Details
Stereochemistry | ABSOLUTE |
Molecular Formula | C37H48N6O5S2 |
Molecular Weight | 720.944 |
Optical Activity | UNSPECIFIED |
Defined Stereocenters | 4 / 4 |
E/Z Centers | 0 |
Charge | 0 |
SHOW SMILES / InChI
SMILES
CC(C)[C@H](NC(=O)N(C)CC1=CSC(=N1)C(C)C)C(=O)N[C@H](C[C@H](O)[C@H](CC2=CC=CC=C2)NC(=O)OCC3=CN=CS3)CC4=CC=CC=C4
InChI
InChIKey=NCDNCNXCDXHOMX-XGKFQTDJSA-N
InChI=1S/C37H48N6O5S2/c1-24(2)33(42-36(46)43(5)20-29-22-49-35(40-29)25(3)4)34(45)39-28(16-26-12-8-6-9-13-26)18-32(44)31(17-27-14-10-7-11-15-27)41-37(47)48-21-30-19-38-23-50-30/h6-15,19,22-25,28,31-33,44H,16-18,20-21H2,1-5H3,(H,39,45)(H,41,47)(H,42,46)/t28-,31-,32-,33-/m0/s1
DescriptionCurator's Comment: description was created based on several sources, including:
http://www.rxlist.com/norvir-drug.htm
https://www.drugs.com/mtm/ritonavir.html
http://www.wikidoc.org/index.php/Ritonavir
Curator's Comment: description was created based on several sources, including:
http://www.rxlist.com/norvir-drug.htm
https://www.drugs.com/mtm/ritonavir.html
http://www.wikidoc.org/index.php/Ritonavir
Ritonavir is a protease inhibitor with activity against Human Immunodeficiency Virus Type 1 (HIV-1). Ritonavir binds to the protease active site and inhibits the activity of the enzyme. It is FDA approved for the treatment of HIV-1 infection. In patients receiving medications metabolized by CYP3A or initiation of medications metabolized by CYP3A in patients already receiving Ritonavir, may increase plasma concentrations of medications metabolized by CYP3A. The most frequently reported adverse drug reactions among patients receiving Ritonavir alone or in combination with other antiretroviral drugs were gastrointestinal (including diarrhea, nausea, vomiting, abdominal pain (upper and lower)), neurological disturbances (including paresthesia and oral paresthesia), rash, and fatigue/asthenia.
CNS Activity
Sources: https://www.ncbi.nlm.nih.gov/pubmed/14634041 | https://www.ncbi.nlm.nih.gov/pubmed/9107549
Curator's Comment: Known to be CNS penetrant in guinea pig and rats. Human data not available.
Originator
Approval Year
Targets
Primary Target | Pharmacology | Condition | Potency |
---|---|---|---|
Target ID: CHEMBL4729 Sources: https://www.ncbi.nlm.nih.gov/pubmed/11159797 |
2.2 µM [IC50] | ||
Target ID: CHEMBL2364675 Sources: https://www.ncbi.nlm.nih.gov/pubmed/10952482 |
0.14 µM [IC50] | ||
Target ID: CHEMBL243 Sources: https://www.ncbi.nlm.nih.gov/pubmed/17627597 |
0.01 nM [Ki] |
Conditions
Condition | Modality | Targets | Highest Phase | Product |
---|---|---|---|---|
Primary | NORVIR Approved UseKALETRA is indicated in combination with other antiretroviral agents for the treatment of HIV-1 infection. The following points should be considered when initiating therapy with KALETRA: The use of other active agents with KALETRA is associated with a greater likelihood of treatment response [see Clinical Pharmacology (12.4) and Clinical Studies (14) Launch Date8.2563839E11 |
Cmax
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
11.2 μg/mL |
600 mg 2 times / day steady-state, oral dose: 600 mg route of administration: Oral experiment type: STEADY-STATE co-administered: |
RITONAVIR unknown | Homo sapiens population: HEALTHY age: ADULT sex: UNKNOWN food status: UNKNOWN |
AUC
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
129 μg × h/mL |
600 mg single, oral dose: 600 mg route of administration: Oral experiment type: SINGLE co-administered: |
RITONAVIR unknown | Homo sapiens population: HEALTHY age: ADULT sex: UNKNOWN food status: UNKNOWN |
T1/2
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
5 h |
600 mg 2 times / day steady-state, oral dose: 600 mg route of administration: Oral experiment type: STEADY-STATE co-administered: |
