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(ri toe' na veer)Taking ritonavir with certain other medications may cause serious or life-threatening side effects. Tell your doctor if you are taking any of the following medications: ergot medications such as dihydroergotamine (D.H.E. 45, Migranal), ergotamine (Ergomar, in Cafergot, in Migergot), ergonovine, and methylergonovine (Methergine); medications for irregular heartbeat such as amiodarone (Cordarone, Nexterone, Pacerone), flecainide, propafenone (Rhythmol), and quinidine (in Nuedexta); and sedatives or sleeping pills such as midazolam (Versed) and triazolam (Halcion). Your doctor will probably tell you not to take ritonavir if you are taking any of these medications.
Before taking ritonavir,
- tell your doctor and pharmacist if you are allergic to ritonavir, any other medications, or any of the ingredients in ritonavir tablets, capsules, or solution. Ask your pharmacist for a list of the ingredients.
- tell your doctor if you are taking any of the medications in the IMPORTANT WARNING section or any of the following: alfuzosin (Uroxatral), cisapride (Propulsid) (not available in U.S.), lovastatin (Altoprev), lurasidone (Latuda), pimozide (Orap), sildenafil (only Revatio brand used for lung disease), simvastatin (Zocor, in Vytorin), St. John's wort, or voriconazole (Vfend). Your doctor will probably tell you not to take ritonavir if you are taking one or more of these medications.
- also tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: anticoagulants ('blood thinners') such as warfarin (Coumadin, Jantoven); antidepressants such as bupropion (Aplenzin, Forfivo XL, Wellbutrin, Zyban, others), desipramine (Norpramin), nefazodone, and trazodone; atovaquone (Mepron, in Malarone); beta-blockers such as metoprolol (Lopressor, Toprol XL, in Dutoprol, in Lopressor HCT) and timolol; boceprevir (no longer available in the U.S.; Victrelis); bosentan (Tracleer); buspirone; calcium channel blockers such as diltiazem (Cardizem, Cartia, Tiazac, others), nifedipine (Adalat, Afeditab CR, Procardia), and verapamil (Calan, Covera, Verelan, in Tarka); cholesterol-lowering medications such as atorvastatin (Lipitor, in Caduet) and rosuvastatin (Crestor); clarithromycin (Biaxin, in PrevPac); clorazepate (Gen-Xene, Tranxene); colchicine (Colcrys, Mitigare); dexamethasone; diazepam (Diastat, Valium); digoxin (Lanoxin); dronabinol (Marinol); estazolam; fluticasone (Flovent, in Advair); itraconazole (Onmel, Sporanox); ketoconazole (Nizoral); lidocaine (Lidoderm; in Xylocaine with Epinephrine); other medications for HIV such as atazanavir (Reyataz, in Evotaz), darunavir (Prezista, in Prezcobix), delavirdine (Rescriptor), fosamprenavir (Lexiva), indinavir (Crixivan), maraviroc (Selzentry), saquinavir (Invirase), and tipranavir (Aptivus); medications for erectile dysfunction such as sildenafil (Viagra), tadalafil (Adcirca, Cialis) and vardenafil (Levitra); medications that suppress the immune system such as cyclosporine (Gengraf, Neoral, Sandimmune), sirolimus (Rapamune) and tacrolimus (Astagraf XL, Prograf); certain medications for seizures such as carbamazepine (Epitol, Equetro, Tegretol, others), clonazepam (Klonopin), divalproex (Depakote), ethosuximide (Zarontin), lamotrigine (Lamictal), and phenytoin (Dilantin, Phenytek); meperidine (Demerol); methadone (Dolophine, Methadose); methamphetamine (Desoxyn); mexiletine; nefazodone; perphenazine; prednisone; quetiapine (Seroquel); quinine (Qualaquin); rifabutin (Mycobutin); rifampin (Rifadin, Rimactane, in Rifamate, in Rifater); risperidone; salmeterol (Serevent, in Advair); theophylline (Theo 24, Uniphyl, others); thioridazine; vinblastine; vincristine; and zolpidem (Ambien, Edluar, Intermezzo, others). Many other medications may also interact with ritonavir, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- if you are taking ritonavir oral suspension, also tell your doctor if you are taking disulfiram (Antabuse) or metronidazole (Flagyl, Nuvessa, Vandazole).
- tell your doctor if you have or have ever had a prolonged QT interval (a rare heart problem that may cause irregular heartbeat, fainting, or sudden death), diabetes, hemophilia, high cholesterol or triglycerides (fats) in the blood, or heart or liver disease, including hepatitis B or C.
- tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking ritonavir, call your doctor immediately. You should not breastfeed if you are infected with HIV or if you are taking ritonavir.
- you should know that ritonavir may decrease the effectiveness of hormonal contraceptives (birth control pills, patches, rings, or injections). Talk to your doctor about using another form of birth control.
- you should be aware that your body fat may increase or move to different areas of your body, such as your upper back, neck (''buffalo hump''), breasts, and around your stomach. You may notice a loss of body fat from your face, legs, and arms.
- you should know that you may experience hyperglycemia (increases in your blood sugar) while you are taking this medication, even if you do not already have diabetes. Tell your doctor immediately if you have any of the following symptoms while you are taking ritonavir: extreme thirst, frequent urination, extreme hunger, blurred vision, or weakness. It is very important to call your doctor as soon as you have any of these symptoms, because high blood sugar that is not treated can cause a serious condition called ketoacidosis. Ketoacidosis may become life-threatening if it is not treated at an early stage. Symptoms of ketoacidosis include dry mouth, nausea and vomiting, shortness of breath, breath that smells fruity, and decreased consciousness.
- you should know that while you are taking medications to treat HIV infection, your immune system may get stronger and begin to fight other infections that were already in your body. This may cause you to develop symptoms of those infections. If you have new or worsening symptoms after starting treatment with ritonavir, be sure to tell your doctor.
- change in ability to taste food
- numbness, burning, or tingling of the hands, feet, or area around the mouth
- muscle or joint pain
- blistering or peeling of the skin
- swelling of the eyes, face, tongue, lips, or throat
- tightening of the throat
- difficulty breathing or swallowing
- stomach pain
- excessive tiredness
- lack of energy
- loss of appetite
- pain in the upper right part of the stomach
- yellowing of the skin or eyes
- loss of consciousness
- irregular heartbeat