Name of drug

Formulations

Pharmacokinetic data available

Age/weight, dose^a and dose frequency

Other comments

Nucleoside analogue reverse transcriptase inhibitors

Zidovudine (ZDV)

Syrup: 10 mg/ml
Capsules: 100 mg; 250 mg
Tablet: 300 mg

All ages

<4 weeks: 4 mg/kg/dose twice daily
4 weeks to 13 years: 180 mg/ m²/dose twice daily
Maximum dose:
³ 13years: 300 mg/dose twice daily

Large volume of syrup not well tolerated in older children
Needs storage in glass jars and is light-sensitive
Can be given with food Doses of 600 mg/m²/dose twice daily required for HIV encephalopathy
Do not use with d4T (antagonistic antiretroviral effect)

Lamivudine (3TC)

Oral solution: 10 mg/ml
Tablet: 150 mg

All ages

<30 days: 2 mg/kg/dose twice daily
³ 30 days or <60 kg: 4 mg/kg/ dose twice daily
Maximum dose:
>60 kg: 150 mg/dose twice daily

Well tolerated
Can be given with food
Store solution at room temperature(use within one month of opening)

Fixed-dose combination of ZDV plus 3TC

No liquid available
Tablet: 300 mg ZDV plus150 mg 3TC

Adolescents and adults

Maximum dose:
>13 yrs or >60 kg: 1 tablet/dose twice daily

Tablet should not be split

Didanosine (ddI, dideoxyinosine)

Oral suspension paediatricpowder/water: 10 mg/ml; In many countries needs to be made up with additional antacid
Chewable tablets: 25 mg, 50 mg, 100 mg, 150 mg, 200 mg
Enteric-coated beadlets in capsules: 125 mg, 200 mg, 250 mg, 400 mg

All ages

<3 months: 50mg/m²/dose twice daily
³ 3 months to <13 yrs: 90 mg/ m²/dose twice daily or 240 mg/ m²/dose once daily
Maximum dose:
³ 13 yrs or >60 kg: 200 mg/dose twice daily or 400mg once daily

Keep suspension refrigerated; stable for 30 days; must be well shaken Ideally taken 1 hour or 2 hours after food; may be less important in children
Enteric-coated beadlets in capsules can be opened and sprinkled on small amount of food

Nucleoside analogue reverse transcriptase inhibitors

Stavudine (d4T)

Oral solution: 1 mg/ml
Capsules: 15 mg, 20 mg, 30 mg, 40 mg

All ages

<30kg: 1 mg/kg/dose twice daily30 to 60 kg: 30 mg/dose twice daily
Maximum dose:
>60 kg: 40 mg/dose twice daily

Large volume of solution
Keep solution refrigerated; stable for 30 days; must be well shaken.
Needs to be stored in glass bottles
Capsules opened up and mixed with small amount of food are well tolerated (stable in solution for 24 hours if kept refrigerated)
Do not use with AZT (antagonistic antiretroviral effect)

Abacavir (ABC)

Oral solution: 20 mg/ml
Tablet: 300 mg

Over age 3 months

<16 years or <37.5 kg: 8 mg/kg/ dose twice daily
Maximum dose:
>16 years or 37.5 kg: 300 mg/ dose twice daily

Syrup well tolerated or tablet can be crushed
Can be given with food
PARENTS MUST BE WARNED ABOUT HYPERSENSITIVITY REACTION
ABC should be stopped permanently if hypersensitivity reaction occurs

Fixed-dose combination of ZDV plus 3TC plus ABC

No liquid available
Tablet: ZDV 300 mg plus3TC 150 mg plus ABC300 mg

Adolescents and adults

Maximum dose:
>40 kg: 1 tablet/dose twice daily

Tablet cannot be split
PARENTS MUST BE WARNED ABOUT HYPERSENSITIVITY REACTION
Abacavir should be stopped permanently if hypersensitivity reaction occurs

Nevirapine (NVP)

