Alltera

Alltera tablet which exhibits anti-retroviral property. Alltera tablet is a which contain combination of Lopinavir 200mg and Ritonavir 50mg Both peak active ingredients consist of anti-viral activity against human immunodeficiency virus (HIV) which is required for causing AIDS Alltera is preventing the progression of HIV virus from multiplication. Alltera tablet is used to reduce problem related to AIDS, it is not cure or prevent the disease. Alltera combination helps to postpone the symptoms caused by HIV/AIDS.

Lopinavir and Ritonavir

Alltera

200mg & 50mg

Mylan





Alltera indication

Alltera is primarily indicated for; HIV infection associated AIDS Normally, Alltera is used as combination with other anti-retroviral medicines.

Alltera is used to suppress the progression of HIV virus in immune cells and increase T cell counts. The number of Lopinavir blockade associated substitutions affects the virologic action of Alltera

Mechanism of action

Alltera is an anti-viral medicine that has two prime compounds which are inhibitors of HIV protease and effective against retrovirus. Retrovirus has capable of converting RNA into DNA with the help of reverse transcriptase enzyme.

Then the viral DNA incorporated into DNA of affected immune cells and then multiplied Anti-viral activity of Alltera is exhibited by Lopinavir; it is a virulent protease inhibitor which inhibits the separation of Gag-Pol polyprotein.

Gag-Pol polyprotein is most important protein in the augmentation of active virus. This viral protease enzyme breaks the Gag-Pol polyprotein at the last stage of multiplication, an active and grown virus released into infected immune cells. A Alltera tablet prohibits the proteases enzyme that leads to formation of premature, non-infectious viral particles.




PHARMACOKINETIC

After oral administration, ritonavir present in Alltera tablet inhibits the metabolism of Lopinavir; therefore, the plasma level of Lopinavir is elevated. The peak plasma concentration of the Lopinavir occurs only at 4 hours after administration The effect of food, there is no significant difference between fasted and fed condition. Alltera should be taken with or without food.

The drug Lopinavir is highly bound to the human plasma protein around 98-99%.

Lopinavir is undergoes oxidative metabolism, it is metabolized by CYP3A isoenzymes. Ritonavir is a potent CYP3A inhibitor, prohibits metabolism of Lopinavir and increased the plasma level of Lopinavir.

Alltera is highly excreted through urine and feces. Lopinavir is a potent protease inhibitor which is responsible for anti-viral activity. The terminal half-life period is approximately 2.33 hours in case of twice daily, 2.44 hours at once daily.





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Alltera
Brand Alltera
Ingredients Lopinavir and Ritonavir
Strength 200mg & 50mg
Manufactured Mylan
Rating


Alltera Dosage and administration

Alltera tablet should be taken with or without food. Alltera is available in fixed dose combination (Lopinavir 200mg + ritonavir 50mg)

In adults

Alltera 400mg/100mg should be given as 200mg/50mg as two tablets two times a day Alltera 800mg/200mg should be taken as 200mg/50mg as four tablets once a day. Alltera should not administered as a single dose, in case of combination with carbamazepine, Phenobarbital, or phenytoin.

Combinational therapy:
Alltera should be combined with some other anti-viral medicines; Efavirenz Nevirapine Nelfinavir By combining with the above mentioned anti-viral medicines, the prescribed dose of Alltera is 500mg/125mg, it is taken as 200mg/50mg as two tablets & 100mg/25mg as one tablet at two times a day in concomitant with efavirenz, nevirapine, Nelfinavir

In pediatric

The dose of Alltera in children is recommended on the basis of; Body weight or Body surface area (BSA) Alltera is not given as single dose for pediatric patients who are under the age of <18 years

Alltera not combined with efavirenz, nevirapine, Nelfinavir

15kg to 25kg: The BSA should be ≥0.6 to <0.9, the prescribed dose of Alltera 100mg/25mg as two tablets two times a day
>25kg to 35kg: BSA- ≥0.9 to <1.4, the recommended dose of Alltera 100mg/25mg as three tablets two times a day
>35kg: BSA ≥1.4, the dose should be taken as Alltera 100mg/25mg tablets as four tablets or two Alltera 200mg/50mg tablets.

