Kaletra (Lopinavir/Ritonavir) 2025: Uses, Dosage, Side Effects, Interactions - NZ Guide

Sep, 3 2025

If you typed Kaletra into a search bar, you probably want two things fast: what it actually does in 2025 and the safest, quickest way to the official dosing and safety info for New Zealand. Short answer: Kaletra (lopinavir/ritonavir) is an older HIV medicine that still shows up in specific situations, but it is not recommended for COVID-19. This page gives you the fastest path to the official data sheet and patient info, the key risks you should check before starting or stopping anything, and the practical gotchas that cause problems in real life. No fluff-just what you need to act with confidence.

Fastest path to official Kaletra info (NZ and global)

When you are dealing with antivirals, guessing is expensive. Here is the straight route to the sources that clinicians in New Zealand actually use, with cues so you know you are on the right page.

1. Medsafe NZ data sheet (professional, definitive dosing and safety)
   • Search: Medsafe Kaletra data sheet.
   • Click the result that looks like: Kaletra (lopinavir/ritonavir) Data Sheet - Medsafe. It is usually a PDF with a revision date at the top.
   • On the first page: look for the sponsor name, formulation details (tablets, oral solution), and a Last updated date. That date matters for interactions and pregnancy guidance.
   • Use the Contents sidebar in the PDF to jump to the sections you need: Dosage and administration, Contraindications, Interactions, Use in pregnancy and lactation.
2. Consumer Medicine Information (CMI) for patients in NZ
   • Search: Medsafe Kaletra consumer information.
   • Click the PDF or HTML page titled Consumer Information or CMI. It translates the data sheet into plain language.
   • Check the List of side effects and the What to tell your doctor section if you are on other meds.
3. Pharmac (funding and availability in NZ)
   • Search: Pharmac Schedule Kaletra or Pharmac lopinavir ritonavir.
   • Open the current Pharmaceutical Schedule. Look for lopinavir with ritonavir under Antivirals. Confirm formulation, pack size, subsidies, and any Special Authority criteria.
   • If you cannot find it listed, it might be unfunded, hospital-only, supplied via Section 29, or replaced by a generic. Your pharmacist or hospital pharmacy can confirm real-world stock status.
4. Global labels for cross-check (handy if the NZ sheet is outdated)
   • US FDA Prescribing Information: search FDA Kaletra label. Expect a comprehensive PDF with boxed warnings, detailed PK data, and pediatric dosing.
   • EMA SmPC: search EMA Kaletra SmPC. The format is similar to the NZ data sheet but sometimes with different emphasis on dose adjustments and pregnancy data.
5. Interactions checker (the gold standard many clinicians use)
   • Search: Liverpool HIV interactions Kaletra. Use the University of Liverpool HIV Drug Interactions checker.
   • Type each medicine you take (including supplements). Look for red (contraindicated), amber (potential interaction), and green (no interaction) flags. Read the clinical notes.

Tip: Screenshot the exact product name and strength on your box or script before you search. Formulation details change the advice-especially with the oral solution.

What Kaletra does, who it is for, and how it is taken

Kaletra combines two drugs: lopinavir (the main antiviral) and ritonavir (a booster that slows lopinavir breakdown so levels stay high enough to work). It is a protease inhibitor combo for HIV-1. In 2025, it is not a first-line HIV option in most guidelines. Modern regimens based on integrase inhibitors are usually preferred because they are better tolerated and simpler. But Kaletra still shows up for people who cannot take first-line drugs, for certain resistance patterns, and in some pediatric scenarios.

COVID-19? Despite the early pandemic hype, large randomized trials found no benefit. The RECOVERY trial in the UK and the WHO SOLIDARITY trial both reported no meaningful improvement in mortality or progression with lopinavir/ritonavir. WHO and NIH guidance do not recommend it for COVID-19 in 2025.

Core uses in 2025 (typical):

• Part of combination therapy for HIV-1 in adults and children, usually when other options are not suitable.
• Occasional use in pregnancy under specialist care; however, newer options are often preferred.
• Hospital or specialist-initiated regimens where prior resistance or interactions narrow choices.

