# Lopinavir/Ritonavir in Nigeria

Lopinavir/Ritonavir has 1 active NAFDAC registration in our October 2026 copy of the register, from 1 registration holder; 5 further listings have lapsed.

- Source: https://ogbogwu.com/drugs/lopinavir-ritonavir/
- Drug class: HIV protease inhibitor, ritonavir-boosted (fixed-dose combination) (Anti-HIV/ARVs)
- Also known as: LPV/r, Aluvia, Kaletra, Ritocom, Alltera, Boosted lopinavir, Second-line ARV
- Prescription required: yes
- On the WHO Model List of Essential Medicines
- Last updated: October 2026

## Price in Nigeria

Our sampled online pharmacies held no lopinavir/ritonavir listing this cycle, so we quote no price. Like every antiretroviral in Nigeria it is supplied free through the public treatment programme: patients on second-line therapy at an accredited ART site collect it at no charge, and the registered generic is procured in bulk by the programme and its partners rather than sold over a counter. A pharmacy quoting a price for it is selling outside that chain. Ask the treatment site first.

## What is Lopinavir/Ritonavir?

Lopinavir/ritonavir is a fixed-dose combination of two HIV protease inhibitors in one tablet. Lopinavir does the work of blocking the virus from assembling new copies of itself; the small dose of ritonavir does almost no antiviral work but blocks the liver enzyme that would otherwise destroy lopinavir within hours, 'boosting' it to a level that lasts twelve hours. It is the medicine Nigerian clinics know as Aluvia — AbbVie's developing-world name for the drug sold as Kaletra elsewhere — and, in the programme's shorthand, LPV/r.

Its place in Nigerian treatment has narrowed since dolutegravir arrived. Most adults now start and stay on TLD, and the national guidelines prefer atazanavir/ritonavir for adults who move to second line, so lopinavir/ritonavir is mainly a medicine for the youngest children — the 40 mg/10 mg granules and pellets for infants and the 100 mg/25 mg tablets for small children — and for adults in whom atazanavir cannot be used. It is on the WHO Model List of Essential Medicines for both adults and children.

The register tells that story in numbers. In our October 2026 copy of the NAFDAC register lopinavir/ritonavir has one active registration, Aurobindo's 200 mg/50 mg tablet held by Phillips Pharmaceuticals (A4-3852, to May 2029); the other five listings in our October 2026 copy are Inactive or Expired. Both Aluvia registrations have lapsed — the capsule in April 2023, the 100 mg/25 mg tablets in August 2024 — along with Hetero's Ritocom, Mylan's generic and the Alltera granules for infants. Supply to patients continues through the ART programme, which procures from WHO-prequalified makers under its own arrangements; a shop pack carrying one of the lapsed numbers should be read with that in mind.

## What is Lopinavir/Ritonavir used for?

- HIV-1 infection in adults and children, always in combination with at least two other antiretrovirals
- Second-line therapy after failure of a first-line regimen
- First-line therapy in infants and young children, in the formulation their weight allows
- Pregnant women needing a protease-inhibitor regimen
- Post-exposure prophylaxis in some protocols, where dolutegravir is unavailable

## Dosage

Always follow a doctor's or pharmacist's instructions; this is general reference information.

- Adults: 400 mg/100 mg twice daily — two 200 mg/50 mg tablets morning and evening, with or without food, swallowed whole. Once-daily 800 mg/200 mg (four tablets) is an option only for adults with no previous protease-inhibitor resistance and not in pregnancy. When given with efavirenz or nevirapine, the dose rises to 500 mg/125 mg twice daily (two 200/50 tablets plus one 100/25). With rifampicin for tuberculosis the standard dose is inadequate; a 'super-boosted' or doubled regimen is needed under specialist direction, and rifabutin is preferred where available. Do not stop or skip doses: a missed protease inhibitor is how resistance starts.
- Children: Dosed by weight or body surface area at 230 mg/57.5 mg per m² twice daily, roughly 12 mg/3 mg per kg for children under 15 kg and 10 mg/2.5 mg per kg above it, up to the adult dose. Infants from 14 days may take the 40 mg/10 mg oral pellets or granules sprinkled on soft food or given with a spoon of milk — not in the bottle, where the dose is lost. The oral solution contains about 42% alcohol and propylene glycol and must not be given to newborns under 14 days or to premature infants until 14 days past their due date. Tablets must be swallowed whole, which most children manage from about three years.
- Elderly: No change in dose. Watch the heart, the lipids and the interactions, since older patients are on more medicines that lopinavir/ritonavir affects.

