Didanosine adverse effects

The adverse effects with which stavudine is most frequently associated are headache, diarrhea, skin rash, nausea, vomiting, insomnia, anorexia, myalgia, and weakness. Peripheral neuropathy consisting of numbness, tingling, or pain in the hands or feet is also common with higher doses of the drug. Significant elevation of hepatic enzymes may be seen in approximately 10 to 15% of patients. Lactic acidosis occurs more frequently with stavudine than with other NRTIs. Viral resistance to stavudine may develop, and cross-resistance to zidovudine and didanosine may occur. 

The most common adverse effect produced by didanosine is diarrhea. Abdominal pain, nausea, vomiting, anorexia, and dose-related peripheral neuropathy may occur. Pancreatitis occurs rarely, as do hyperuricemia, bone marrow suppression, retinal depigmentation, and optical neuritis. Resistance to didanosine appears to result from mutations different from those responsible for zidovudine resistance. 

Lamivudine is the best-tolerated NRTI. Its most common adverse effects include headache, malaise, fatigue, and insomnia. Pancreatitis is rare. Gastrointestinal complaints are common with lamivudine-zidovudine therapy but are probably mainly due to the zidovudine component. Lamivudine resistance sometimes occurs early in treatment. Cross-resistance to zal-citabine, didanosine, and abacavir can occur simultaneously. Withdrawal of lamivudine in patients infected with both hepatitis B virus and HIV can cause a flare-up of hepatitis symptoms. 

T effects OF amiodarone, astemizole, atorvastadn, barbiturates, bepridil, bupropion, cerivastatin, cisapride, clorazepate, clozapine, clarithromycin, desipramine, diazepam, encainide, ergot alkaloids, estazolam, flecainide, flurazepam, indinavir, ketoconazole, lovastatin, meperidine, midazolam, nelfinavir, phenytoin, pimozide, piroxicam, propafenone, propoxyphene, quinidine, rifabutin, saquinavir, sildenafil, simvastatin, SSRIs, TCAs, terfenadine, triazolam, troleandomycin, zolpidem X effects W/ barbiturates, carbamazepine, phenytoin, rifabutin, rifampin, St. John s wort, tobacco X effects OF didanosine, hypnotics, methadone, OCPs, sedatives, theophylline, warfarin EMS T Effects of amiodarone, diazepam, midazolam and BBs, may need X- doses concurrent use of Viagra-type drugs can lead to hypotension X- effects of warfarin concurrent EtOH use can T adverse effects T glucose ODs May cause an extension of adverse SEs symptomatic and supportive Rivasrigmine (Exelon) [Cholinesterase Inhibitor/Anri ... 

The major dose-limiting toxicides of didanosine include peripheral neuropathy and pancreatitis. The neuropathy is typically symmetrical distal sensory neuropathy, which is reversible, and typically causes paresthesias, numbness and pain in lower extremities. Didanosine also causes retinal changes and optic neuritis. Other adverse effects include diarrhea, skin rash, headache, insomnia, seizures, hepatic toxicity, elevated hepatic transaminases and asymptomatic hyperuricemia. 

Adverse effects Pancreatitis, which may be fatal, is a major toxicity of ddl treatment, and requires monitoring of serum amylase. The dose-limiting toxicity of didanosine is peripheral neuropathy. [Note The buffering of stomach contents may interfere in the absorption of other drugs that require an acidic milieu for absorption, such as ketoconazole.]... 

PHENYTOIN NUCLEOSIDE REVERSE TRANSCRIPASE INHIBITORS - DIDANOSINE, STAVUDINE, ZIDOVUDINE Possibly t adverse effects (e.g. peripheral neuropathy) with didanosine, stavudine and zidovudine Additive effect Monitor closely for peripheral neuropathy during prolonged combination... 

HYDROXYCARBAMIDE ANTIVIRALS -DIDANOSINE, ZIDOVUDINE t adverse effects with didanosine and possibly zidovudine Additive effects, enhanced antiretroviral activity via 1 intracellular deoxynudeotides Avoid co-administration... 

ISONIAZID ANTIVIRALS-NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS t adverse effects with didanosine and possibly stavudine Additive side-effects Monitor closely for the development of peripheral neuropathy, but no dose adjustment is required... 

PENTAMIDINE ISETIONATE NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS t adverse effects with didanosine, tenofbvir and zidovudine Additive toxicity Monitor FBC and renal function closely. Consider stopping didanosine while pentamidine is required for Pneumocystis jiroveci pneumonia... 

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS GANCICLOVIRAfALGANCIC LOVIR 1. T adverse effects with tenofovir, zidovudine and possibly didanosine, lamivudine and zalcitabine 2. Possibly 1 efficacy of ganciclovir 1. Uncertain possibly additive toxicity. Lamivudine may compete for active tubular secretion in the kidneys 2. Uncertain L bioavailability 1. Avoid if possible otherwise monitor FBC and renal function weekly. It has been suggested that the dose of zidovudine should be halved from 600 mg to 300 mg daily. Monitor for peripheral neuropathy, particularly with zalcitabine 2. Uncertain clinical significance if in doubt, consider alternative cytomegalovirus prophylaxis... 

DIDANOSINE STAVUDINE t adverse effects, including pancreatitis and neuropathy Additive effect Monitor more closely, especially for pancreatitis and peripheral neuropathy. Relative risk of neuropathy stavudine alone 1.39 compared with didanosine combined use 3.5. Sometimes fatal lactic acidosis is reported in pregnancy... 

DIDANOSINE TENOFOVIR Possibly t adverse effects, including pancreatitis, lactic acidosis and neuropathy t plasma levels of didanosine additive effects Co-administration not recommended. Monitor closely for antiviral efficacy and side-effects (pancreatitis, neuropathy, lactic acidosis, renal failure). Not recommended in patients with a high viral load and low CD4 count (enteric-coated and buffered tablets), i dose of didanosine to 250 mg has been tried. Do not use in combination as triple therapy with lamivudine as there is a high level of treatment failure... 

DIDANOSINE ZIDOVUDINE Possibly t adverse effects Uncertain Monitor more closely, especially for haematological toxicity... 

Adverse effects are most commonly manifest as acute pancreatitis. The strongest association is with alcohol abuse. High plasma calcium, including that caused by hypervitaminosis D, and parenteral nutrition also increase the risk. Corticosteroids, didanosine, azathoipurine, diuretics (including thiazides and frusemide), sodium valproate, mesalazine and paracetamol (in overdose) have also been causally related. 

Adverse effects Didanosine Lamivudine Stavudine Zalcitabine Zidovudine... 

Cardiomyopathy is a rare adverse effect that has been observed in patients treated with didanosine, zidovudine, and zalcitabine (12). In a retrospective, case-control study, cardiomyopathy was 8.4 (95% Cl = 1.7, 42) times more likely to develop in children who had previously used zidovudine than in children who had never been exposed to it (13). 

Several large-scale studies of the efficacy of combined antiretroviral treatment with zalcitabine and zidovudine in HIV-infected patients (compared with zidovudine monotherapy or a combination of zidovudine and didanosine) have not shown unexpected adverse effects (6-9). The most common adverse effects in patients taking zalcitabine were peripheral neuropathy and aphthous mouth ulcers. 

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