What it looks like and how it is taken:

• Tablets: film-coated, designed to be swallowed whole. Do not crush, split, or chew.
• Oral solution: contains alcohol and propylene glycol; taste is bitter; dosing must be exact. Avoid in premature neonates. Watch for interactions with disulfiram or metronidazole due to ethanol content.
• Take with food to improve absorption and reduce stomach upset.

Rules of thumb you can use (but still confirm with the data sheet or your HIV team):

• Food helps. Assume with food unless a prescriber says otherwise.
• Tablets are whole. If swallowing is a problem, ask about alternative formulations rather than crushing.
• Ritonavir is a booster. Expect interactions until proven otherwise-especially with heart, cholesterol, and seizure medicines.
• Do not start or stop Kaletra alongside a new medicine without an interaction check. The risk of either toxicity or treatment failure is real.

Storage notes you will actually use:

• Tablets: room temperature is usually fine-check the pack. Keep in original bottle to protect from moisture.
• Oral solution: historically refrigerated before dispensing and then room temp for a limited time. Check your label for exact timelines because they vary.

Safety, interactions, and real-world tips (2025 NZ context)

Protease inhibitors are powerful and fussy. Most issues come from interactions or taking the drug the wrong way. Here is the short, practical list to stay out of trouble.

High-stakes interactions to avoid (red flags):

• Heart rhythm drugs: amiodarone, dronedarone, flecainide, propafenone. Risk: serious arrhythmias. Seek cardiology input if you think there is no alternative.
• Cholesterol drugs: simvastatin and lovastatin are a hard no. Use pravastatin or low-dose atorvastatin/rosuvastatin with monitoring if needed.
• Migraine ergot alkaloids: ergotamine, dihydroergotamine. Risk: ergot toxicity.
• Tranquilizers/sedatives: oral midazolam and triazolam are contraindicated. Parenteral midazolam can sometimes be used with close monitoring.
• St John’s wort: reduces antiviral levels and can cause failure. Avoid completely.
• Rifampicin (TB drug): strong inducer that can crash levels. If TB is in the mix, specialist to specialist discussion is mandatory.

Other common interaction issues:

• Anticoagulants: apixaban and rivaroxaban levels can rise. Warfarin control may swing. Dosing changes and monitoring are often needed.
• Mood and sleep meds: quetiapine can spike and sedate; trazodone levels rise; many SSRIs are manageable but watch for side effects.
• Seizure meds: carbamazepine, phenytoin, phenobarbital can reduce levels. Alternatives or monitoring plans are needed.
• Oral contraceptives: hormone levels may drop. Back-up contraception is smart.
• Antifungals: voriconazole and ketoconazole have two-way interactions. Dose adjustments or alternatives may be required.

Side effects you will see in the real world:

• Stomach and gut: nausea, diarrhoea, abdominal discomfort-usually ease with food and time.
• Metabolic: higher cholesterol and triglycerides; insulin resistance. Lipid checks are routine.
• Liver enzymes: can rise. Add baseline and follow-up LFTs, especially if hepatitis B or C is present.
• Pancreas: rare pancreatitis-seek urgent care if severe upper abdominal pain radiating to the back, with vomiting.
• Rash: usually mild, but report any severe rash or mucosal symptoms urgently.

Pregnancy and breastfeeding, simplified:

• Pregnancy: modern guidelines often prefer other regimens; Kaletra may be used if benefits outweigh risks and other options are not suitable. Some data sheets discuss altered drug levels in late pregnancy; specialist oversight is key.
• Breastfeeding: guidance differs by country due to HIV transmission risks and resource settings. In NZ, decisions are individualised with the HIV team.

Kidney and liver considerations:

• Kidneys: no major dose adjustment for renal impairment, but watch for effects of other renally cleared meds that interact.
• Liver: caution in hepatic impairment; severe liver disease can increase risk. LFT monitoring matters.

