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Ritonavir (Norvir) is associated with several important safety considerations that patients and healthcare professionals should be aware of. Please review the following points carefully and discuss any concerns with your healthcare provider.

• Interactions with Other Medications: Ritonavir may interact with various drugs, potentially leading to severe reactions. Certain medications can hinder the body's ability to eliminate ritonavir, impacting its efficacy and increasing the risk of side effects. Consult your healthcare provider or pharmacist to ensure compatibility with other medications you are taking.

• Liver Issues: Ritonavir can cause serious liver problems, particularly within the first three months of treatment. Regular blood tests will be conducted to monitor liver function. Seek immediate medical attention if symptoms of liver damage occur, such as drowsiness, nausea, appetite loss, light-colored stool, upper right stomach pain, jaundice, or dark urine. Those with hepatitis B or C or a history of liver problems are at increased risk.

• Pancreatitis Risk: Although rare, ritonavir may lead to inflammation of the pancreas (pancreatitis), especially in individuals with high triglycerides or advanced HIV. If symptoms like upper stomach pain, fever, nausea, or vomiting arise, discontinue use and contact your healthcare provider immediately.

• Heart Rhythm Concerns: Ritonavir can affect heart rhythm (PR prolongation), which can be life-threatening. Increased risk is associated with imbalanced electrolytes, existing heart rhythm issues, or concurrent use of medications affecting heart rhythm. Seek urgent medical care if you experience palpitations, difficulty breathing, chest pain, or dizziness.

• Severe Skin and Allergic Reactions: Ritonavir may cause mild to moderate rashes; however, severe reactions warrant immediate medical attention. Discontinue use if a severe rash is accompanied by fever, discomfort, muscle or joint pain, mouth sores, blisters, or facial swelling.

• High Blood Sugar and Cholesterol Levels: Ritonavir can elevate blood sugar and cholesterol levels, especially when taken with certain HIV medications. Patients with diabetes may need dosage adjustments of their diabetic medications. Monitor blood sugar and cholesterol levels, and inform your provider of any significant changes or history of these conditions.

• Body Fat Changes: Some individuals may experience altered body fat distribution, such as fat accumulation in certain areas or loss in others. Report any noticeable changes to your healthcare provider.

• Overactive Immune System: Combination antiretroviral therapy, including ritonavir, might result in immune reconstitution syndrome, where the immune system becomes excessively active. Report any new symptoms, such as fever, pain, hair loss, bulging eyes, or sweating, to your healthcare provider.

• Bleeding Risk: Individuals with a history of bleeding disorders, like hemophilia, may experience increased bleeding. Inform your provider if unexpected or difficult-to-stop bleeding occurs.

• Potential Harm to Newborns: The oral solution of ritonavir contains ethanol and propylene glycol, which could be hazardous to prematurely born infants. Seek immediate medical attention if symptoms such as breathing difficulties, dizziness, or nausea arise.

• Contraindications: Ritonavir should not be used with certain medications metabolized by the liver protein CYP3A4, including alfuzosin, dronedarone, lovastatin, and simvastatin, due to potential serious health risks. Consult your healthcare provider if you are taking these medications.

These guidelines are crucial for ensuring the safe use of ritonavir. Always communicate openly with your healthcare provider regarding any medications you are taking or health conditions you may have.

Common side effects:

• Diarrhea
• Nausea
• Vomiting
• Dizziness
• Feeling tired or weak
• Heartburn
• Stomach pain
• Changes in taste
• Tingling sensation in the mouth
• Increased cholesterol levels
• Rash
• Back and joint pain
• Coughing
• Throat pain
• Excessive gas
• Blurry vision
• Swelling
• Muscle pain
• Spinning sensation
• Frequent urination
• Sensation of cold in hands and feet

Serious side effects:

• Severe allergic reactions (facial swelling, hives, trouble breathing)
• Serious liver problems (persistent nausea, vomiting, abdominal pain, yellowing of the skin or eyes, dark urine)
• Abnormal heart rhythms (chest pain, feeling faint)

Interactions with high risk of serious adverse effects and should be avoided:

• alfuzosin
• antiarrhythmics (such as amiodarone, flecainide, propafenone, quinidine)
• azole antifungals (such as voriconazole)
• certain benzodiazepines (midazolam, triazolam)
• certain 'blood thinners' (such as rivaroxaban, warfarin)
• eletriptan
• drugs to treat erectile dysfunction-ED or pulmonary hypertension (such as avanafil, sildenafil)
• ergot alkaloids (such as dihydroergotamine, ergonovine, ergotamine, methylergonovine)
• lurasidone
• certain opioid pain medications (such as fentanyl, meperidine)
• pimozide
• ranolazine
• salmeterol
• 'statin' cholesterol drugs (such as simvastatin, lovastatin)

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• cobicistat
• disulfiram
• orlistat

Interactions with low risk that usually do not require a change in therapy:

• apalutamide
• rifampin
• St. John's wort