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nelfinavir, Viracept

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GENERIC NAME: nelfinavir

BRAND NAME: Viracept

DRUG CLASS AND MECHANISM: Nelfinavir 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 indinavir (Crixivan), amprenavir (Agenerase), ritonavir (Norvir) 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. Nelfinavir 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, nelfinavir does not prevent the transmission of HIV among individuals, and it does not cure HIV infections or AIDS. Nelfinavir was approved by the FDA in March, 1997.

GENERIC AVAILABLE: No

PRESCRIPTION: Yes

PREPARATIONS: Tablets: 250 mg; Oral powder: 50 mg/g

STORAGE: Store capsules and powder at room temperature, 15-30°C (59-86°F). The oral powder should be consumed within 6 hours after mixing it with water or other liquids.

PRESCRIBED FOR: Nelfinavir is used in combination with other anti-HIV drugs for the treatment of HIV infection.

DOSING: The recommended dose for adults is 1250 mg twice daily or 750 mg three times daily. The recommended dose for children 2-13 years of age is 20-30 mg/kg three times daily.

Nelfinavir should be administered with food or a light snack. The tablets may be crushed and dissolved in water or mixed with food. Once mixed in water or food, the mixture should be consumed within 6 hours.

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

Nelfinavir should not be used together with amiodarone (Cordarone), quinidine (Quinaglute, Cardioquin), ergot derivatives (e.g. Ergostat), triazolam (Halcion), midazolam (Versed) because serious adverse effects could occur due to increased levels of these drug in the body.

Nelfinavir also increases the concentrations in blood of rifabutin (Mycobutin) and sildenafil (Viagra). Therefore, the doses of rifabutin and sildenafil should be reduced.

Nelfinavir may increase the blood concentration of lovastatin (Mevacor), simvastatin (Zocor), atorvastatin (Lipitor) and cerivastatin (Baycol). This may result in increased occurrence of myopathy (muscle pain) or rhabdomyolysis (muscle breakdown).

St. John's wort decreases the concentration of nelfinavir in the body and this could reduce the effectiveness of nelfinavir.

Nelfinavir may decrease the effectiveness of oral contraceptives.

PREGNANCY: Nelfinavir has not been adequately evaluated in pregnant women.

NURSING MOTHERS: It is not known whether nelfinavir is secreted 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 are nausea, diarrhea, flatulence, allergic reactions and rash. Nelfinavir may also cause jaundice, metabolic disturbance, liver failure and failure of the pancreas (pancreatitis). Nelfinavir oral powder contains phenylalanine and should therefore be avoided by individuals with phenylketonuria. Like other protease inhibitors, use of nelfinavir may be associated with redistribution or accumulation of body fat, increased cholesterol and worsening of diabetes.

Reference: FDA Prescribing Information

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