8.02 - Usual Paediatric Anti-Retroviral Dosages

Last updated 6th December 2016


Anti-Retroviral

Usual Dosage

Remarks

Nucleoside Reverse Transcriptase Inhibitor (NRTI)


Zidovudine

4 kg to < 9 kg :
12 mg / kg PO q12H

9 kg to < 30 kg :
9 mg / kg PO q12H

≥ 30 kg (Age ≥ 18 years) :
300 mg PO q12H
or
180 – 240 mg / m2 (max: 300 mg) PO q12H

For MTCT prevention in neonates

≥ 30 to < 35 week gestation:
2 mg / kg PO q12H (first 2 weeks);
3 mg / kg PO q12H (3 weeks to 8 weeks)

≥ 35 week gestation :
4 mg / kg PO q12H

Neonates who cannot tolerate oral dosing, use intravenous zidovudine at 75% of oral dose.

Lamivudine (3TC)


Age < 4 weeks old :
2 mg/kg PO q12H

Age ≥ 4 weeks old :
4 mg / kg (max 150 mg) PO q12H



Combivir Fixed Dose Combination
(Zidovudine 300 mg + Lamivudine 150 mg)

 
Adolescent (Weight ≥ 30 kg) :
1 tablet PO q12H



Abacavir (ABC)


Age ≥ 3 months old :
8 mg / kg (max 300 mg) PO q12H

Adolescent (Weight ≥ 25 kg) and Adult dose :
300 mg PO q12H
or
600 mg PO q24H


Not approved for infants < 3 months.

Once daily dosing: 16 mg / kg (max 600 mg) PO q24H

Trizivir Fixed Dose Combination
(Abacavir 300 mg + Zidovudine 300 mg + Lamivudine 150 mg)

 
Adolescent (Weight ≥ 40 kg) :
1 tablet PO q12H
 


Didanosine (ddI)


Age 2 week to < 3 month :
50 mg/m2 BSA PO q12H

Age ≥ 3 month to 8 month :
100 mg/mBSA PO q12H

Age > 8 month :
120 mg/m2 BSA PO q12H

3 to 21 years old:
240 mg/m2 BSA PO q24H  


Avoid combining Didanosine with Tenofovir Disoproxil Fumarate (TDF) as it enhances Didanosine toxicity.

Didanosine EC (Delayed Release)



20 kg to < 25 kg :
200 mg PO q24H

25 kg to < 60 kg :
250 mg PO q24H

≥ 60 kg :
400 mg PO q24H




Emtricitabine (FTC)

Infant < 3 month :
3 mg / kg PO q24H

Age ≥ 3 month to 17 years old :
6 mg / kg (max 240 mg oral solution) PO q24H

Weight > 33 kg (Adult ≥ 18 yr) :
200 mg capsule PO q24H

Fixed Dose Combination of Emtricitabine + Tenofovir Disoproxil Fumarate once daily available for those older patients > 17 kg BW.

Tenofovir Disoproxil Fumarate (TDF)

Age ≥ 2 years to < 12 years :
8 mg/ kg PO q24H

Age ≥ 2 years and Weight > 17 kg :
17 to < 22 kg : 150 mg PO q24H
22 to < 28 kg : 200 mg PO q24H
28 to < 35 kg : 250 mg PO q24H
≥ 35 kg : 300 mg PO q24H


Screen for HBV status;
Severe acute exacerbation of hepatitis can occur if Tenofovir Disoproxil Fumarate discontinued.

Fixed Dose Combination of Emtricitabine + Tenofovir available as Truvada.

Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)


Efavirenz

Children Age ≥ 3 years and Weight ≥ 10 kg :
10 kg to < 15 kg : 200 mg PO q24H
15 kg to < 20 kg : 250 mg PO q24H
20 kg to < 25 kg : 300 mg PO q24H
25 kg to < 32.5 kg : 350 mg PO q24H
32.5 kg to < 40 kg : 400 mg PO q24H
≥ 40 kg : 600 mg PO q24H


Not approved in neonates.

For patient age 3 months to < 3 years old, optimal dosing not generally established.

Nevirapine


Treatment dose:
>1 month to < 8 years old :
200 mg/m2 PO q12H
(max 200 mg PO q12H)

≥8 years old :
120 - 150 mg / m/ dose PO q12H
(max 200 mg PO q12H)


For prevention of vertical transmission in neonates born to HIV-infected mothers, Zidovudine in addition to Nevirapine: 

Birth weight 1.5 kg to 2 kg :
8 mg / dose PO

Birth weight > 2 kg :
12 mg/dose PO
6 weeks of Zidovudine plus three doses of Nevirapine given during the first week of life (first dose at birth –48 hours, second dose 48 hours after first dose, and third dose 96 hours after second dose)


Lead in required in both instances. Start with half (once daily) of age-related appropriate dose with immediate release for first 14 days as lead in.

If no rash or other adverse effects continue then on with twice daily.


   

HIV-infected women who have not received antepartum or intrapartum ARV drugs or have received only intrapartum ARV drugs or have received antepartum ARV drugs but do not have viral suppression near delivery.

Protease Inhibitor (PI)


Lopinavir / Ritonavir


Dose without concomitant use of Efavirenz, Nevirapine, Nelfinavir, Fosamprenavir.

Age 14 days to 12 month :
300 mg / 75 mg LPV / RV /m2 PO q12H
Approx 16 mg / 4 mg LPV / RV per kg PO q12H (under 12 months)

Age >12 months to 18 years :
300 mg / 75 mg LPV / RV per m2 PO q12H (max 400 mg /100 mg LPV/RV PO q12H)


Different dosing if concomitant use of Efavirenz, Nevirapine or Nelfinavir, Fosamprenavir (Please refer to manufacturer’s recommendations).

Darunavir


10 to 15 kg :
20 mg / kg Darunavir + 3 mg/kg Ritonavir PO q12H with food.

15 kg to < 30 kg :
375 mg Darunavir / 48 mg Ritonavir PO q12H

30 kg to <40 kg :
450 mg Darunavir / 100 mg Ritonavir PO q12H

≥40 kg :
600 mg Darunavir /100 mg Ritonavir PO q12H


Do not use in children <3 years or weight <10 kg.

Do not use without a boosting (PK enhancer) agent like Ritonavir.

INSTI Integrase Inhibitor


Raltegravir

Children 2 to <12 years :
< 25 kg : 6 mg / kg (max 300 mg) PO q12H
≥ 25 kg : 400 mg film-coated tablets PO q12H

≥12 years and Adults :
400 mg film-coated tablets PO q12H




Chewable tablets (100 mg) for children >2 years old