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Drug Target dosing range
ABC 8-10mg/kg/dose twice daily
AZT
180-240mg/m2 /dose twice daily
d4T
1mg/kg/dose twice daily
ddI
≤3 months of age:
50mg/m2/dose;
>3 months of age:
120mg/m2/dose twice daily
4mg/kg/dose twice daily
3TC
NVP
A BSA dose range of 150200mg/m2/dose twice daily is
used to generate weight band
dosing
EFV
By weight band
(15-18.75mg/kg/dose solid
formulation or 19.5mg/kg/dose
suspension, once daily
<6 months:
<15kg – 12/3 mg/kg/dose;
≥15kg – 10/2.5 mg/kg/dose
twice daily
Approved dose is
230/75.5mg/m2/dose twice daily;
L/r
Considerations
Clearance in children <3 years old is
increased, but recent data on once daily
dosing in children from 3 months of age
suggests favourable PK profile.
Twice daily dosing is acceptable and
preferred
Dosing at the upper end of the range is
recommended for central nervous system
HIV disease, dosing at the lower end may
be preferred is settings where anaemia is
prevalent.
Needed as a priority product despite well
recognised longer term toxicities
(lipodystrophy), as it is initially well
tolerated, is safer to use in anaemia than
AZT, and has lower laboratory monitoring
requirements. Avoid over-dosing wherever
possible (noting recent revision to adult
dosing recommendation to reduce dose)
and especially for extended periods to
minimise toxicity.
Enteric coated formulations are preferred
over the buffered form. Needs to be given
1 hour before or 2 hours after food. Once
daily dosing accepted over 6 years of age.
Clearance in children <3 years old is
increased, and minimal observed toxicity
allows for higher dosing in younger
children (up to 5mg/kg/dose twice daily).
Under-dosing must be avoided wherever
possible due to low barrier development of
HIV drug resistance. A reduced dose (150200mg/m2/dose once daily) is
recommended for the first 2 weeks when
initiating NVP treatment regimens. Young
children require a higher NVP dose
relative to the NRTI components than
delivered in current adult FDCs.
Dosing not established for children <3
years. Suspension is over 30% less
bioavailable than solid formulations.
Clearance in children <2 years old is
increased. Actual exposure depends on
metabolism and inter-patient variability,
which is considerable. Heat-stable
paediatric formulation is recently
approved (awaiting registration in SA).
300/75mg/m2/dose is
recommended in children <2
years of age, if taken with
NNRTI, or for PI-experienced
patients
RTV Co-formulated with lopinavir
Needed for use as a pharmacological
(L:r ratio 4:1).
booster with PI-based treatment and for
For patients receiving
children receiving rifampicin-based antirifampicin, additional RTV
tuberculosis therapy
dosed at 0.75 x L/r dose to
achieve L:r ratio of 1:1
Table 2
ABC, abacavir; AZT, zidovudine; d4T, stavudine; ddI, didanosine; 3TC, lamivudine;
NVP, nevirapine; EFV, efavirenz; L/r, lopinavir/ritonavir; RTV, ritonavir; NNRTI,
non-nucleoside reverse transcriptase inhibitor; BSA, body surface area; FDC, fixed
dose combination; SA, South Africa
Adapted from [18]