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PHARMACOKINETIC

Absorption

After oral administration the peak plasma concentration of Lopinavir occurs at 4 hours approximately. While taking Alltera with or without food no alteration of pharmacokinetic effect occurs.

Distribution

Lopinavir & Ritonavir are heavily bound to human plasma protein with the range of 98 to 99%.

Metabolism

Hepatically Lopinavir is metabolized, by using CYP3A isoenzymes. Ritonavir is available as an unchanged form, in circulation. The primary metabolite of Ritonavir is Isopropylthiazole oxidation metabolite which is present as low level attaining anti-retroviral activity. CYP3A & CYP2D6 isoenzymes are main cytochrome enzyme required for metabolism of ritonavir.

Excretion

The Lopinavir half life period of is 12 hours after dosing with range of 5 to 6 hours The Ritonavir half life period is 3 to 5 hours. The unchanged form of Lopinavir is encountered with the range of via urine 2.2% & feces 19.8%. Ritonavir metabolite should be eliminated through feces & urine.







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Brand : Alltera
Ingredients : Lopinavir & ritonavir
Strength : 200mg & 50mg
Manufactured : Mylan
Package : 120 Tablets

Dosage regimens and administration of Alltera

In adults, the prescribed dose of Alltera is 400mg/100mg that is 2 tablets of Alltera It should be administered orally as two times a day.

Patient with lesser three Lopinavir resistance related substitutions

The prescribed dose of Alltera tablets is 800mg/200mg given by 4 Alltera tablets should be administered orally as single dose. This 800mg/200mg dose should not be recommended for the patients with 3 or greater Lopinavir resistance related substitutions. Alltera should not be used as single dose for combined with carbamazepine, Phenobarbital or phenytoin Alltera should not be used as single dose therapy by combining with efavirenz, nevirapine, or Nelfinavir. During the combination of these drugs, the Alltera dose should be 500mg/125mg( 2 tablets of 200mg/50mg Alltera & one tablet of 100mg/25mg Alltera) as twice a day In pediatrics: Alltera tablets as mono therapy should not be recommended in pediatric patients with the age of <18 years. Based up on the body weight or body surface area of pediatric patients, To avoid the problems like under dosing or over dosing.the dose should be calculated 6 months to 18 years:

Without combining with efavirenz, nevirapine or Nelfinavir

The prescribed dose of Alltera is 2 tablets of 100mg/25mg Alltera tablets should be administered as two times a day for body weight of 15 to 25kg or ≥ 0.6 to <0.9 m2 The prescribed dose of Alltera is 3 tablets of 100mg/25mg Alltera tablets should be used as two times a day for >25 to 35kg or ≥0.9 to <14 m2 The prescribed dose is 4 tablets of 100mg/25mg of Alltera tablets or 2 tablets of 200mg/50mg Alltera tablets should be suggested as two times a day for body weight of >35kg or ≥ 1.4 m2

Concomitant use with efavirenz, nevirapine or Nelfinavir

2 tablets of 100mg/25mg Alltera should be administered as two times a day is given for patients weighing 15 to 20kg or ≥0.6 to <0.8m2 The prescribed dose is 3 tablets 100mg/25mg of Alltera should be administered as two times a day is given for patients weighing >20 to 30kg or ≥0.8 to <1.2 m2. The prescribed dose is 4 tablets 100mg/25mg of Alltera should be administered as two times a day is given for patients weighing >30 to 45kg or ≥1.2 to <1.7 m2 The prescribed dose is 5 tablets 100mg/25mg of Alltera should be administered as two times a day is given for patients weighing >45kg or ≥1.7 m2. Alltera tablets should be administered with food or without food. Alltera tablets should not be chewed, crushed or broke

Alltera caused side effects

The major adverse effects; PR interval extension, QT interval extension Drug interactions Pancreatitis Liver toxicity The most common side effects; Diarrhea Nausea Vomiting Abdominal pain Dyspepsia Flatulence Asthenia Bronchitis Loss of weight Anorexia Myalgia Headache Insomnia Depression Loss of libido Rash Vasodilatation Increased glucose levels Increased uric acid level Increased AST, ALT Elevation of cholesterol Elevation of amylase, lipase Depletion of creatinine clearance Neutropenia In pediatrics; Increased sodium levels Increased total bilirubin Increased AST, ALT increased amylase Decreased platelets count Decreased neutrophils Post marketing: Fat redistribution Brady arrhythmias Toxic epidermal necrolysis, Stevens Johnson’s syndrome

Safety measures

Diabetes mellitus: Patients blood glucose level should be maintained by checking the levels frequently. QT prolongation: Stop the therapy. Immune reconstitution syndrome: Discontinue the Alltera treatment Fat redistribution: Reaccumulation of fat occur which may results as obesity. In severe condition, discontinue the therapy. Drug interaction-CYP3A enzyme prohibition, causes increased plasma concentration of concurrent used drugs. Avoid the concomitant use. Toxicity occurs to neonates, potential risk may occur while using Alltera in neonates. Take alcohol & propylene glycol from all the drugs should be given to infants for reducing thwe toxicity associated to the components.

Pancreatitis

Elevation of triglyceride levels may leads to cause pancreatitis. Pancreatitis is the major risk factor during the Alltera treatment. Lipase and amylase value should be monitored periodically.

Liver toxicity

Due to elevation of AST, ALT & bilirubin, leads to cause liver injury this may concluds as liver damage or failure. Monitor liver function test periodically during or after completion of treatment.



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DRUG INTERACTION

Interaction of Alltera is an inhibitor of CYP3A, may uplift the plasma concentration of agents that ate formerly metabolized by CYP3A. While Alltera is a CYP3A substrate, when Alltera is co administered with CYP3A inducers causes depletion of Lopinavir plasma concentration and leads to loss of effectiveness. Alltera interaction with NNRTI like efavirenz or nevirapine causes decreasing the effect of concentration of Lopinavir.

Interaction Alltera with delaveridine causes elevation of effect of concentration of Lopinavir. Alltera interaction with tenofovir, causes increasing effect of concentration of tenofovir. Interaction of Alltera with calcium channel blocker leads to cause elevating the effect of concentration of these drugs.

Alltera Interaction with dexamethasone decreases the concentration of Lopinavir. Combination of Alltera tablets with lipid lowering drugs or Immuno suppressants leads to cause increasing concentration of these drugs Concomitant use with abacavir, leads to decreasing the effect of concentration of abacavir. Interaction of Alltera with anti-gout or anti-mycobacterials causes increasing effect of concentration of these drugs.


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