Lopinavir/ Ritonavir
Lopinavir and ritonavir are protease inhibitors approved for use in human immunodeficiency virus (HIV) 1. They are among the drugs being trialled for possible repurposing in COVID-19 treatment. Lopinavir/ritonavir is usually given as a combination therapy as ritonavir is said to increase the half-life of lopinavir by inhibiting the cytochrome P450 that metabolises it. Protease inhibitors generally prevent maturation of the viral particles by binding to the HIV-1 protease enzyme and preventing the cleavage of Gag-pol polyproteins (group-specific antigen-polymerase). This leads to the production of nascent immature, defective viral particles that are non-infectious (Yan et al, 2020; Dionne, 2019; Sheahan et al., 2020; Painstil & Cheng, 2019; Tobaiqy et al., 2020).
The adverse effects that have been reported with lopinavir/ritonavir include nausea and vomiting, diarrhea, anemia, hyperlipidaemia, alanine transaminase elevation, impaired cognition or memory, insomnia and skin toxicity (Su et al, 2019; Jespersen et al., 2018; Dionne, 2019; Silva et al., 2020). It is therefore instructive to be cautious in administering lopinavir/ritonavir to patients that have impaired liver functions, dyslipidaemia and psychiatric disposition.