Find out about the new formulation of LPV/r pellets and why they are recommended for young children, and view a comparison chart with other formulations. Download a PDF of this page [PDF, 179KB] to use offline.

Why LPV/r pellets are recommended for young children

In 2015, the United States Food and Drug Administration tentatively approved a new formulation of lopinavir/ritonavir (LPV/r), a pediatric antiretroviral: See Latest Research.

  • The pellets are approved only for use in children 3 months or older and weighing 5 kilograms or more. See Fact Sheet on Lopinavir and Ritonavir (LPV/r) Pellets [PDF, 713KB].
  • Caregivers should give infants and young children living with HIV LPV/r pellets two times each day. See Weight Dosing Tool.
  • For younger children, the pellets are easier to swallow than tablets. Both pellets and tablets must be swallowed fully intact. They cannot be stirred, broken, crushed, chewed, or dissolved.
  • The pellets' taste can be masked by food or breast milk, unlike the LPV/r solution.
  • The pellets do not require refrigeration unlike the LPV/r solution.

Current WHO-Recommended Pediatric Optimal First Line ART Regimen

  0-2 weeks old 2 weeks – 3 months old 3 - 36 months old
Preferred AZT + 3TC + NVP (ABC or AZT) + 3TC +
LPV/r Solution
(ABC or AZT) + 3TC +
LPV/r Pellets
Alternative AZT + 3TC + NVP AZT + 3TC + NVP (ABC or AZT) + 3TC +
LPV/r Pellets
Special circumstances AZT + 3TC + NVP (ABC or AZT) + 3TC + RAL (ABC or AZT) + 3TC + RAL

3TC: lamivudine, ABC: abacavir, AZT: zidovudine, LPV: lopinavir, NVP: nevirapine, r: ritonavir, RAL: raltegravir

Children eligible to take pellets

LPV/r pellets are appropriate for infants and children who:

  1. Weigh ≥ 5 kilograms, and
  2. Are ≥ 3 months old, and
  3. Are able to swallow pellets that are taken with liquid (such as breast milk) or for older infants (beginning at age 6 months), are able to swallow pellets with age-appropriate soft foods that do not require chewing.

Appropriate LPV/r formulations

The table below provides a side-by-side comparison to help determine the appropriate LPV/r formulation.

Side-by-Side Comparison of LPV/r Solution, Pellets, and Tablets

  Solution
80mg/20mg
Pellets
40mg/10mg
Tablet
100 mg/25mg
Who should get this formulation?
  • Patients weighing 3 kilograms or more.
  • Patients who are 14 days or older.
  • Patients weighing 5 kilograms or more.
  • Patients who are 3 months or older.
  • Patients who are able to swallow pellets.
  • Patients weighing 10 kilograms or more.
  • Patients who are able to swallow the whole tablet.
What are the advantages of this formulation?
  • Solution can be taken with or without food.
  • Pellets do not need to be stored in a refrigerator like the LPV/r solution does.
  • Pellets can be taken with age-appropriate soft food or liquid to ease administration.
  • Tablets are heat stable and do not need to be stored at cold temperatures.
  • Tablets can be taken with or without food.
What are the disadvantages of this formulation?
  • Solution has a very unpleasant taste.
  • Solution should be stored in a refrigerator until given to the patient.
  • Multiple capsules may be required for older children in a single dose.
  • Caregivers may not be familiar with the required way to administer pellets.
  • Pellets cannot be removed from their container. They will discolor, become brittle, and stick to your hands.
  • Pellets must be taken whole. They cannot be stirred, broken, crushed, chewed, or dissolved.
  • Tablets must be taken whole; they cannot be stirred, broken, crushed, chewed, or dissolved.

Additional Resources

Acknowledgements

Thank you to the following organizations for their help in developing this resource.