Indinavir dosing

Decrease indinavir dose to 600 mg b.i.d., when coadministered with KALETRA 400/100mg b.i.d. (see Clinical Pharmacology . Table 3A) Sildenafil Use with caution at reduced doses of 25 mg every 48 hours with increased monitoring for adverse events... 

INDINAVIR RITONAVIR t efficacy and t adverse effects of indinavir. Risk of nephrolithiasis if the dose of indinavir exceeds 800 mg twice a day Inhibition of CYP3A4-mediated metabolism of indinavir Dose of indinavir can be i from 800 mg three times a day to 600 mg twice daily. Adequate hydration and monitoring are essential. Adults must drink at least 1500 mL/24 hours... 

Indinavir raises rifabutin concentrations and increases rifabntin toxicity the rifabutin daily dose, therefore, should be reduced by 50%. Drugs that induce CYP3A4 may lower indinavir concentrations and should be avoided. Rifampin lowers the indinavir AUC by 90% and is contraindicated efavirenz, nevirapine, and rifabutin lower indinavir levels less snbstantially (by 25% to 35%) and may necessitate an increased indinavir dose. 

The information about the interactions of protease inhibitors with itraconazole is limited. On the basis of the available data, it is possible that itraconazole has greater effects than ketoconazole , (below), on protease inhibitor levels. The manufacturers of indinavir advise modestly reducing the indinavir dose to 600 mg every 8 hours if it is to be given with itraconazole. The UK manufacturer of saquinavir recommends monitoring for saquinavir toxicity if itraconazole is used. Some protease inhibitors, especially ritonavir and possibly indinavir, may increase itraconazole levels and most manufacturers say that doses of itraconazole greater than 200 mg a day are not recommended. The US manufacturers of amprenavir recommend increased monitoring for adverse effects and state that the dose of itraconazole may need to be reduced if it is greater than 400 mg daily. ... 

Indinavir Rifabutin dose halved (150 mg daily or 300 mg three times per week). Indinavir dose increased (1 to 1.2 g every 8 hours). Not recommended (indinavir levels markedly reduced, rifampicin levels raised). 3,6-8... 

In a single-drug pharmacokinetic study, 8 healthy subjects were given three 800-mg doses of indinavir on day 1 of to achieve steady-state serum levels, and then an 800-mg dose on day 2. For the next 14 days they were given St John s wort extract 300 mg three times daily. Starting on day 16, the indinavir dosing was repeated. It was found that the St John s wort reduced the mean AUC of indinavir by 54% and decreased the 8-hour indinavir trough serum level by 81%. ... 

Sildenafil doses should be decreased when any potent cytochrome P450 3A4 inhibitor is used (e g., cimetidine, erythromycin, clarithromycin, ketoconazole, itraconazole, ritonavir, and saquinavir). Vardenafil doses vary accordingto which agent is used (2.5 mg q 72 h for ritonavir, 2.5 mg q 24 h for indinavir, ketoconazole 400 mg daily, and itraconazole 400 mg daily and 5 mg q 24 h for ketoconazole 200 mg daily, itraconazole200 mg daily, and erythromycin). Tadalafil doses are reduced only when it is used with the most potent cytochrome P450 3A4 inhibitors (e g., ketoconazole or ritonavir). 

Concomitant mecf/caf/ons - The dosage of vardenafil may require adjustment in patients receiving certain CYP3A4 inhibitors. For ritonavir, do not exceed a single dose of 2.5 mg vardenafil in a 72-hour period. For indinavir, ketoconazole 400 mg/day, and itraconazole 400 mg/day, do not exceed a single dose of 2.5 mg vardenafil in a 24-hour period. For ketoconazole 200 mg/day, itraconazole 200 mg/day, and erythromycin, do not exceed a single dose of 5 mg vardenafil in a 24-hour period. 

