enfuvirtide

en·fu·vir·tide (n-fyvîr-td)

n.

An antiretroviral drug of the fusion inhibitor class used to treat HIV infection.

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enfuvirtide

Fuzeon

Pharmacologic class: Human immunodeficiency-1 (HIV-1) fusion inhibitor

Therapeutic class: Antiretroviral

Pregnancy risk category B

Action

Interferes with entry of HIV-1 into cells by inhibiting fusion of viral and cellular membranes

Availability

Powder for injection: 90 mg/1-ml vial

⊘Indications and dosages

➣ HIV-1 infection

Adults: 90 mg subcutaneously b.i.d. in upper arm, anterior thigh, or abdomen

Children ages 6 to 16: 2 mg/kg subcutaneously b.i.d. in upper arm, anterior thigh, or abdomen. Maximum dosage is 90 mg b.i.d.

Contraindications

• Hypersensitivity to drug or its components

Precautions

Use cautiously in:
• increased risk of pneumonia
• injection site reaction
• elderly patients
• children younger than age 6 (safety and efficacy not established).

Administration

• Rotate injection sites.
• Be aware that preferred injection sites are upper arm, anterior thigh, and abdomen.
• Reconstitute with 1.1 ml of sterile water for injection, and gently tap vial for 10 seconds. Then gently roll vial between hands or allow vial to stand until product dissolves completely (could take up to 45 minutes).
• Know that drug is usually given with other antiretrovirals.
• Use reconstituted solution immediately.

Route	Onset	Peak	Duration
Subcut.	Unknown	4 hr	Unknown

Adverse reactions

CNS: fatigue, asthenia, insomnia, depression, anxiety, peripheral neuropathy

EENT: conjunctivitis, sinusitis

GI: nausea, diarrhea, upper abdominal pain, dry mouth, anorexia, pancreatitis

Hematologic: lymphadenopathy

Musculoskeletal: limb pain, myalgia

Respiratory: cough, pneumonia

Skin: folliculitis

Other: taste disturbance, decreased appetite, weight loss, herpes simplex infection, injection site reactions (erythema, induration, nodules, cysts, mild to moderate pain, infection), flulike illness, hypersensitivity reactions

Interactions

Drug-diagnostic tests. Alanine aminotransferase, amylase, aspartate aminotransferase, creatine kinase, eosinophils, gamma-glutamyltransferase, lipase, triglycerides: increased levels

Hemoglobin: decreased level

Patient monitoring

• Inspect injection sites frequently for adverse reactions.
• Monitor CBC with white cell differential, lipid panel, liver function test results, and gastric enzymes levels.
• Watch for hypersensitivity reactions.
• Monitor nutritional and hydration status in light of GI adverse effects and underlying disease.

Patient teaching

• Teach patient (or caregiver) how to reconstitute and self-administer drug, as appropriate.
☞ Instruct patient not to change dosage or stop taking drug unless prescriber approves.
☞ Tell patient to immediately report signs or symptoms of hypersensitivity reaction (such as rash, fever, nausea and vomiting, and chills).
• Teach patient how to recognize signs and symptoms of injection site reaction. Tell him to contact prescriber if these occur, especially if they last more than 7 days.
• Advise female patient to notify prescriber if she is pregnant or plans to become pregnant.
• Tell HIV-infected patient not to breastfeed.
• If patient misses a dose, instruct him to take it as soon as he remembers. However, if it's almost time for next dose, tell him to skip the missed dose and take next dose on schedule.
• As appropriate, review all other significant adverse reactions and interactions, especially those related to the tests mentioned above.