Protease Inhibitors (PI Drug Class)

  • Pharmacy Author:
    Omudhome Ogbru, PharmD

    Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.

  • Medical and Pharmacy Editor: Charles Patrick Davis, MD, PhD
    Charles Patrick Davis, MD, PhD

    Charles Patrick Davis, MD, PhD

    Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

What are protease inhibitors (PIs), and how do they work?

Protease inhibitors (PIs) are antiviral drugs used for treating human immunodeficiency virus (HIV) infections and hepatitis C virus (HCV) infections.

During infection with HIV or hepatitis C, the HIV or HCV multiply 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 and hepatitis C 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 form the body of the virus. Other proteins are enzymes that manufacture DNA and other components for the new viruses. Protease is an enzyme that is used in the formation of new structural proteins and enzymes. Protease inhibitors block the activity of protease (cleavage of protein precursors needed for viral structure synthesis) and this results in the formation of defective viruses that are unable to infect the body's cells. As a result, the number of HIV or hepatitis C viruses in the body (the viral load) decreases.

List of 16 examples of brand and generic names available for protease inhibitors (PIs) in the US

HIV protease inhibitors

Hepatitis C virus (HCV) protease inhibitors

Quick GuideHepatitis C (Hep C) Symptoms and Treatment

Hepatitis C (Hep C) Symptoms and Treatment

What are the uses for protease inhibitors (PIs)?

  • Protease inhibitors are used to treat HIV or hepatitis C virus infections. HIV protease inhibitors do not prevent the transmission of HIV among individuals, and they do not cure HIV infection or AIDS. However, HIV protease inhibitors can reduce the viral load to very low levels and reduce the risk of opportunistic infections. The discovery of HIV protease inhibitors revolutionized the management of HIV infection and the course of the disease.
  • Hepatitis C virus protease inhibitors can cure hepatitis C infection, and are more effective than other hepatitis C treatments.
  • The FDA approved the first hepatitis C virus protease inhibitor in 2011.

What are the side effects of HIV protease inhibitors (PIs)?

Common side effects of HIV protease inhibitors:

Serious side effects of HIV protease inhibitors include:

What are the side effects of hepatitis C virus (HCV) protease inhibitors?

Common side effects of hepatitis C virus protease inhibitors:

Serious side effects of hepatitis C virus protease inhibitors include:

  • Liver failure
  • Sun sensitivity
  • Severe skin reactions
  • Reactivation of HBV infection (hepatitis B virus)

What drug interactions occur with protease inhibitors (PIs)?

Protease inhibitors have many drug interactions because they affect the action of liver enzymes that alter many drugs and because several other drugs affect the breakdown of protease inhibitors in the liver. Here are some examples of protease inhibitor drug interactions.

Protease inhibitor drugs may increase blood levels of the following drugs:

These drugs may increase blood levels of protease inhibitors:

The following drugs reduce blood levels of protease inhibitors:

Are protease inhibitors (PIs) safe to use during pregnancy or while breastfeeding?

  • Lopinavir/ritonavir and indinavir/ritonavir combinations are used for the treatment of HIV-infected pregnant women. Other HIV protease inhibitor regimens have not been adequately studied in pregnant women, may not be effective, or may have unacceptable toxicity.
  • Hepatitis C virus protease inhibitors have not been adequately evaluated in pregnant women or nursing mothers.
  • The patient's OB/GYN doctor should be consulted before protease inhibitors are used in a pregnant or nursing woman. Guidelines are available for the use of protease inhibitors in pregnant women, neonates, and children (see references).

What forms and preparations of protease inhibitors (PIs) are available?

  • Protease inhibitors are supplied as capsules, tablets, oral suspension or solution, and powder for suspension.

REFERENCES:

AIDSinfo.gov. "Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States." Updated: Oct 26, 2016.
<https://aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/0gt;

FDA Prescribing Information

Summary

Protease Inhibitors (PIs) are a class of antiviral drugs prescribed to treat HIV and hepatitis (HCV) viral infections. There are several protease inhibitors that treat HIV infection, for example:

Examples of hepatitis C virus protease inhibitors include:

  • Olysio (simeprevir)
  • Technivie (ombitasvir/paritaprevir and ritonavir, a combination of these three drugs)
  • Viekira Pak (ombitasvir/paritaprevir/ritonavir and dasabuvir, a combination of these four drugs)

Drug interactions, dosage, preparations, and pregnancy and breastfeeding safety should be reviewed prior to taking these drugs.

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Reviewed on 1/5/2017
References
REFERENCES:

AIDSinfo.gov. "Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States." Updated: Oct 26, 2016.
<https://aidsinfo.nih.gov/guidelines/html/3/perinatal-guidelines/0gt;

FDA Prescribing Information

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