POZ IRELAND
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POZ IRELAND
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INDINAVIR Crixivan® (MSD) Approved for use in HIV infection in combination with other antiviral drugs. DESCRIPTION: Indinavir is a protease inhibitor. DOSE: Adults / adolescents: 800 mg every eight hours in a fasted state (one hour before or two hours after meals) or with a light snack with no or very little fat content. Paediatric: 500 mg/m2 is under investigation. Neonates: Not determined. Possibly contraindicated in neonates due to hyperbilirubinaemia. Twice-daily dosing is not recommended due to more frequent virologic failures. SIDE EFFECTS: Kidney stones (Nephrolithiasis), pain on urination (dysuria) and back and flank pain. To prevent kidney stones indinavir should be taken with at least 1.5 –2 litres of fluid daily. Haemolytic anaemia has been reported but is rare. Metabolic abnormalities, redistribution of body fat and diabetes have been associated with regimens containing protease inhibitors. Lipid abnormalities, especially elevated triglyceride and cholesterol levels, are common with indinavir use. RESISTANCE: There is possibly cross resistance between currently available PIs. Resistance is less likely to occur in people who take indinavir in combination with other antiretroviral drugs that they have not previously taken, particularly if the viral load is low. INTERACTIONS: Astemizole, Cisapride, Midazolam, Rifampicin, Terfenadine, Triazolam: should be avoided with indinavir. Didanosine: The buffering agent in ddI interferes with the absorption of indinavir. The two drugs should be taken at least one hour apart. Ketoconazole: Ketoconazole inhibits the metabolism of indinavir. The manufacturer suggests that the indinavir dose be reduced to 600 mg three times daily when taken with ketoconazole. Rifabutin: Indinavir inhibits the metabolism of rifabutin, requiring a 50% reduction in the dose of rifabutin. Viagra (Sildenafil): Indinavir may increase levels of sildenafil. Sildenafil dose reductions are suggested. St. John's Wort: The herbal St. John's wort was reported to reduce indinavir levels in a study of eight HIV-negative subjects. Statins: Statin use may increase statin levels and cause myopathy. Prevastatin may have the least interaction with the PIs. |
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