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Pharmacologic class: Protease inhibitor
Therapeutic class: Antiretroviral
Pregnancy risk category C
Inhibits replication, function, and maturation of human immunodeficiency virus (HIV) protease, an enzyme essential to formation of infectious virus. As a result, further spread of virus is prevented.
Capsules: 100 mg, 200 mg, 333 mg, 400 mg
Indications and dosages
➣ HIV infection
Adults: 800 mg P.O. q 8 hours
• Mild to moderate hepatic insufficiency secondary to cirrhosis
• Hypersensitivity to drug or its components
• Concurrent use of amiodarone, ergot derivatives, cisapride, pimozide, or oral midazolam, triazolam, alprazolam, alfuzosin, sildenafil
Use cautiously in:
• renal or severe hepatic impairment, history of renal calculi
• pregnant or breastfeeding patients
• Know that drug is usually given with other antiretrovirals.
• Give with full glass of water on empty stomach 1 hour before or 2 hours after meals.
• If GI upset occurs, give with a light meal.
☞ Don't give concurrently with alfuzosin, amiodarone, sildenafil, cisapride (not available in U.S.), ergot derivatives, midazolam, pimozide, or triazolam.
CNS: depression, dizziness, headache, drowsiness, malaise, asthenia
CV: angina, myocardial infarction
EENT: oral paresthesia
GI: nausea, vomiting, diarrhea, abdominal pain or distention, dyspepsia, acid regurgitation, pancreatitis
GU: dysuria, crystalluria, nephrolithiasis or urolithiasis leading to renal insufficiency or failure, interstitial nephritis
Hematologic: anemia, acute hemolytic anemia, increased spontaneous bleeding (in hemophiliacs)
Hepatic: jaundice, hepatic dysfunction, hepatic failure
Metabolic: new onset or exacerbation of diabetes mellitus, hyperglycemia
Musculoskeletal: joint or back pain
Respiratory: cough, dyspnea
Skin: urticaria, rash, pruritus
Other: abnormal taste, increased or decreased appetite, body fat redistribution or accumulation, fever, anaphylactoid reactions
Drug-drug. Azole antifungals, delavirdine, interleukins: elevated indinavir blood level, greater risk of toxicity
Cisapride, ergot derivatives, midazolam, pimozide, triazolam: CYP3A4 inhibition by indinavir, leading to increased blood levels of these drugs and dangerous reactions
Didanosine, efavirenz, rifamycins: decreased indinavir effects
Drug-diagnostic tests. Alanine aminotransferase, amylase, aspartate aminotransferase, bilirubin, cholesterol, glucose, triglycerides: increased values
Hemoglobin, neutrophils, platelets: decreased values
Drug-food. Any food: decreased indinavir absorption
Drug-herbs. St. John's wort: decreased indinavir blood level
• Assess fluid intake and output to ensure adequate hydration and help prevent nephrolithiasis or urolithiasis.
• Monitor for adverse GI and CNS effects.
• Evaluate liver function test results. Assess for hyperbilirubinemia.
• Monitor cholesterol, glucose, and CBC with white cell differential.
• Tell patient to take 1 hour before or 2 hours after meals with a full glass of water.
• If GI upset occurs, advise patient to take with a light meal.
☞ Instruct patient to report severe nausea or diarrhea, fever, chills, flank pain, urine or stool color changes, yellowing of skin or eyes, or personality changes.
• Tell patient that drug doesn't cure HIV infection and that its long-term effects are largely unknown.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, foods, and herbs mentioned above.