Foods Delavirdine

Administer delavirdine with or without food. Patients with achlorhydria should take delavirdine with an acidic beverage (eg, orange or cranberry juice). However, the effect of an acidic beverage on the absorption of delavirdine in patients with achlorhydria has not been investigated. 

Delavirdine is a non-nucleoside reverse transcriptase inhibitor, which is dosed three times daily. No food restrictions apply. It is metabolized mainly by CYP3A, and so interactions with other drugs that use this metabolic pathway can occur. 

By inhibiting their metabolism, ritonavir potentiates the actions of other protease inhibitors. The addition of delavirdine instead of another NNRTI in three patients taking protease inhibitors plus ritonavir further increased the exposure to the protease inhibitors (6). Combining delavirdine with indinavir removes the food restrictions during indinavir administration (4). The superior virological response observed in antiretroviral regimens containing delavirdine and protease inhibitors has been attributed in part to the pharmacokinetic interaction. 

Absorption, Distribution, and Elimination These drugs are administered oraUy and rapidly absorbed. Food generally does not affect their absorption. They are metabolized primarily by hepatic CYPs 3A4 or 2B6. Thus, they are subject to multiple interactions with other drugs that are either substrates or inducers of these enzymes. Efavirenz and nevirapine are moderately potent inducers of CYP3A4, whereas delavirdine is an inhibitor. 

Food has no clinically relevant effect on the levels of delavirdine or nevirapine. Food modestly increases efavirenz levels, and the manufacturer su ests that this might increase the frequency of adverse effects. 

Morse GD, Fischl MA, Cox SR, Thompsixi L, Della-Coletta AA, Freimuth WW. Effect of food on the steady-state (SS) phannacokinetics of delavirdine mesylate (DLV) in HIV+ patients. Intersci ConfAntimicr Agents Chemother 99S) 35,210. 

Cox SR, Della-Coletta AA, Turner SW, Freimuth WW. Single-dose pharmacddnedc (P studies with delavirdine (DLV) mesylate dose ixqx>rtionality and effects of food and antacid. Intersci ConfAntimicrob Agents Chemother( 994) 34,82. 

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