Medical Advocates
Ritonavir (Norvir)
 
Journal Citations: Adverse
Events
General Reports                 
Blood Disorders                 
Bone Disorders                  
Candidiasis                        
Cardiovascular Disorders
Endocrine Disorders
 Endothelial Mitochondrial DNA Damage
 Ergotism
Eye Disorders		 Gastrointestinal Disorders
 Granulomatous Lesions
 Hepatotoxicity 
Hypersensitivity  
Metabolic Disorders
Pain Management
Pancreatic Disorders

 
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Last Update:  January 13, 2017
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General/Miscellaneous Reports
 
  Ritonavir Use in Human Immunodeficiency Virus-Positive Surgical Patients Is Not Associated with an Increase in Postoperative Critical Respiratory Events.
 Maher DP, Lee J, Woo P, Zhang X, et al
J Pain Palliat Care Pharmacother. 2016 Feb 9:1-
 Abstract

Injecting epidural and intra-articular triamcinolone in HIV-positive patients on ritonavir: beware of iatrogenic
Cushing's syndrome.
Maviki M, Cowley P, Marmery H.
 Skeletal Radiol. 2012 Nov 15.
 Abstract

Impact of Ritonavir, Atazanavir and their Combination on the CYP3A4 Induction Potential
of Efavirenz in Primary Human Hepatocytes.
 Mugundu GM, Hariparsad N, Desai PB.
Drug Metab Lett. 2010 Mar 4.
Abstract
Blood Disorders 
 
  Ritonavir and Epidural Triamcinolone as a Cause of Iatrogenic Cushing's Syndrome.
Albert NE, Kazi S, Santoro J, Dougherty R
 Am J Med Sci. 2012 Apr 25.

Effects of Tipranavir, Darunavir, and Ritonavir on Platelet Function, Coagulation,
and Fibrinolysis in Healthy Volunteers.
Kort JJ, Aslanyan S, Scherer J, et al
Curr HIV Res. 2011 Jun 14
 Abstract

Acute hepatitis and bleeding possibly induced by zidovudine and ritonavir in an infant
with HIV infection.
 Pai VB, Koranyi K, Nahata MC.
 Pharmacotherapy. 2000 Sep;20(9):1135-40.
 Abstract
Bone Disorders
 
  Iatrogenic Osteoporosis, Bilateral hip Osteonecrosis, and Secondary Adrenal
Suppression in an HIV-infected Patient Receiving Inhaled Corticosteroids and
Ritonavir-Boosted HAART.
 Kaviani N, Bukberg P, Manessis A, Yen V, Young I.
Endocr Pract. 2010 Aug 16:1-16.
Abstract
Candidiasis
 
  Oropharyngeal candidiasis in HIV-infected patients under treatment with protease
inhibitors.
 Migliorati CA, Birman EG, Cury AE. et al
 Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 2004 Sep;98(3):301-10
Abstract
Cardiovascular Disorders
 
  Ritonavir binds to and downregulates estrogen receptors: Molecular mechanism of promoting early atherosclerosis.
Xiang J, Wang Y, Su K, et al
Exp Cell Res. 2014 Jul 10.
 Abstract

Ritonavir-boosted protease inhibitors, Part 2: cardiac implications of lipid alterations.
 Cohen CJ. 
AIDS Read. 2005 Oct;15(10):528-32, 537-8.
Abstract
Endocrine Disorders
 
 
Ritonavir and Topical Ocular Corticosteroid Induced Cushing's Syndrome in an Adolescent with HIV-1 Infection.
Rainsbury PG, Sharp J, Tappin A, et al
Pediatr Infect Dis J. 2017 Jan 3.
 Abstract

Iatrogenic Cushing's syndrome due to drug interaction between glucocorticoids and the ritonavir or cobicistat containing HIV therapies.
 Elliot ER, Theodoraki A, Jain LR, et al
Clin Med (Lond). 2016 Oct;16(5):412-418.
 Abstract

Iatrogenic Cushing syndrome and adrenal insufficiency during concomitant therapy with ritonavir and fluticasone.
 Epperla N, McKiernan F.
Springerplus. 2015 Aug 27;4:455.
Abstract

Iatrogenic Cushing Syndrome Secondary to Ritonavir-Epidural Triamcinolone Interaction: An Illustrative Case and Review.
 Sadarangani S, Berg ML, Mauck W, Rizza S.
Interdiscip Perspect Infect Dis. 2014;2014:849432.
Abstract

Adrenal Enzyme Impairment in Neonates and Adolescents Treated with Ritonavir and Protease Inhibitors for HIV Exposure or Infection.
 Kariyawasam D, Simon A, Laborde K,  et al
Horm Res Paediatr. 2014 Feb 26
 Abstract