The film-coated tablets are heat-stable and need no refrigerator, which is what made Aluvia usable across Nigeria; the oral solution must be kept cold and tastes bitter. Diarrhoea is commonest in the first weeks and usually settles — loperamide helps, and taking the dose with food helps the stomach. Have fasting lipids and glucose checked when starting and yearly, and tell every prescriber, dentist and chemist that you take a ritonavir-boosted medicine before accepting any other drug.

## Side effects

Common: Diarrhoea, nausea, vomiting and abdominal pain, especially in the first weeks; Raised cholesterol and triglycerides; Raised blood sugar; new or worsening diabetes over time; Headache, tiredness, insomnia; Rash; Changes in body fat distribution with long use.

Serious (seek medical help immediately): Pancreatitis: severe upper abdominal pain with vomiting, particularly when triglycerides are very high; Hepatitis and liver failure, more likely with hepatitis B or C co-infection or heavy alcohol use; Heart rhythm changes (PR and QT prolongation): fainting, palpitations, especially with other rhythm-affecting drugs; Severe skin reactions including Stevens-Johnson syndrome (rare); Immune reconstitution syndrome in the first weeks of effective treatment, as hidden infections flare.

When to see a doctor: Seek care the same day for severe abdominal pain, yellow eyes or dark urine, fainting or an irregular heartbeat, or a spreading rash with fever or mouth sores. Diarrhoea that causes weakness or more than six stools a day, or that persists beyond a month, needs review. Any new medicine — including herbal remedies, antimalarials and the cholesterol tablets sold without prescription — should be checked against this one first.

## Warnings

Do not take if: Known allergy to lopinavir or ritonavir; Severe liver failure; Co-administration with medicines whose levels become dangerous when ritonavir blocks their breakdown: simvastatin, lovastatin, ergot alkaloids, oral midazolam, triazolam, amiodarone, dronedarone, quinidine, pimozide, lurasidone, sildenafil for pulmonary hypertension, alfuzosin, colchicine in kidney or liver disease, St John's wort, and rifampicin at the standard LPV/r dose; The oral solution in newborns under 14 days, premature infants, pregnancy and anyone taking disulfiram or metronidazole, because of its alcohol and propylene glycol content.

Interactions: Rifampicin (TB treatment) — slashes lopinavir levels; needs a super-boosted or doubled regimen under specialist care, or rifabutin instead; Efavirenz and nevirapine — lower lopinavir levels; the LPV/r dose is increased; Statins — simvastatin and lovastatin are contraindicated; use low-dose atorvastatin or pravastatin or rosuvastatin; Artemether-lumefantrine (Coartem) — lumefantrine levels rise several-fold; the combination is used under monitoring, and quinine or artesunate levels also change; Hormonal contraceptives — ethinylestradiol levels fall; add a barrier method or use an injectable or implant with advice; Inhaled or intranasal fluticasone and budesonide, and injected triamcinolone — Cushing's syndrome from steroid build-up; use beclometasone; Ketoconazole and itraconazole — do not exceed 200 mg a day; voriconazole is avoided; Sildenafil, tadalafil for erectile dysfunction — much lower doses, no more than once in 48 to 72 hours; Methadone — levels fall; watch for withdrawal; Anticonvulsants (carbamazepine, phenytoin, phenobarbital) — both drugs' levels change; dolutegravir-sparing regimens are reviewed by the clinic; Warfarin, digoxin, clarithromycin, metformin, quetiapine and many others are affected — check every addition.

Pregnancy & breastfeeding: Lopinavir/ritonavir has been used widely in pregnancy for twenty years and is not associated with birth defects; the tablets are the form to use, twice daily, never once daily, and some clinicians raise the dose in the third trimester when levels fall. The oral solution is avoided in pregnancy because of its alcohol content. Nigerian guidance supports breastfeeding for women on effective antiretroviral therapy with an undetectable viral load; small amounts pass into milk and the infant's own prophylaxis is given according to the PMTCT protocol.

