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indinavir, Crixivan

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GENERIC NAME: indinavir

BRAND NAME: Crixivan

DRUG CLASS AND MECHANISM: Indinavir is an oral medication that is used for treating infections with the human immunodeficiency virus (HIV). It is in a class of drugs called protease inhibitors which also includes ritonavir (Norvir), nelfinavir (Viracept) and saquinavir (Invirase, Fortovase). During infection with HIV, the HIV virus multiplies within the body's cells. Viruses are released from the cells and spread throughout the body where they infect other cells. In this manner, HIV infection is perpetuated among new cells that the body produces continually. During the production of the viruses, new proteins are made. Some of the proteins are structural proteins, that, is, proteins that form the body of the virus. Other proteins are enzymes which manufacture DNA and other components for the new viruses. Protease is the enzyme that forms the new structural proteins and enzymes. Indinavir blocks the activity of protease and results in the formation of defective viruses that are unable to infect the body's cells. As a result, the number of viruses in the body (the viral load) decreases. Nevertheless, indinavir does not prevent the transmission of HIV among individuals, and it does not cure HIV infections or AIDS. Indinavir was approved by the FDA in March, 1995.

GENERIC AVAILABLE: No

PRESCRIPTION: Yes

PREPARATIONS: Capsules: 100, 200, 333 and 400 mg

STORAGE: Store at room temperature, 20-25°C (68-77°F), in the original container and keep away from moisture. Do not discard the desiccant (drying agent) in the original bottle.

PRESCRIBED FOR: Indinavir is used for the treatment of HIV infection.

DOSING: The recommended dose for adults is 800 mg every eight hours. Food reduces the absorption of indinavir. Therefore, for optimal absorption, indinavir should be taken one hour before or two hours after a meal; however, it may administered with skim milk, juice, coffee, tea or with a light meal such as dry toast or corn flakes.

DRUG INTERACTIONS: Indinavir interacts with many drugs. Some of the important interactions are mentioned below. Viewers should consult their healthcare provider before combining any drugs with indinavir.

Indinavir increases blood concentrations of triazolam (Halcion), midazolam (Versed), stavudine (Zerit), oral contraceptives and clarithromycin (Claritin). Increased blood levels may result in more frequent side effects.

Indinavir decreases the blood concentration of didanosine (Videx) in the body and can thereby reduce the effectiveness of didanosine. Therefore, when didanosine and indinavir are both being used for treatment, their ingestion should be separated by one hour.

Indinavir also may inhibit the break-down of the cholesterol-lowering drugs lovastatin (Mevacor), simvastatin (Zocor), atorvastatin (Lipitor) and cerivastatin (Baycol). This may increase the risk of muscle breakdown (rhabdomyolysis) that may be seen when these drugs accumulate in the body.

Ketoconazole (Nizoral), itraconazole (Sporanox), delavirdine (Rescriptor) and clarithromycin (Claritin) can increase blood levels of indinavir and this could result in more frequent or severe side effects from indinavir.

Rifampin (Rifadin), rifabutin (Mycobutin), St. John's Wort and efavirenz (Sustiva) decrease the blood levels of indinavir and this can reduce the effect of indinavir.

PREGNANCY: Use of indinavir during pregnancy has not been adequately evaluated.

NURSING MOTHERS: It is not known whether indinavir is excreted in breast milk. Nevertheless, HIV-infected mothers should not breast-feed because of the potential risk of transmitting HIV to an infant that is not infected.

SIDE EFFECTS: The most common side effects of indinavir are abdominal pain, weakness, nausea, diarrhea, vomiting, headache, insomnia and abnormal taste sensation. Indinavir may cause hemolytic anemia (break-down of red blood cells), liver failure and kidney stones. Kidney stones may be prevented by adequate fluid intake. Adequate fluid intake can be achieved by consuming at least 48 ounces of fluid daily. Like other protease inhibitors, use of indinavir may be associated with redistribution or accumulation of body fat, increased blood cholesterol and worsening of diabetes.

Reference: FDA Prescribing Information

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