Drug | Available formulation | Gestational age at birth | Dosing | |
Zidovudine (ZDV)* | Oral syrup (10 mg/mL) | ≥35 weeks |
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Weight band (kg) | Dose (volume) of ZDV 10 mg/mL oral syrup | |||
2 to <3 kg | 10 mg (1 mL) orally twice daily | |||
3 to <4 kg | 15 mg (1.5 mL) orally twice daily | |||
4 to <5 kg | 20 mg (2 mL) orally twice daily | |||
≥30 to <35 weeks |
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<30 weeks |
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Lamivudine (3TC) | Oral solution (10 mg/mL) | ≥32 weeks |
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Nevirapine (NVP)¶ | Oral suspension (10 mg/mL) | ≥37 weeks |
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≥34 to <37 weeks |
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≥32 to <34 weeksΔ |
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Raltegravir (RAL)◊§ | 100 mg single-use packet (sachet) reconstituted to 10 mg/mL oral suspension | ≥37 weeks and weighing ≥2 kg | Body weight (kg) | Dose (volume) of RAL 10 mg/mL suspension |
Birth to 1 week: Once-daily dosing, approximately 1.5 mg/kg/dose | ||||
2 to <3 kg | 4 mg (0.4 mL) orally once daily | |||
3 to <4 kg | 5 mg (0.5 mL) orally once daily | |||
4 to <5 kg | 7 mg (0.7 mL) orally once daily | |||
1 to 4 weeks: Twice-daily dosing, approximately 3 mg/kg/dose | ||||
2 to <3 kg | 8 mg (0.8 mL) orally twice daily | |||
3 to <4 kg | 10 mg (1 mL) orally twice daily | |||
4 to <5 kg | 15 mg (1.5 mL) orally twice daily | |||
4 to 6 weeks: Twice-daily dosing, approximately 6 mg/kg/dose | ||||
3 to <4 kg | 25 mg (2.5 mL) orally twice daily | |||
4 to <6 kg | 30 mg (3 mL) orally twice daily | |||
6 to <8 kg | 40 mg (4 mL) orally twice daily |
ARV: antiretroviral; HIV: human immunodeficiency virus; IV: intravenous.
* For newborns who are unable to tolerate oral agents, the IV dose of ZDV is 75% of the oral dose listed above while maintaining the same dosing interval.
¶ Nevirapine should not be used if there is concern for nevirapine resistance in the mother or exposure to HIV-2 infection.
Δ These doses may underestimate potential toxicity in infants in this age group as the doses are based on modeling and lower doses were used to develop the model than what is now recommended.
◊ If the mother has taken an integrase inhibitor (raltegravir, dolutegravir, or bictegravir) 2 to 24 hours prior to delivery, the neonate's first dose of RAL should be delayed until 24 to 48 hours after birth; ZDV and 3TC, however, should be started as soon as possible after birth. RAL dosing is increased at 1 and 4 weeks of age because metabolism by UGT1A1 is low at birth and increases rapidly during the next 4 to 6 weeks of life. If the two dose changes in the first month of life seem challenging for a family, an alternative is to increase to the 3 mg/kg twice daily dose upon discharge on day 4 or 5 of life.
§ No dosing information for RAL is available for preterm or infants weighing <2 kg at birth.