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The Protease Inhibitors (PIs) |
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Detailed Prescribing Information |
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October 2005 |
| Indinavir = Crixivan | |
| Dosing Forms | 100, 200, 333, 400 mg capsules |
| Dosing |
2x400 mg every 8 hours on an empty
stomach Boosted dose: 2x400 mg twice a day plus ritonavir 1-2x100 mg twice a day, both with or without food Increase to 1,000 mg every 8 hours, when taken with nevirapine, efavirenz, rifabutin [unboosted dosing] Stagger dosing of indinavir after wafer form
dosing of didanosine by a minimum of 1 hour. |
| Hepatic insufficiency: reduce dose to 600 mg every 8 hours for mild to moderate cirrhosis [no data for severe cirrhosis] | |
| Nephrolithiasis: temporary cessation or discontinuation may be necessary | |
| Food Dependence | Indinavir should be taken on an empty stomach (either 1 hour before food or 2 hours after food) except when co-administered with ritonavir |
| Adverse Effects |
5-10% incidence of kidney stones. This may be prevented effectively by drinking 48-64 oz water or other nonalcoholic fluid per day! Asymptomatic hyperbilirubinemia is extremely common. No intervention is required.
Chapped lips, ingrown toenails, and hair loss
are occasionally seen. |
| Interactions |
Effects of indinavir on other drugs Increases trazodone levels: consider dose decrease of trazodone. Levels of all erectile dysfunction drugs are increased: the lowest dose of these drugs must be used as a maximum and at intervals not be be decreased beyond every 48-72 hours. |
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Effects of other drugs on indinavir Nevirapine, efavirenz, rifabutin lowers indinavir levels (dose adjustment above.) Itraconazole, ketoconazole, delavirdine
increase indinavir levels |
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| Unknown interactions: phenytoin, carbamazepine, dexamethasone | |
| Suggested laboratory evaluations |
Liver profile and glucose monthly x 3
months, then every 3-4 months Lipid profile every 3-4 months |
| Contraindications |
Indinavir should not be used with atazanavir due
to possible severe hyperbilirubinemia. Rifampin should not be administered with indinavir |
| Warnings |
The incidence of nephrolithiasis may be
increased by boosting indinavir with low doses of ritonavir. Past history of kidney stones = relative contraindication. Avoid concomitant use of phenytoin, carbamazepine, dexamethasone |
| Full Prescribing Information | http://www.crixivan.com |
| Links to Antiretroviral Sections (click on anything) |
| Nucleoside & Nucleotide Reverse Transcriptase Inhibitors (NRTI) |
| AZT | ddC | ddI | d4T | 3TC | ABC | FTC | TDF | Combivir | Trizivir | Epzicom | Truvada |
| Nonnucleoside Reverse Transcriptase Inhibitors (NNRTI) |
| efavirenz | nevirapine | delavirdine |
| Protease Inhibitors (PI) | Boosted Protease Inhibitors |
| saquinavir | indinavir | ritonavir | nelfinavir | amprenavir | lopinavir + ritonavir | atazanavir | fosamprenavir | tipranavir |
| Fusion Inhibitors |
| enfuvirtide |
10.25.2005
