disease, including chronic hepatitis B or C, may be at increased risk of severe and potentially fatal liver side effects.

Tell your doctor if you experience

• Nausea, vomiting, abdominal pain, difficulty breathing, and severe weakness in the muscles of the legs and arms (these symptoms may indicate raised lactic acid levels).
• Thirst, frequent urination, blurred vision, or weight loss (these may indicate raised blood sugar levels).
• Nausea, vomiting, or abdominal pain, especially if triglycerides are high (these symptoms may suggest pancreatitis).
• Changes in body shape due to changes in fat distribution (for example, loss of fat from the legs, arms, and face; increased fat in the abdomen and internal organs; breast enlargement; fatty lumps on the back of the neck).
• Signs and symptoms of inflammation from previous infections soon after anti-HIV treatment is started (immune reconstitution).
• Joint stiffness, aches and pains (especially in the hip, knee, or shoulder), and difficulty moving (possible osteonecrosis).
• Muscle pain, tenderness, or weakness; in rare cases these muscle problems have been serious.

Taking other medications

Please tell your doctor or pharmacist if you are taking or have recently taken any other medications, including medications obtained without a prescription. Special care may be needed if you take Kaletra together with certain antibiotics, antifungals, antidepressants, anti-epileptic medications, cancer medications, heart medications (including digoxin and medications for heart rhythm), cholesterol-lowering medications, immunosuppressants, pain medications (including fentanyl), methadone, non-nucleoside reverse transcriptase inhibitors (NNRTIs), other protease inhibitors, sedatives, steroids, or warfarin. Also read the section 'Do not take Kaletra with any of the following medications' for medications that you must not take with Kaletra.

Erectile dysfunction medications (vardenafil, sildenafil, tadalafil)

Do not take Kaletra if you are currently taking vardenafil. You must not take Kaletra with sildenafil used to treat pulmonary arterial hypertension. If sildenafil or tadalafil are taken together with Kaletra, you may be at risk of side effects such as low blood pressure, fainting, vision changes, and an erection lasting more than 4 hours. If an erection lasts longer than 4 hours, get medical help right away. Your doctor can explain these symptoms to you.

Contraceptives

If you are using an oral contraceptive or a contraceptive patch to prevent pregnancy, use an additional or different type of contraception (for example, a condom) because Kaletra may reduce how well oral and patch contraceptives work. Kaletra does not reduce the risk of passing HIV to others, so appropriate precautions (for example, condom use) should be taken to prevent transmission through sexual contact.

Taking Kaletra with food and drink

Kaletra tablets can be taken with or without food.

Pregnancy and breast-feeding

Tell your doctor right away if you are pregnant, think you may be pregnant, or are breast-feeding. Pregnant or breast-feeding mothers should not take Kaletra unless a doctor specifically tells them to. It is recommended that women with HIV do not breast-feed their infants because HIV can be passed to the baby through breast milk.

Driving or using machines

Kaletra has not been specifically tested for possible effects on the ability to drive or use machines. Do not drive or operate machinery if you have side effects (for example, nausea) that affect your ability to do so safely. Contact your doctor if this happens.

How to take Kaletra

It is important to swallow Kaletra tablets whole and not chew, break, or crush them. Kaletra tablets can be taken with or without food. Always take Kaletra exactly as your doctor has told you, and check with your doctor or pharmacist if you are not sure how to take your medication.

How much Kaletra should be taken and when?

The usual adult dose is 400 mg/100 mg twice a day (every 12 hours) in combination with other anti-HIV medications. Adults who have not previously taken other antiviral medications can also take Kaletra once daily as an 800 mg/200 mg dose. Your doctor will tell you how many tablets to take. Kaletra must not be taken once daily with amprenavir, efavirenz, nevirapine, nelfinavir, carbamazepine, phenobarbital, or phenytoin.

For children, your doctor will decide the right dose (number of tablets) based on the child's height and weight. Kaletra is also supplied as 200 mg/50 mg film-coated tablets. Kaletra oral solution is available for patients who cannot take tablets.

Can I stop taking Kaletra or change my dose?

Do not stop or change your daily dose of Kaletra without first talking to your doctor. Kaletra should be taken every day to help control HIV infection, even if you feel better. Taking Kaletra as recommended gives you the best chance of delaying resistance. If a side effect is stopping you from taking Kaletra as directed, tell your doctor right away. Always keep enough Kaletra on hand so you do not run out, including when travelling or staying in the hospital. Keep taking this medication until your doctor tells you otherwise.