Adherence matters more than you think:

• Missed dose rule of thumb: if it is close to your next dose, skip and carry on. Do not double up unless your prescriber says so.
• Travel: keep tablets in the original bottle. For solutions, plan ahead for temperature and customs questions about alcohol content.
• Alcohol: the oral solution contains alcohol. If alcohol is an issue for you for any reason, flag this with your team.

Is Kaletra still a good idea in 2025?

• First-line HIV therapy: generally no. Most guidelines (e.g., US DHHS 2024 update) favour integrase inhibitor-based regimens for new starts because they are simpler and better tolerated.
• Second-line/salvage or specific cases: yes, sometimes. High barrier to resistance can help when options are limited. This is a specialist decision.
• COVID-19: no. Major trials (RECOVERY 2020; WHO SOLIDARITY final reports) found no benefit. Not recommended by WHO or NIH in 2025.

How to sanity-check advice you hear:

1. Cross-check the latest Medsafe data sheet date with the FDA or EMA label. If NZ is older, review the newer label sections on interactions and pregnancy.
2. Run every medicine and supplement through the Liverpool HIV interactions checker. Assume interaction until it is green.
3. If your pharmacist says a statin is a problem, they are almost certainly right. Ask which statin and dose is safer instead of arguing.
4. If your clinician suggests once-daily dosing, confirm you meet label or guideline criteria. Some patients do better on twice-daily.

Citations you can name in a consult or referral letter (no links here):

• Medsafe New Zealand. Kaletra (lopinavir/ritonavir) Data Sheet. Latest revision date as per PDF.
• US Food and Drug Administration. Kaletra Prescribing Information. Label updates through 2023.
• Department of Health and Human Services (US). Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV. Updated 2024.
• RECOVERY Collaborative Group. Lopinavir-ritonavir in patients admitted to hospital with COVID-19. Lancet 2020.
• WHO Solidarity Trial Consortium. Repurposed antiviral drugs for COVID-19. Final analyses 2021-2022.

NZ-specific practicalities (as of September 2025 from a Dunedin perch):

• Availability can be patchy. Hospital pharmacies often know the real stock situation before community pharmacies do.
• Funding moves. Check the current Pharmac Schedule for listing status and any Special Authority criteria. If not listed, your prescriber can discuss hospital supply options.
• If you are swapping from a protease inhibitor to an integrase inhibitor regimen, plan the handover to avoid resistance windows.

Common questions people ask right after they search Kaletra:

• Can I drink coffee or take antacids with it? Coffee is fine. Antacids are not a big issue here unlike some HIV meds, but still check everything in the interactions tool because add-ons matter.
• Do I need a fat-rich meal? No special diet, just take it with food. A normal meal or snack is enough.
• How long until side effects settle? Stomach issues often improve in 1-2 weeks. If they do not, tell your team-small timing tweaks or anti-nausea strategies can help.
• What if I lost weight and pills feel too strong? Do not self-adjust. Report symptoms; your specialist may change the regimen rather than the dose.
• Does it affect driving? If you feel dizzy, sedated, or foggy, avoid driving until you feel steady.

Next steps and troubleshooting (pick the one that fits you):

• I need official dosing now: grab the Medsafe data sheet first, then verify against FDA or EMA if the NZ date looks old.
• I am on many meds: run the Liverpool interactions checker for every item, then ask your prescriber or pharmacist about the reds and ambers.
• I think I have side effects: keep a 48-hour symptom diary tied to dose timing and food. Bring it to your pharmacist or clinic; it helps them adjust.
• I cannot swallow tablets: do not crush them. Ask about oral solution or an alternative regimen.
• I am pregnant or planning: book a consult with an HIV specialist. You may be switched to a regimen with better pregnancy data.
• I saw a COVID-19 post about Kaletra: set it aside. Not recommended in 2025 based on large trials.

Bottom line: Kaletra still has a place, but it is no longer the workhorse. If you stick to the official data sheet, check interactions before any change, and take it with food, you will avoid most stumbles. When in doubt, your HIV team and pharmacist are your quickest path to safe answers.