Delavirdine Consider dose reduction of indinavir to 600 mg every 8 hours when administering delavirdine 400 mg 3 times/day. 

Rifabutin Dose reduction of rifabutin to half the standard dose and a dose increase of indinavir to 1000 mg (three 333 mg capsules) every 8 hours are recommended when rifabutin and indinavir are coadministered. 

Metabolism - Following a 400 mg dose of C-indinavir, 83% and 19% of the total radioactivity was recovered in feces and urine, respectively radioactivity caused by parent drug in feces and urine was 19.1% and 9.4%, respectively. Seven metabolites have been identified 1 glucuronide conjugate and 6 oxidative metabolites. In vitro studies indicate that cytochrome P450 3A4 (CYP3A4) is the major enzyme responsible for formation of the oxidative metabolites. 

Budesonide, Oral (Entocort EC) [Anti-inflammatory> Corticosteroid] Uses Mild-mod Crohn Dz Action Steroid, anti-inflammatory Dose Adults. Initial, 9 mg PO qAM to 8 wk max maint 6 mg PO qAM taper by 3 mo avoid grapefruit juice Contra Active TB and fungal Infxn Caution [C, /-] DM, glaucoma, cataracts, HTN, CHF Disp Caps SE HA, cough, hoarseness, Candida Infxn, epistaxis Interactions T Effects W/ erythromycin, indinavir, itraconazole, ketoconazole, ritonavir, grapefruit EMS Monitor ECG and BP for signs of electrolyte disturbances and hypovolemia OD Acute OD unlikely to cause a problem, chronic OD can reduce natural production of certain steroids symptomatic and supportive... 

Deravirdine (Rescnptor) [Antiretroviral/NNRTI] Uses HIV Infxn Action Nonnucleoside RT inhibitor Dose 400 mg PO tid Caution [C, ] CDC recommends HIV-infected mothers not to breast-feed (transmission risk) w/ renal/hepatic impair Contra Use w/ drugs dependent on CYP3A for clearance (Table VI-8) Disp Tabs SE Fat redistribution, immune reconstitution synd, HA, fatigue, rash, T transaminases, N/V/D Interactions T Effects W/ fluoxetine T effects OF benzodiazepines, cisapride, clarithromycin, dapsone, ergotamine, indinavir, lovastatin, midazolam, nifedipine, quinidine, ritonavir, simvastatin, terfena-dine, triazolam, warfarin effects W/ antacids, barbiturates, carbamazepine, cimetidine, famotidine, lansoprazole, nizatidine, phenobarbital, phenytoin, ranitidine, rifabutin, rifampin effects OF didanosine EMS Use of benzodiazepines and CCBs should be avoided may cause a widespread rash located on upper body and arms OD May cause an extension of nl SEs symptomatic and supportive Deferasirox (Exjade) [Iron Chelator] Uses Chronic iron overload d/t transfusion in pts >2 y Action Oral iron chelator Dose Initial 20 mg/kg... 

Efavirenz (Sustiva) [Antiretroviral/NNRTI] Uses Hiv infxns Action Antiretroviral nonnucleoside RTI Dose Adults. 600 mg/d PO qhs Feds. See package insert avoid high-fat meals Caution [D, ] CDC recommends HIV-infected mothers not breast-feed Contra Component sensitivity Disp Caps SE Somnolence, vivid dreams, dizziness, rash, N/V/D Interactions T Effects W/ ritonavir T effects OF CNS depressants, ergot derivatives, midazolam, ritonavir, simvastatin, triazolam, warfarin X effects W/ carbamazepine, phenobarbital, rifabutin, rifampin, saquinavir, St. John s wort i effects OF amprenavir, carbamazepine, clarithromycin, indinavir, phenobarbital, saquinavir, warfarin may alter effectiveness OF OCPs EMS Concurrent EtOH usage can t CNS d ression OD May cause muscle contractions and adverse CNS effects activated charcoal may be effective... 

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