RITONAVIR unknown | Homo sapiens population: HEALTHY age: ADULT sex: UNKNOWN food status: UNKNOWN |
Funbound
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
2% |
600 mg 2 times / day steady-state, oral dose: 600 mg route of administration: Oral experiment type: STEADY-STATE co-administered: |
RITONAVIR unknown | Homo sapiens population: HEALTHY age: ADULT sex: UNKNOWN food status: UNKNOWN |
Doses
Dose | Population | Adverse events |
---|---|---|
200 mg 1 times / day steady, oral Highest studied dose Dose: 200 mg, 1 times / day Route: oral Route: steady Dose: 200 mg, 1 times / day Co-administed with:: elvitegravir(125 mg) Sources: |
healthy, 29 years n = 10 Health Status: healthy Age Group: 29 years Sex: M+F Population Size: 10 Sources: |
Disc. AE: Death fetal... AEs leading to discontinuation/dose reduction: Death fetal (1 patient) Sources: |
50 mg 1 times / day steady, oral Studied dose Dose: 50 mg, 1 times / day Route: oral Route: steady Dose: 50 mg, 1 times / day Co-administed with:: elvitegravir(125 mg) Sources: |
healthy, 29 years n = 10 Health Status: healthy Age Group: 29 years Sex: M+F Population Size: 10 Sources: |
Disc. AE: Hypertension... AEs leading to discontinuation/dose reduction: Hypertension (grade 2, 1 patient) Sources: |
600 mg 2 times / day steady, oral Recommended Dose: 600 mg, 2 times / day Route: oral Route: steady Dose: 600 mg, 2 times / day Sources: |
unhealthy, adult Health Status: unhealthy Condition: HIV-1 Age Group: adult Sex: M+F Sources: |
Other AEs: Gastrointestinal disorder NOS, Lipids abnormal... Other AEs: Gastrointestinal disorder NOS Sources: Lipids abnormal Insulin resistance Lipoatrophy |
AEs
AE | Significance | Dose | Population |
---|---|---|---|
Death fetal | 1 patient Disc. AE |
200 mg 1 times / day steady, oral Highest studied dose Dose: 200 mg, 1 times / day Route: oral Route: steady Dose: 200 mg, 1 times / day Co-administed with:: elvitegravir(125 mg) Sources: |
healthy, 29 years n = 10 Health Status: healthy Age Group: 29 years Sex: M+F Population Size: 10 Sources: |
Hypertension | grade 2, 1 patient Disc. AE |
50 mg 1 times / day steady, oral Studied dose Dose: 50 mg, 1 times / day Route: oral Route: steady Dose: 50 mg, 1 times / day Co-administed with:: elvitegravir(125 mg) Sources: |
healthy, 29 years n = 10 Health Status: healthy Age Group: 29 years Sex: M+F Population Size: 10 Sources: |
Gastrointestinal disorder NOS | 600 mg 2 times / day steady, oral Recommended Dose: 600 mg, 2 times / day Route: oral Route: steady Dose: 600 mg, 2 times / day Sources: |
unhealthy, adult Health Status: unhealthy Condition: HIV-1 Age Group: adult Sex: M+F Sources: |
|
Insulin resistance | 600 mg 2 times / day steady, oral Recommended Dose: 600 mg, 2 times / day Route: oral Route: steady Dose: 600 mg, 2 times / day Sources: |
unhealthy, adult Health Status: unhealthy Condition: HIV-1 Age Group: adult Sex: M+F Sources: |
|
Lipids abnormal | 600 mg 2 times / day steady, oral Recommended Dose: 600 mg, 2 times / day Route: oral Route: steady Dose: 600 mg, 2 times / day Sources: |
unhealthy, adult Health Status: unhealthy Condition: HIV-1 Age Group: adult Sex: M+F Sources: |
|
Lipoatrophy | 600 mg 2 times / day steady, oral Recommended Dose: 600 mg, 2 times / day Route: oral Route: steady Dose: 600 mg, 2 times / day Sources: |
unhealthy, adult Health Status: unhealthy Condition: HIV-1 Age Group: adult Sex: M+F Sources: |
Overview
CYP3A4 | CYP2C9 | CYP2D6 | hERG |
---|---|---|---|
OverviewOther
Other Inhibitor | Other Substrate | Other Inducer |
---|---|---|
Drug as perpetrator
Drug as victim
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
major | ||||
