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:
- Weigh ≥ 5 kilograms, and
- Are ≥ 3 months old, and
- 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 |
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|---|---|---|---|
| Who should get this formulation? |
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| What are the advantages of this formulation? |
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| What are the disadvantages of this formulation? |
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Additional Resources
- Fact Sheet on Lopinavir and Ritonavir (LPV/r) Oral Pellets [PDF, 713KB] IATT, UNICEF, and WHO fact sheet from September 2015 that provides simplified information to facilitate proper dosing and administration of lopinavir and ritonavir 40mg/10mg oral pellets.
- Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection: Recommendations for a Public Health Approach - Second edition: [PDF, 5.3MB] June 2016 guidelines that provide guidance on the diagnosis of human immunodeficiency virus (HIV) infection, the use of antiretroviral (ARV) drugs for treating and preventing HIV infection and the care of people living with HIV. They are structured along the continuum of HIV testing, prevention, treatment and care.
Acknowledgements
Thank you to the following organizations for their help in developing this resource.
