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Appendix B, Table 7. Antiretroviral Dosing Recommendations in Patients with Renal or Hepatic
Insufficiency (Last updated March 27, 2012; last reviewed March 27, 2012) (page 4 of 4)

Antiretrovirals Usual Daily Dose
Generic Name (Refer to Appendix B, Dosing in Renal Insufficiency
(abbreviation)/ Tables 1–6 for additional (Including with chronic ambulatory Dosing in Hepatic Impairment
Trade Name peritoneal dialysis and hemodialysis)
dosing information.)
Lopinavir/ 400/100 mg PO BID or Avoid once-daily dosing in patients on HD No dosage recommendation; use with
ritonavir (LPV/r) 800/200 mg PO once daily caution in patients with hepatic
Kaletra impairment.
Nelfinavir 1250 mg PO BID No dosage adjustment necessary Mild hepatic impairment: no dosage
(NFV)/ adjustment
Viracept
Moderate-to-severe hepatic impairment:
do not use
Ritonavir As a PI-boosting agent: No dosage adjustment necessary Refer to recommendations for the primary
(RTV)/ 100–400 mg per day PI.
Norvir

Saquinavir (SQV 1000 mg + No dosage adjustment necessary Mild-to-moderate hepatic impairment: use
(SQV)/ RTV 100 mg) PO BID with caution
Invirase
Severe hepatic impairment:
contraindicated
Tipranavir (TPV 500 mg + No dosage adjustment necessary Child-Pugh Class A: use with caution
(TPV)/ RTV 200 mg) PO BID
Aptivus Child-Pugh Class B or C: contraindicated
Fusion Inhibitor
Enfuvirtide 90 mg subcutaneous BID No dosage adjustment necessary No dosage adjustment necessary
(T20)/
Fuzeon

CCR5 Antagonist
Maraviroc The recommended dose differs CrCl <30 mL/min or HD No dosage recommendations.
(MVC)/ based on concomitant Concentrations will likely be increased in
Selzentry medications and potential for Without potent CYP3A inhibitors or inducers: patients with hepatic impairment.
drug-drug interactions. See 300 mg BID; reduce to 150 mg BID if postural
Appendix B, Table 6 for detailed hypotension occurs
dosing information.
With potent CYP3A inducers or inhibitors: not
recommended
Integrase Inhibitor
Raltegravir 400 mg BID No dosage adjustment necessary Mild-to-moderate hepatic insufficiency: no
(RAL)/ dosage adjustment necessary
Isentress
Severe hepatic insufficiency: no
recommendation

Key to Abbreviations: 3TC = lamivudine, ABC = abacavir, ARV = antiretroviral, ATV = atazanavir, AZT = zidovudine, BID = twice daily, CAPD = chronic ambulatory
peritoneal dialysis, CrCl = creatinine clearance, CYP = cytochrome P, d4T = stavudine, ddI = didanosine, DLV = delavirdine, DRV = darunavir, EC = enteric coated, EFV
= efavirenz, ETR = etravirine, FPV = fosamprenavir, FTC = emtricitabine, hr = hour, HD = hemodialysis, IDV = indinavir, LPV/r = lopinavir/ritonavir,
MVC = maraviroc, NFV = nelfinavir, NNRTI = non-nucleoside reverse transcriptase inhibitor, NRTI = nucleoside reverse transcriptase inhibitor, NVP = nevirapine,
PI = protease inhibitor, PO = orally, RAL = raltegravir, RPV = rilpivirine, RTV = ritonavir, SQV = saquinavir, T20 = enfuvirtide, TDF = tenofovir, TID = three times daily,
TPV = tipranavir, XR = extended release, ZVD = zidovudine

Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents O-16

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