Triamcinolone and ritonavir leading to drug-induced Cushing syndrome and adrenal suppression: description of a new case and review of the literature.
 Schwarze-Zander C, Klingmüller D, Klümper J, et al
Infection. 2013 Jul 20
 Abstract

Iatrogenic Cushing's Syndrome in Patients Receiving Inhaled Budesonide and Itraconazole or Ritonavir: Two Cases and Literature Review.
 Blondin MC, Beauregard H, Serri O.
Endocr Pract. 2013 Jun 27:1-11
 Abstract

Iatrogenic Cushing Syndrome and Secondary Adrenal Insufficiency Related to Concomitant Triamcinolone and Ritonavir Administration: A Case Report and Review.
 Song Y, Schroeder JR, Bush LM. J
 Int Assoc Provid AIDS Care. 2013 Jun 18
 Abstract

Cushing's syndrome during HIV treatment: pharmacological interaction during use of ritonavir
 Eeftinck Schattenkerk JK, Lager PS.
Ned Tijdschr Geneeskd. 2013;157(14):A5509
 Abstract

Injecting epidural and intra-articular triamcinolone in HIV-positive patients on ritonavir: beware of iatrogenic
Cushing's syndrome.
 Maviki M, Cowley P, Marmery H.
 Skeletal Radiol. 2012 Nov 15.
 Abstract

FULL-TEXT ARTICLE
 Cushing syndrome due to ritonavir-fluticasone interaction.
Canalejo E, Pacheco MS.
CMAJ. 2012 May 14.
Paper

Adrenal suppression and Cushing's syndrome secondary to ritonavir and
budesonide.
 Gray D, Roux P, Carrihill M, Klein M.
S Afr Med J. 2010 May 4;100(5):296-7.
 Abstract

Cushing's syndrome induced by combined treatment with inhaled fluticasone and
oral ritonavir.
 Dupont C, Giraud V, Leporrier J, et al 
Rev Mal Respir. 2009 Sep;26(7):779-82.
 Abstract

Adrenal suppression and Cushing's syndrome secondary to an interaction between ritonavir and fluticasone:
a review of the literature.
 Foisy MM, Yakiwchuk EM, Chiu I, Singh AE.
 HIV Med. 2008 May 3
 Abstract

Ritonavir-Fluticasone Interaction Causing Cushing Syndrome in HIV-Infected Children
and Adolescents.
 Arrington-Sanders R, Hutton N, Siberry GK.
Pediatr Infect Dis J. 2006 Nov;25(11):1044-1048.
Abstract

Cushing syndrome with secondary adrenal insufficiency from concomitant therapy
with ritonavir and fluticasone.
 Johnson SR, Marion AA, Vrchoticky T, et al 
J Pediatr. 2006 Mar;148(3):386-388.
Abstract
Endothelial Mitochondrial DNA Damage and Cell Death
 
HIV protease inhibitor ritonavir induces cytotoxicity of human endothelial cells.
Zhong DS, Lu XH, Conklin BS
Arterioscler Thromb Vasc Biol 2002 Oct 1;22(10):1560-6
Abstract
Ergotism
 
  Splenic infarction. Ergotism induced by ritonavir?
 Dal Verme A, López E, Grinspon S,  et al
Medicina (B Aires). 2012;72(6):475-7
 Abstract

Irreversible coma, ergotamine, and ritonavir.
 Pardo Rey C, Yebra M, Borrallo M, 
Clin Infect Dis. 2003
 Abstract
 
  Clinical ergotism induced by ritonavir.
Vila A, Mykietiuk A, Bonvehi P, Temporiti E, et al
 Scand J Infect Dis. 2001;33(10):788-9.
Abstract
Eye Disorders
 
Ritonavir -Associated Toxicity Mimicking Retinitis Pigmentosa In an HIV-Infected Patient  on Highly Active Antirational Therapy
 Papavasileiou E, Younis S, Zygoura V,  et al
 Retin Cases Brief Rep. 2016 Jun 9.
 Abstract

Bull's eye maculopathy in an HIV-positive patient receiving ritonavir.
 Non L, Jeroudi A, Smith BT, Parsaei S.
Antivir Ther. 2015 Nov 11.
Abstract
Gastrointestinal Disorders
 
In vivo administration of ritonavir worsens intestinal damage caused by cyclooxygease inhibitors.
 Renga B, Mencarelli A, Cipriani S, D'Amore C,  et al
Eur J Pharmacol. 2013 Dec 4
 Abstract

Scutellaria baicalensis and a constituent flavonoid, baicalein, attenuate
ritonavir-induced gastrointestinal side-effects.
 Mehendale S, Aung H, Wang CZ, et al
J Pharm Pharmacol. 2007 Nov;59(11):1567-72.
Abstract
Granulomatous Lesions
 