Sources: https://dmd.aspetjournals.org/content/26/6/552 Page: - |
yes [Km 0.05 uM] | |||
Sources: https://dmd.aspetjournals.org/content/26/6/552 Page: - |
yes [Km 0.21 uM] | |||
yes |
Tox targets
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
Page: - |
PubMed
Title | Date | PubMed |
---|---|---|
Protease inhibitors shine in triple combinations. | 1996 Mar |
|
BMS-232632, a highly potent human immunodeficiency virus protease inhibitor that can be used in combination with other available antiretroviral agents. | 2000 Aug |
|
Inhibitory effect of human immunodeficiency virus protease inhibitors on multidrug resistance transporter P-glycoproteins. | 2000 Dec |
|
Increasing cerebrospinal fluid chemokine concentrations despite undetectable cerebrospinal fluid HIV RNA in HIV-1-infected patients receiving antiretroviral therapy. | 2000 Dec 15 |
|
In vitro activity of human immunodeficiency virus protease inhibitors against Pneumocystis carinii. | 2000 May |
|
Ritonavir increases the level of active ADD-1/SREBP-1 protein during adipogenesis. | 2000 Nov 10 |
|
Anti-toxoplasma activities of antiretroviral drugs and interactions with pyrimethamine and sulfadiazine in vitro. | 2000 Sep |
|
Virologic outcome and predictors of virologic failure of highly active antiretroviral therapy containing protease inhibitors. | 2001 Apr |
|
An open-label randomized trial to evaluate different therapeutic strategies of combination therapy in HIV-1 infection: design, rationale, and methods of the initio trial. | 2001 Apr |
|
P-glycoprotein limits oral availability, brain, and fetal penetration of saquinavir even with high doses of ritonavir. | 2001 Apr |
|
Anti-human immunodeficiency virus activity of YK-FH312 (a betulinic acid derivative), a novel compound blocking viral maturation. | 2001 Apr |
|
Impact of HIV type 1 protease, reverse transcriptase, cleavage site, and p6 mutations on the virological response to quadruple therapy with saquinavir, ritonavir, and two nucleoside analogs. | 2001 Apr 10 |
|
Differences in the intracellular accumulation of HIV protease inhibitors in vitro and the effect of active transport. | 2001 Apr 13 |
|
Determination of serum levels of thirteen human immunodeficiency virus-suppressing drugs by high-performance liquid chromatography. | 2001 Apr 13 |
|
Determination of interaction kinetic constants for HIV-1 protease inhibitors using optical biosensor technology. | 2001 Apr 15 |
|
High prevalence of genotypic and phenotypic HIV-1 drug-resistant strains among patients receiving antiretroviral therapy in Abidjan, Côte d'Ivoire. | 2001 Apr 15 |
|
[An option even for patients with multiple pretreatment]. | 2001 Apr 2 |
|
[Overcoming weaknesses in therapy. Protease inhibitors with high IQ]. | 2001 Apr 2 |
|
[Possible complication of HIV therapy. Protease inhibitor-induced femur head necrosis]. | 2001 Apr 2 |
|
[Improving the pharmacokinetics of protease inhibitors in a more innovative manner. HIV drugs administered in a more clever way]. | 2001 Apr 2 |
|
[No resistance even after 1 year. New drug combination against HIV]. | 2001 Apr 2 |
|
[Indinavir-ritonavir combination: pharmacologic results and tolerance in patients infected by HIV]. | 2001 Apr 21 |
|
Use of HIV protease inhibitors as pharmacoenhancers. | 2001 Feb |
|
Switch of protease inhibitor-containing HAART in routine clinical practice: a four-year prospective observational study. | 2001 Feb |
|
Sensitive and rapid method for the simultaneous quantification of the HIV-protease inhibitors indinavir, nelfinavir, ritonavir, and saquinavir in human plasma by reversed-phase liquid chromatography. | 2001 Feb |
|
CYP3A4 is the major CYP isoform mediating the in vitro hydroxylation and demethylation of flunitrazepam. | 2001 Feb |