## Brands in Nigeria

Well-known NAFDAC-registered brands: Lopinavir 200 mg/Ritonavir 50 mg (Phillips Pharmaceuticals (Nigeria) Limited, made in India); Aluvia 100 mg/25 mg Tablets (Phillips Pharmaceuticals (Nigeria) Limited, made in Germany); Aluvia (Phillips Pharmaceuticals (Nigeria) Limited, made in Germany); Ritocom Tablets (Hetero Labs Nigeria Limited, made in India); Alltera 50 Granules (Healthline Limited, made in India); Lopinavir/Ritonavir 200 mg/50 mg Tablet (Healthline Limited, made in India).
Full searchable brand list: https://ogbogwu.com/drugs/lopinavir-ritonavir/brands/

## How to verify it is genuine

1. Antiretrovirals in Nigeria reach patients through accredited ART sites, and programme stock is labelled for the programme; a pack carrying a donor or programme marking rather than a retail NAFDAC number is expected there and is not a warning sign
2. A pack sold in a pharmacy should carry a NAFDAC registration number. In our October 2026 copy of the register the only current one is Aurobindo's Lopinavir 200 mg/Ritonavir 50 mg tablet, A4-3852, held by Phillips Pharmaceuticals (to May 2029)
3. Aluvia 200 mg/50 mg capsules (A4-1004) and Aluvia 100 mg/25 mg tablets (A4-2135) are recorded Expired, since April 2023 and August 2024; Ritocom (B4-0455), Mylan's Lopinavir/Ritonavir tablet (A4-1023) and Alltera 50 granules (A4-100094) are recorded Inactive. A pack under any of these names should be checked by its printed number, batch and expiry, and the renewal confirmed on the official Greenbook
4. Enter the number in our free NAFDAC checker and confirm the product name, strength and holder match the pack. Film-coated tablets should be intact and dry; the oral solution must have been kept cold — a bottle that has sat warm for weeks has lost potency

Verify any NAFDAC number free (no login): https://ogbogwu.com/nafdac-checker/

## FAQs

### Is Aluvia still registered in Nigeria?

Not in our October 2026 copy of the NAFDAC register. Aluvia 200 mg/50 mg capsules (A4-1004) are recorded Expired since 3 April 2023 and Aluvia 100 mg/25 mg tablets (A4-2135) since 28 August 2024, both held by Phillips Pharmaceuticals for AbbVie. The same molecule has one current registration in our copy — Aurobindo's Lopinavir 200 mg/Ritonavir 50 mg tablet (A4-3852), also held by Phillips — and the ART programme continues to supply it through treatment sites. Listings can lag renewals, so confirm a recent Aluvia pack on the official Greenbook.

### Is Aluvia the same as Kaletra?

Yes. Both are AbbVie's lopinavir/ritonavir; Kaletra is the name in Europe and the Americas, Aluvia the name registered in Africa and other developing-country markets at a lower price. The heat-stable 200 mg/50 mg tablet is the same product under either name. A pack labelled Kaletra in Nigeria has usually come through an unofficial route, which is a reason to check it, not a sign that it is better.

### Who gets lopinavir/ritonavir in Nigeria today?

Mostly children. Infants and children under three start on it, as granules or pellets and later the small 100 mg/25 mg tablet, because dolutegravir dosing for the smallest children is still being rolled out. Adults are more likely to be given atazanavir/ritonavir if their first regimen fails, but lopinavir/ritonavir remains the alternative when atazanavir cannot be used — for instance with certain drug interactions or jaundice — and in some pregnancy and salvage regimens. It is dispensed at ART sites free of charge.

### Can I take Coartem or other malaria drugs with lopinavir/ritonavir?

With care, and tell the clinic. Ritonavir raises the blood level of lumefantrine, the second drug in Coartem and its generics, several-fold; the combination is still used because the alternative — untreated malaria — is worse, but a doctor should know, and an ECG is sensible if there are other heart-rhythm risks. Artesunate for severe malaria is fine. Avoid quinine where possible, as its levels also change. Never buy an antimalarial for someone on antiretrovirals without saying so at the counter.

### Does lopinavir/ritonavir treat COVID-19?

No. It was tried early in the pandemic because it works against a related viral enzyme in the laboratory, and demand for Aluvia in Nigeria rose sharply in 2020 as a result. The large RECOVERY and WHO Solidarity trials found no benefit in hospitalised patients, and no guideline recommends it for COVID-19. Buying it for that purpose wastes a medicine HIV patients need.

### Why does ritonavir cause so many drug interactions?

Because its whole job is to block CYP3A4, the liver enzyme that breaks down lopinavir — and the same enzyme breaks down roughly half of all medicines. Anything cleared that way builds up: statins to the point of muscle breakdown, inhaled steroids to the point of Cushing's syndrome, sedatives to dangerous sleepiness. Other drugs, such as rifampicin, push the other way and strip lopinavir out of the blood. The rule is simple even if the list is long: nothing new, including herbs and over-the-counter tablets, without checking first.

## Sources

- NAFDAC Greenbook (official register of approved products in Nigeria)
- WHO Model List of Essential Medicines
- British National Formulary (BNF)
- Nigerian Standard Treatment Guidelines (Federal Ministry of Health)