Oral suspension: 10 mg/ml
Tablet: 200 mg

All ages

15 to 30 days: 5 mg/kg/doseonce daily for two weeks, then120 mg/m²/dose twice daily fortwo weeks, then 200 mg/m²/dose twice daily
>30 days to 13 years: 120 mg/ m²/dose twice daily for two weeks, then 200 mg/m²/dose twice daily
Maximum dose:
>13 yrs: 200 mg/dose once daily for first two weeks, then 200 mg/ dose twice daily

If rifampicin coadministration, increase NVP dose by ~30% oravoid use (see Chapter XII).
Store suspension at roomtemperature; must be well shaken.
Can be given with food
PARENTS MUST BE WARNEDABOUT RASH. Do not escalate dose if rash occurs (if mild/moderate rash, hold drug; when rash has cleared, restart dosing as from beginning of dose escalation; if severe rash, discontinue drug)
Drug interactions

Nucleoside analogue reverse transcriptase inhibitors

Efavirenz (EFZ)

Syrup: 30 mg/ml (Note: syrup requires higher doses than capsules; see dosing chart)
Capsules: 50 mg, 100 mg, 200 mg

Only for children over 3 years

Capsule (liquid) dose for >3 years:
10 to 15 kg: 200 mg (270 mg = 9 ml) once daily
15 to <20 kg: 250 mg (300 mg = 10 ml) once daily
20 to <25 kg: 300 mg (360 mg = 12 ml) once daily
25 to <33 kg: 350 mg (450 mg = 15 ml) once daily
33 to <40 kg: 400 mg (510 mg = 17 ml) once daily
Maximum dose:
³ 40 kg: 600mg once daily

Capsules may be opened andadded to food but have verypeppery taste; however, can bemixed with sweet foods or jam todisguise taste
Can be given with food (but avoid after high-fat meals which increase absorption by 50%)
Best given at bedtime, especially for first two weeks, to reduce central nervous system side-effects
Drug interactions

Nelfinavir (NFV)

Powder for oral suspension(mix with liquid): 200 mg per level teaspoon (50 mg per1.25-ml scoop): 5 ml
Tablet: 250 mg (tablet can be halved; can be crushed and added to food or dissolved in water)

All ages; however, extensive pharmacokinetic variability in infants, with requirement for very high doses in infants <1 year

<1 year: 40-50 mg/kg/dose three times daily or 65-75 mg/kg/ dose twice daily
>1 year to <13 years: 55 to65 mg/kg/dose twice daily
Maximum dose:
13 years: 1250 mg/dose twice daily

Powder is sweet, faintly bitter, but gritty and hard to dissolve; must be reconstituted immediately before administration in water, milk, formula, pudding, etc. – do not use acidic food or juice (increases bitter taste)
Because of difficulties with use of powder, use of crushed tablets preferred (even for infants) if appropriate dose can be given
Powder and tablets can be stored at room temperature
Take with food
Drug interactions (less than ritonavir- containing protease inhibitors)

Lopinavir/ritonavir, (LPV/r)

Oral solution: 80 mg/ml lopinavir plus 20 mg/ml ritonavir
Capsules: 133.3 mg lopinavir plus 33.3 mg ritonavir

6 months of age or older

>6 months to 13 years: 225 mg/m² LPV/57.5 mg/m²ritonavir twice daily
Or weight-based dosing:
7-15 kg: 12 mg/kg LPV/3 mg/ kg ritonavir/dose twice daily15-40 kg: 10 mg/kg lopinavir/5 mg/kg ritonavir twice daily
Maximum dose: >40 kg: 400 mg LPV/100 mg ritonavir (3 capsules or 5 ml) twice daily

Oral solution and capsules shouldpreferably be refrigerated; however, can be stored at room temperature up to 25 ^oC (77 ^oF) for two months.
Liquid formulation has low volume but bitter taste
Preferably refrigerated
Capsules large
Should be taken with food
Drug interactions