|
Ritonavir, efavirenz, and nelfinavir inhibit CYP2B6 activity in vitro: potential drug interactions with bupropion. | 2001 Feb |
|
Ritonavir-induced carbamazepine toxicity. | 2001 Jan |
|
Effect of alpha1-acid glycoprotein on the intracellular accumulation of the HIV protease inhibitors saquinavir, ritonavir and indinavir in vitro. | 2001 Jan |
|
The use of and response to second-line protease inhibitor regimens: results from the EuroSIDA study. | 2001 Jan 26 |
|
ABT-378/ritonavir plus stavudine and lamivudine for the treatment of antiretroviral-naive adults with HIV-1 infection: 48-week results. | 2001 Jan 5 |
|
Lopinavir/ritonavir: a protease inhibitor combination. | 2001 Jan 8 |
|
New developments in anti-HIV chemotherapy. | 2001 Jan-Feb |
|
Effect of ritonavir/saquinavir on stereoselective pharmacokinetics of methadone: results of AIDS Clinical Trials Group (ACTG) 401. | 2001 Jun 1 |
|
The effect of nevirapine in combination with nelfinavir in heavily pretreated HIV-1-infected patients: a prospective, open-label, controlled, randomized study. | 2001 Jun 1 |
|
The binding energetics of first- and second-generation HIV-1 protease inhibitors: implications for drug design. | 2001 Jun 15 |
|
Analysis of human immunodeficiency virus type 1 drug resistance in children receiving nucleoside analogue reverse-transcriptase inhibitors plus nevirapine, nelfinavir, or ritonavir (Pediatric AIDS Clinical Trials Group 377). | 2001 Jun 15 |
|
A comprehensive account on the role of efflux transporters in the gastrointestinal absorption of 13 commonly used substrate drugs in humans. | 2001 Mar |
|
Pharmacokinetics of ritonavir and nevirapine in peritoneal dialysis. | 2001 Mar |
|
Spinal epidural lipomatosis in a human immunodeficiency virus-positive patient receiving steroids and protease inhibitor therapy. | 2001 Mar 1 |
|
[HIV: a guide on management of seropositive patients]. | 2001 Mar 3 |
|
Lopinavir/ritonavir. | 2001 Mar-Apr |
|
Structure-activity studies of FIV and HIV protease inhibitors containing allophenylnorstatine. | 2001 May |
|
Secreted aspartic proteases of Candida albicans, Candida tropicalis, Candida parapsilosis and Candida lusitaniae. Inhibition with peptidomimetic inhibitors. | 2001 May |
|
P1/P1' modified HIV protease inhibitors as tools in two new sensitive surface plasmon resonance biosensor screening assays. | 2001 May |
|
Low incidence of genotypic and phenotypic resistance in paediatric HIV-infected patients on long-term first-line antiretroviral triple therapy. | 2001 May 25 |
|
Pharmacokinetics and safety of amprenavir and ritonavir following multiple-dose, co-administration to healthy volunteers. | 2001 May 25 |
|
Clinical outcome among HIV-infected patients starting saquinavir hard gel compared to ritonavir or indinavir. | 2001 May 25 |
|
[Effective in HIV: dual combination with indinavir and ritonavir]. | 2001 May 4 |
|
Simultaneous determination of the HIV protease inhibitors indinavir, amprenavir, saquinavir, ritonavir and nelfinavir in human plasma by high-performance liquid chromatography. | 2001 May 5 |
Patents
Sample Use Guides
600 mg twice-day with meals.
Ritonavir should be started at no less than 300 mg twice daily and increased at 2 to 3 day intervals by 100 mg twice daily.
Route of Administration:
Oral
In Vitro Use Guide
Sources: https://www.ncbi.nlm.nih.gov/pubmed/12964850
Ritonavir diminished the growth rate of Candida albicans as well as the activity of its secreted aspartyl proteinases (Saps) in a nitrogen-limited medium, yeast carbon base and bovine serum albumin (YCB-BSA). This inhibition occurred in a dose-dependent fashion; with 8 mg/l of ritonavir a partial growth inhibition (44%) was produced.