Granulomatous Lesions
 
  Subcutaneous granulomatous lesions related to ritonavir therapy in a HIV infected patient.
 Kawsar M, El-Gadi S.
 Int J STD AIDS. 2002 Apr;13(4):273-4.
Abstract
Hepatotoxicity
 
Risk Factors for Hepatotoxicity in HIV-1-Infected Patients Receiving Ritonavir and
Saquinavir with or without Stavudine. 
Abstract
  Risk of Liver Enzyme Elevation during Treatment with Ritonavir-boosted Protease Inhibitors among HIV-monoinfected and HIV/HCV Coinfected Patients.
 Lapadula G, Costarelli S, Chatenoud L, et al
J Acquir Immune Defic Syndr. 2015 Feb 26.
 Abstract 

Liver toxicity associated with antiretroviral therapy including efavirenz or ritonavir-boosted protease
inhibitors in a cohort of HIV/hepatitis C virus co-infected patients.
 Neukam K, Mira JA, Ruiz-Morales J, et al
J Antimicrob Chemother. 2011 Sep 7.
Abstract

Hepatotoxicity associated with protease inhibitor-based antiretroviral regimens with or
without concurrent ritonavir.
 Sulkowski MS, Mehta SH, Chaisson RE, et al 
AIDS. 2004 Nov 19;18(17):2277-84.
 Abstract
Hypersensitivity
 
  Clinical ritonavir and lopinavir hypersensitivity confirmed by a specific in vitro cellular
allergen stimulation test.
Manfredi R, Sabbatani S, Bergonzi S.
 Curr HIV Res. 2007 Jul;5(4):440-2
Abstract
Metabolic Disorders
 
 
Hemeoxygenase-1 as a novel driver in ritonavir-induced insulin resistance in HIV-1-infected patients.
 Taylor N, Kremser I, Auer S, et al 
J Acquir Immune Defic Syndr. 2016 Oct 27
 Abstract

Ritonavir-induced lipoatrophy and dyslipidaemia is reversed by the anti-inflammatory drug
leflunomide in a PPAR-γ-dependent manner.
 Mencarelli A, Francisci D, Renga B,  et al
Antivir Ther. 2012 Jan 25.
Abstract

The lopinavir/ritonavir-associated rise in lipids is not related to lopinavir or ritonavir plasma
concentration.
Bierman WF, van Vonderen MG, Veldkamp AI,  et al
Antivir Ther. 2011;16(5):647-55.
 Abstract

Long-Term Ritonavir Exposure Increases Fatty Acid and Glycerol Recycling in 3T3-L1
Adipocytes as Compensatory Mechanisms for Increased Triacylglycerol Hydrolysis.
Adler-Wailes DC, Guiney EL, et al
Endocrinology. 2010 Mar 12
 Abstract

Effects of first-line use of nucleoside analogues, efavirenz, and ritonavir-boosted protease
inhibitors on lipid levels.
Hill A, Sawyer W, Gazzard B., et al
 HIV Clin Trials. 2009 Jan-Feb;10(1):1-12.
Abstract
Pancreatic Disorders
 
Risk Factors for Hepatotoxicity in HIV-1-Infected Patients Receiving Ritonavir and
Saquinavir with or without Stavudine. 
Abstract
  Ritonavir-Mediated Induction of Apoptosis in Pancreatic Cancer Occurs via the RB/E2F-1 and AKT Pathways.
 Batchu RB, Gruzdyn OV, Bryant CS,  et al
Pharmaceuticals (Basel). 2014 Jan 9;7(1):46-57
 Abstract
Renal Disorders
 
Risk Factors for Hepatotoxicity in HIV-1-Infected Patients Receiving Ritonavir and
Saquinavir with or without Stavudine. 
Abstract
  FULL-TEXT ARTICLE
Ritonavir-induced acute kidney injury: kidney biopsy findings and review of literature.
Shafi T, Choi MJ, Racusen LC,  et al
 Clin Nephrol. 2011 Sup;75(S1):60-64.
 Paper
Pain Management
 
Risk Factors for Hepatotoxicity in HIV-1-Infected Patients Receiving Ritonavir and
Saquinavir with or without Stavudine. 
Abstract
  FULL-TEXT DRTICLE
 Iatrogenic Hypercortisolism Complicating Triamcinolone Acetonide Injections in Patients with HIV on
Ritonavir-Boosted Protease Inhibitors.
 Fessler D, Beach J, Keel J, Stead W.
 Pain Physician. 2012 Nov;15(6):489-93.
 Paper

 
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Ritonavir Adverse Events