Alltera combined with efavirenz, nevirapine, Nelfinavir

15kg to 20kg: The BSA should be ≥0.6 to <0.8, the prescribed dose of Alltera 100mg/25mg as two tablets two times a day
>20kg to 30kg: BSA- ≥0.8 to <1.2, the recommended dose of Alltera 100mg/25mg as three tablets two times a day
>30kg to 45kg: BSA ≥1.2 to <1.7, the dose should be taken as Alltera 100mg/25mg tablets as four tablets or two Alltera 200mg/50mg tablets.
>45kg: BSA ≥1.7, Alltera 100mg/25mg taken as 5 tablets at twice daily

Blood and lymphatic system

Anemia, leucopenia, neutropenia, lymphadenopathy

Cardiac problems

Atherosclerosis such as myocardial infarction, atrioventricular block

Ear and labyrinth problems

Vertigo, tinnitus

Endocrine

Hypogonadism

Eye

Visual impairment

GIT

Diarrhea, nausea, vomiting, abdominal pain, gastroenteritis, colitis, dyspepsia, pancreatitis, ulcers, dry mouth

General

Fatigue, asthenia

Hepatic disorders

AST, ALT and GGT elevation, hepatomegaly, cholangitis, hepatic steatosis

Immuno disorders

Hypersensitivity reaction like; urticaria and angioedema

Infections and infestation

Upper and lower respiratory tract infection, cellulitis, folliculitis and furuncle

Metabolism

Hypercholesterolemia, hyper triglycerides, weight decreased, loss of appetite

Musculoskeletal

Arthralgia, back pain, Myalgia, rhabdomyolysis

Nerve disorders

Headache, insomnia, neuropathy, ageusia, convulsions

Renal

Renal failure, Hematuria, nephritis

Reproduction

Erectile dysfunction, amenorrhea, menorrhagia

Skin

Rashes, seborrheic dermatitis, night sweats, Pruritus, alopecia, capillaritis, vasculitis

Alltera precautions and warning

Drug interaction-CYP3A enzyme prohibition, causes increased plasma concentration of concurrent used drugs. Avoid the concomitant use. Toxicity occurs to neonates, potential risk may occur while using Alltera in neonates. Take alcohol & propylene glycol from all the drugs should be given to infants for reducing the toxicity associated to the components.

Pancreatitis

Elevation of triglyceride levels may leads to cause pancreatitis. Pancreatitis is the major risk factor during the Alltera treatment. Lipase and amylase value should be monitored periodically.

Liver toxicity

Due to elevation of AST, ALT & bilirubin, leads to cause liver injury this may concluds as liver damage or failure.

Caution should be taken

Pregnancy women, Breastfeeding, Hepatic impairment, Geriatric patients

Alltera drug interaction

Some of the medicines involved in drug interaction while taking with Alltera ; HIV-1 proteases inhibitors like Fosamprenavir/ritonavir, Indinavir, Nelfinavir (should not administered as a single dose with Alltera), ritonavir, saquinavir, tipranavir

Non-nucleoside reverse transcriptase inhibitors: efavirenz, nevirapine, delaveridine Nucleoside reverse transcriptase inhibitor: tenofovir, abacavir, zidovudine Amiodarone, lidocaine, quinidine, vincristine, vinblastine, dasatinib, nilotinib, rivaroxaban, etc

Alltera contraindications

Alltera is concomitant with potent CYP3A inducers; it leads to contraindicated causes depletion of plasma concentration of Lopinavir that leads to loss of virologic response .

Alltera is contraindicated to any active ingredients that present in Alltera tablet; Produce anaphylactic reactions like toxic epidermal necrolysis, Stevens-Johnson syndrome, Erythema multiforme, urticaria, angioedema etc.



Pregnancy category: C Alltera is not recommended for pregnancy women or who become pregnant. Alltera cause harm to unborn babies To avoid risk of infection, Alltera is not given to breastfeeding mothers.

The Storage condition of Alltera should between 20°C – 25°C (68°F-77°F). Alltera should be keep away from moisture, heat, and light

If patient fail to take tablet Alltera , it should be taken within a time. Dose should be skipped, and follow the next dose schedule Do not double the dose

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