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Classification Tree | Code System | Code | ||
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LIVERTOX |
NBK548747
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WHO-ATC |
J05AR10
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WHO-ATC |
J05AE03
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WHO-VATC |
QJ05AE03
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FDA ORPHAN DRUG |
549816
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WHO-VATC |
QJ05AR10
Created by
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WHO-ATC |
J05AP52
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EMA ASSESSMENT REPORTS |
LOPINAVIR (AUHTORIZED: HIV INFECTIONS)
Created by
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WHO-ATC |
J05AX66
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NCI_THESAURUS |
C97366
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WHO-ESSENTIAL MEDICINES LIST |
6.4.2.3
Created by
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EMA ASSESSMENT REPORTS |
KALETRA (AUTHORIZED: HIV INFECTIONS)
Created by
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WHO-ESSENTIAL MEDICINES LIST |
6.4.2.3 (LPV/R)
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WHO-ATC |
J05AR23
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WHO-ATC |
J05AP53
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NDF-RT |
N0000191001
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FDA ORPHAN DRUG |
509215
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NDF-RT |
N0000175889
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FDA ORPHAN DRUG |
484715
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NDF-RT |
N0000000246
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EMA ASSESSMENT REPORTS |
VIEKIRAX (AUTHORIZED: HEPATITIS C, CHRONIC)
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WHO-ATC |
J05AX67
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EMA ASSESSMENT REPORTS |
NORVIR (AUTHORIZED: HIV INFECTIONS)
Created by
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Code System | Code | Type | Description | ||
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RITONAVIR
Created by
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PRIMARY | Description: A white or almost white powder. Solubility: Practically insoluble in water, freely soluble in methanol R, sparingly soluble in acetone R and very slightly soluble in acetonitrile R. Category: Antiretroviral (Protease Inhibitor). Storage: Ritonavir should be kept in a well-closed container, protected from light. Additional information: Ritonavir may exhibit polymorphism. Requirements: Ritonavir contains not less than 98.5 % and not more than 101.0 % of C37H48N6O5S2, calculated with reference to the dried substance. | ||
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O3J8G9O825
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PRIMARY | |||
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CHEMBL163
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PRIMARY | |||
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1604803
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PRIMARY | |||
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7449
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PRIMARY | |||
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SUB10342MIG
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PRIMARY | |||
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RITONAVIR
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PRIMARY | |||
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85762
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PRIMARY | RxNorm | ||
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N0000182137
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PRIMARY | Cytochrome P450 2D6 Inhibitors [MoA] | ||
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N0000182141
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PRIMARY | Cytochrome P450 3A4 Inhibitors [MoA] | ||
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N0000187064
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PRIMARY | Cytochrome P450 2B6 Inducers [MoA] | ||
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DB00503
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PRIMARY | |||
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D019438
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PRIMARY | |||
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Ritonavir
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PRIMARY | |||
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N0000185607
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PRIMARY | Cytochrome P450 2C19 Inducers [MoA] | ||
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2391
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PRIMARY | |||
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N0000191266
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PRIMARY | Cytochrome P450 1A2 Inducers [MoA] | ||
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N0000190113
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PRIMARY | Breast Cancer Resistance Protein Inhibitors [MoA] | ||
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45409
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PRIMARY | |||
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N0000185507
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PRIMARY | Cytochrome P450 2C9 Inducers [MoA] | ||
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DTXSID1048627
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PRIMARY | |||
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N0000190117
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PRIMARY | UDP Glucuronosyltransferases Inducers [MoA] | ||
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N0000190118
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PRIMARY | Cytochrome P450 3A Inducers [MoA] | ||
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693184
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PRIMARY | |||
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O3J8G9O825
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PRIMARY | |||
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M9636
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PRIMARY | Merck Index | ||
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N0000190114
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PRIMARY | Cytochrome P450 3A Inhibitors [MoA] | ||
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392622
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7160
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PRIMARY | |||
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8804
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PRIMARY | |||
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C1609
Created by
admin on Fri Dec 16 17:15:19 UTC 2022 , Edited by admin on Fri Dec 16 17:15:19 UTC 2022
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PRIMARY | |||
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155213-67-5
Created by
admin on Fri Dec 16 17:15:19 UTC 2022 , Edited by admin on Fri Dec 16 17:15:19 UTC 2022
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PRIMARY | |||
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N0000185503
Created by
admin on Fri Dec 16 17:15:19 UTC 2022 , Edited by admin on Fri Dec 16 17:15:19 UTC 2022
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PRIMARY | P-Glycoprotein Inhibitors [MoA] | ||
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GG-103
Created by
admin on Fri Dec 16 17:15:19 UTC 2022 , Edited by admin on Fri Dec 16 17:15:19 UTC 2022
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PRIMARY |
ACTIVE MOIETY
METABOLITE ACTIVE (PARENT)