If you take more Kaletra than you should

If you realize you have taken more Kaletra than you were supposed to, contact your doctor right away. If you cannot contact your doctor, go to the hospital.

If you forget to take Kaletra

If you miss a dose, take it as soon as possible and then continue with your normal schedule. Do not take a double dose to make up for a missed dose.

Possible side effects

Like all medications, Kaletra can cause side effects, although not everybody gets them. It may be hard to tell which side effects are caused by Kaletra and which may be due to other medications you are taking at the same time or to complications of HIV infection. Tell your doctor promptly about these or any other symptoms. If the condition continues or gets worse, seek medical attention.

Very common side effects (affects more than 1 user in 10)

• Diarrhea;
• Nausea;
• Upper respiratory tract infection.

Common side effects (affects 1 to 10 users in 100)

• Inflammation of the pancreas;
• Vomiting, enlarged abdomen, stomach pain, gas, indigestion, decreased appetite, reflux that may cause pain;
• Swelling or inflammation of the stomach, intestines, and colon;
• Increased cholesterol and triglycerides, high blood pressure;
• Reduced ability to handle sugar, including diabetes mellitus, weight loss;
• Low number of red blood cells or white blood cells;
• Rash, eczema, oily skin scaling;
• Dizziness, anxiety, trouble sleeping;
• Feeling tired, lack of strength and energy, headache including migraine;
• Hemorrhoids;
• Inflammation of the liver, including increased liver enzymes;
• Allergic reactions including hives and inflammation in the mouth;
• Changes in body shape due to changes in fat distribution;
• Lower respiratory tract infection;
• Enlargement of the lymph nodes;
• Impotence, heavy or prolonged menstrual bleeding, or lack of menstruation;
• Muscle disorders, pain in the joints, muscles, or back;
• Damage to nerves in the peripheral nervous system;
• Night sweats, itching, rash with raised bumps, skin infection, inflammation of the skin or hair follicles, fluid build-up in tissues.

Further information about nausea, vomiting or abdominal pain

Tell your doctor if you have nausea, vomiting, or abdominal pain, as these symptoms may suggest pancreatitis (inflammation of the pancreas).

Further information about increased cholesterol and triglycerides

Your doctor will monitor your blood fats and may prescribe other medications if needed. Large increases in triglycerides (fats in the blood) have been considered a risk factor for pancreatitis. The long-term risk of complications such as heart attack or stroke due to increased triglycerides and cholesterol is not known at this time.

Changes in body shape due to changes in fat distribution

Combination antiretroviral therapy may cause changes in body shape due to changes in fat distribution. These may include loss of fat from the legs, arms, and face, increased fat in the abdomen and internal organs, breast enlargement, and fatty lumps on the back of the neck ('buffalo hump'). The cause and long-term health effects are not known. Tell your doctor if you notice any changes in your body shape.

Uncommon side effects (affects 1 to 10 users in 1,000)

• Abnormal dreams; loss of taste or changes in taste; hair loss;
• Electrocardiogram changes (atrioventricular block); plaque build-up in arteries;
• Inflammation of blood vessels/capillaries; bile duct inflammation;
• Uncontrolled shaking; constipation; dry mouth;
• Digestive tract inflammation/ulcer/bleeding; red blood cells in urine;
• Fatty deposits in the liver, enlarged liver; decreased testicular function;
• Immune reconstitution flare-up; increased appetite; high bilirubin;
• Decreased sex drive; kidney inflammation/failure;
• Osteonecrosis; mouth sores; breakdown of muscle fibres (myoglobin release);
• Ringing/buzzing in the ears; tremor; valve abnormality; vertigo; abnormal vision; weight gain.

Other side effects reported with Kaletra include yellowing of the skin or whites of the eyes (jaundice), severe or life-threatening skin rashes and blisters (Stevens-Johnson syndrome and erythema multiforme). It is not known how often these effects may happen.

If any side effect becomes serious, or if you notice any side effects not listed in this leaflet, tell your doctor or pharmacist.

How to store Kaletra

Keep this medication out of the sight and reach of children. Do not use Kaletra after the expiry date shown on the package. This medication does not require any special storage conditions.

How should I dispose of any unused Kaletra?

Medications should not be thrown away in wastewater or household garbage. Ask your pharmacist in Canada how to dispose of medications you no longer need. These measures help protect the environment.