Potential side effects and toxicity: Rash, diarrhea, nausea, vomiting, stomach pain, headache, muscle weakness, increased cholesterol and triglycerides (fats in the blood), and AST/ALT (liver function tests, a sign of liver damage; this may be more common in people with hepatitis B or C).
As seen with all other protease inhibitors are increased levels of cholesterol and triglycerides, except possibly unboosted Reyataz (atazanavir) and these increased levels may be associated with heart disease. Other possible side effects are lipodystrophy (body fat changes, including thinning of the face, arms and legs, with or without fat accumulation in the stomach, breasts and sometimes the upper back), onset of new cases or worsening of diabetes (see your doctor promptly) and increased bleeding in hemophiliacs.
Potential drug interactions: Do not take with Versed, Halcion, Hismanol, Seldane, rifampin (Rimactane, Rifadin, Rifater or Rifamate—however, recent studies show that increasing the total daily dose of Kaletra may be an option), ergot derivatives (such as Cafergot, Wigraine and Methergine, D.H.E. 45, in any form—serious interactions seen with dilation during gynecological exams), garlic supplements, or the herb St. John’s wort. Do not use Zocor (simvastatin) or Mevacor (lovastatin); lipid-lowering alternatives are Lipitor (atorvastatin), Lescol, and Pravachol (pravastatin), but they should be used with caution due to potential for liver toxicity. Oral solution contains alcohol, so do not use with Antabuse or Flagyl. Also avoid dihydropuridine calcium channel blockers.
Dosage of methadone may need to be increased when taken with Kaletra. Increase Kaletra dose to 4 capsules twice-a-day with food recommended when using with Sustiva or Viramune in people who previously took HIV drugs, especially protease inhibitors. Not recommended to be taken with Lexiva. Kaletra may lower levels of Retrovir and Ziagen. Videx should be given an hour before or two hours after Kaletra, as Kaletra should be taken with food. Mycobutin (rifabutin) dosage should be reduced to 150 mg every other day (or 150 mg three times per week) when used with Kaletra. Phenobarbital, phenytoin (Dilantin and others) or carbamazepine (Tegretol and others) may lower blood levels of Kaletra. Reduces effectiveness of birth control pills; use alternative contraceptive. Mepron levels may be reduced with Kaletra. Avoid Sporanox doses greater than 200 mg per day with Kaletra. People with kidney impairment may require lower Biaxin doses with Kaletra. Transplant medicines like Sandimmune, Gengraf, Neoral, Prograf and Rapamune require close monitoring with Kaletra. Kaletra may alter coumadin levels. Steroids, especially Decadron, may decrease levels of Kaletra.
Protease inhibitors increase blood levels of Viagra (sidenafil citrate), Cialis (tadalafil) and Levitra (vardenafil). Use with caution. Initially the Viagra dose should be 12.5 mg (1/2 of 25 mg tablet) and increased as needed and tolerated. It’s recommended that people on PIs do not exceed 25 mg of Viagra in a 48-hour period because of potential for serious reaction. Use Cialis at reduced doses of 10 mg every 72 hours and Levitra at reduced doses of no more than 2.5 mg every 72 hours, with increased monitoring for adverse events.
Tips: See Norvir (ritonavir). Doctors and patients report that Kaletra is very tolerable. Great viral load results out to 5 years in people on their first HIV regimen. Good results also seen in heavily treatment-experienced adults, when compared to Reyataz, even those with protease inhibitor resistance. Use Kaletra with caution in people with mild to moderate hepatic (liver) impairment. The taste may be unappealing due to Norvir. Studies examining strength and durability of once-a-day dosing are ongoing. Kaletra capsules and solution are recommended to be stored in the refrigerator, but they are stable for up to 60 days at room temperature (77 F). However, avoid extreme heat and bright light. A new formulation that doesn’t require refrigeration is in the works, especially for resource-poor countries. A once-a-day dose, using a tablet form, is being evaluated. (Using the capsules in a once-daily dosing resulted in a huge increase in side effects.) |
