When you're taking ritonavir, a protease inhibitor used to treat HIV infection by blocking viral replication. Also known as Norvir, it's often boosted with other antiretrovirals to increase their effectiveness, mouth sores can show up out of nowhere. They’re not rare—many people on long-term HIV regimens report them. These aren’t just minor annoyances; they can make eating, talking, and even swallowing painful enough to disrupt daily life and medication adherence.
What’s really going on? ritonavir, an antiretroviral drug that alters liver enzyme activity to boost other HIV medications is known to irritate the mucous membranes in the mouth. It doesn’t just cause dryness—it can trigger inflammation, ulcers, and even fungal overgrowth like oral thrush. The problem gets worse if you’re also taking other antiretrovirals, like zidovudine or tenofovir, which can compound oral toxicity. Some people develop sores because their immune system is still recovering, while others react to the drug’s alcohol-based formulation, which dries out the mouth. It’s not always the virus—it’s often the medicine trying to fight it.
If you’ve noticed red patches, white spots, or open sores inside your cheeks or on your tongue, don’t ignore them. These aren’t just cold sores. They can lead to infections, poor nutrition, and even cause you to skip doses—which risks drug resistance. Simple fixes help: sip water constantly, avoid spicy or acidic foods, use alcohol-free mouthwash, and talk to your doctor about switching to a different formulation or adding a topical treatment. Some patients find relief with magic mouthwash (a mix of antifungal, antacid, and numbing agents), while others benefit from switching to newer HIV drugs with fewer oral side effects.
The good news? You’re not alone. Thousands of people on ritonavir-based regimens deal with this. And while newer HIV treatments like dolutegravir or bictegravir are easier on the mouth, ritonavir is still widely used because it boosts other drugs so effectively. That means understanding how to manage its side effects isn’t optional—it’s essential for staying on track with your treatment. Below, you’ll find real-world insights from people who’ve been there, plus clinical details on what works, what doesn’t, and how to prevent these sores from taking over your life.
Ritonavir can cause dry mouth, thrush, and gum problems. Learn practical steps to protect your teeth and gums while taking this HIV medication, including daily habits, what to avoid, and when to see your dentist.
