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Recommendations on How Physicians Should Address the Taste of Liquid Ritonavir by Charles Farthing, MD, Medical Director, AIDS Healthcare Foundation, Los Angeles

I have been somewhat amazed and dismayed at the response of some physicians to the issue of ritonavir solution having to be used in place of ritonavir capsules. It seems some physicians are making more of a fuss about the taste than is necessary–or wise. Clearly, if patients are well suppressed virologically on ritonavir, or ritonavir/saquinavir plus other antiretrovirals, they should maintain their current treatment if at all possible. We as physicians should be reassuring and supportive of this and not alarmist.

For the last few days at my clinic at the AIDS Healthcare Foundation at Los Angeles, I have had a bottle of ritonavir on my desk and have been getting patients on ritonavir capsules to try it. Nine out of ten have said it is okay and they will not mind taking it–the one exception was a previous user of the solution in the early studies with ritonavir.

It may be a problem, but let’s not get hysterical. If we tell our patients its intolerable, they will probably agree with us. Just as when we are taking a clinical history, we should not ask leading questions–neither should we direct patient thinking by telling them something will be bad.

I have also been concerned how other pharmaceutical companies seem to be approaching doctors with information or requests on "What to switch to." Switching antivirals in controlled patients is surely unwise. And designing algorithms as to what to switch to is also unwise as that will be so individual depending on a patient’s previous drug experience/resistance. My advice is "cool it!"

Posted 9/2/98

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