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# Lopinavir/ritonavir

A fixed combination of lopinavir with ritonavir as booster. Widely used in children and second line; causes diarrhoea and raises lipids.

Updated 2026-11-01

- Class: [HIV protease inhibitors (PIs)](https://durgical.com/en/pharmacology/classes/hiv-protease-inhibitors/)
- Enzyme: HIV-1 protease
- ATC code: J05AR10
- WHO Model List of Essential Medicines

Also called: LPV/r

✂**HIV-1 protease**Lopinavir/ritonavir

ⓘ The figure shows lopinavir in the active site of wild-type HIV-1 protease.

**Target in 3D:** HIV-1 protease. PDB structure 2Q5K (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/2Q5K) · Drag to rotate · pinch to zoom

## Mechanism of action

Lopinavir fills the HIV protease active site and prevents virus maturation. It is metabolised by CYP3A; the ritonavir in the tablet blocks that metabolism and keeps lopinavir at effective levels.

- Ritonavir inhibits CYP3A4 and raises lopinavir
- Lopinavir binds the protease active site
- Virions come out immature

## Pharmacokinetics

**Metabolism**
Lopinavir: CYP3A, inhibited by the ritonavir in the combination

## Indications

- HIV-1 infection in adults and children, combined with other antiretrovirals [HIV infection and AIDS →](https://durgical.com/en/conditions/hiv-infection-and-aids/)

## Adverse effects

### Common

- Diarrhoea (common), nausea, vomiting
- Raised triglycerides and cholesterol

### Serious (rare, important)

- Pancreatitis
- QT and PR prolongation
- Hepatotoxicity
- Toxicity of the oral solution in preterm newborns

## Contraindications

- Drugs highly dependent on CYP3A with serious risk if raised
- Strong inducers such as rifampicin or St John's wort

## Key interactions

**Other QT-prolonging drugs or hypokalaemia**
Higher risk of torsade de pointes

**Statins cleared by CYP3A**
Risk of myopathy

## What is monitored

- Lipids before starting and regularly
- Glucose and liver tests
- ECG if there is long-QT risk

## Administration and safety

- By mouth; tablets are swallowed whole
- The oral solution contains ethanol and propylene glycol: it is not used in preterm newborns right after birth
- In children, check the ordered product and volume
- Keep a full list of medicines and herbal products and review it with pharmacy before any new drug

## Nursing care

- Watch for diarrhoea and hydration
- Check lipids and glucose
- In children, confirm gestational age and weight before the oral solution
- Review interactions before any new drug

## Pregnancy and breastfeeding

Antiretroviral treatment in pregnancy protects the mother and lowers HIV transmission to the baby; the treating team chooses the regimen.

## Memory aid

'LOPinavir: LOose stools and LOts of lipids'.

## Test yourself

Think of the answer, then tap the question to see it.

## Why is lopinavir always sold with ritonavir?

Because lopinavir is cleared by CYP3A, and ritonavir, by inhibiting that enzyme, raises and prolongs its levels.

## Why is the oral solution not used in preterm newborns?

It contains ethanol and propylene glycol, which preterm babies cannot metabolise well: risk of serious toxicity.

## Which gut adverse effect is most common?

Diarrhoea.

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## Related drugs

- [Ritonavir](https://durgical.com/en/pharmacology/ritonavir/)
- [Darunavir](https://durgical.com/en/pharmacology/darunavir/)
- [Atazanavir](https://durgical.com/en/pharmacology/atazanavir/)

## Related conditions

- [HIV infection and AIDS](https://durgical.com/en/conditions/hiv-infection-and-aids/)

[← Back to the class: HIV protease inhibitors (PIs)](https://durgical.com/en/pharmacology/classes/hiv-protease-inhibitors/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - LOPINAVIR AND RITONAVIR tablet, film coated](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=115178c8-5ee2-4d96-820e-ea8264c1ac10) (DailyMed (U.S. National Library of Medicine), 2026); [Lopinavir and Ritonavir: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a602015.html) (MedlinePlus (U.S. National Library of Medicine), 2025); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=J05AR10) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/) (World Health Organization, 2025).

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Representative model, for educational purposes only.

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