Nephrolithiasis indinavir

Indinavir (IDV) 200-, 333-, 800 mg q8hours Mild to moderate hepatic For unboosted IDV Nephrolithiasis Gl intolerance, CYP3A4 inhibitor... 

Prostatic hypertrophy, infection, cancer Improperly placed bladder catheter Anticholinergic medication Cancer with abdominal mass Retroperitoneal fibrosis Nephrolithiasis Nephrolithiasis Oxalate Indinavir Sulfonamides Acyclovir Uric acid... 

Nephrolithiasis/Urolithiasis Nephrolithiasis/Urolithiasis has occurred with indinavir. The frequency of nephrolithiasis is substantially higher in pediatric patients (29%) than in adult patients (9.3%). 

Indinavir is associated with a dose-related risk of nephrolithiasis the risk is thereby increased by drug interactions that result in increased plasma concentrations. 

Indinavir (Crixivan) is a potent inhibitor of HIV reverse transcriptase. It produces the side effects common to aU protease inhibitors and also may produce nephrolithiasis, urolithiasis, and possibly renal insufficiency or renal failure. This problem occurs more fre-... 

Indinavir pi 2 800 mg tid or 800 mg bid with ritonavir 100 mg bid. Adjust dose in hepatic insufficiency Best on an empty stomach. Drink at least 48 oz liquid daily. Separate dosing from ddl by 1 h. Store in original container, which contains desiccant Nephrolithiasis, nausea, indirect hyperbilirubinemia, headache, asthenia, blurred vision See footnote 4 for contraindicated medications. Also avoid efavirenz... 

The most common adverse effects of indinavir are indirect hyperbilirubinemia and nephrolithiasis due to crystallization of the drug. Nephrolithiasis can occur within days after initiating therapy, with an estimated incidence of approximately 10%. Consumption of at least 48 ounces of water daily is important to maintain adequate hydration. Thrombocytopenia, elevations of serum aminotransferase levels, nausea, diarrhea, insomnia, dry throat, dry skin, and indirect hyperbilirubinemia have also been reported. Insulin resistance may be more common with indinavir than with the other Pis, occurring in 3-5% of patients. There have also been rare cases of acute hemolytic anemia. 

Since indinavir is an inhibitor of CYP3A4, numerous and complex drug interactions can occur (Tables 49-3 and 49-4). Combination with ritonavir (boosting) allows for twice-daily rather than thrice-daily dosing and eliminates the food restriction associated with use of indinavir. However, there is potential for an increase in nephrolithiasis with this combination compared with indinavir alone thus, a high fluid intake (1.5-2 L/d) is advised. 

Some patients receiving indinavir exhibit nephrolithiasis/urolithiasis including flank pain that may be accompanied by hematuria. The frequency of nephrolithiasis is dependent on the period of treatment with indinavir. Other side effects associated with indinavir include insulin resistance, hyperglycemia, asymptomatic hyperbilirubinemia, HIV lipodystrophy syndrome and skin abnormalities. Indinavir should not be coadministered with drugs that affect the cytochrome P-450 system (CYP3A4). Antacids are not recommended within 2 h of its administration, specifically didano-sine containing an antacid buffer. 

Indinavir PI 800 mg tid With water or other liquids, 1 hour before or 2 hours after a meal. Drink at least 48 oz of liquid daily. Separate dosing with didanosine by 1 hour. Nephrolithiasi s, nausea, liver function abnormalities Store in original container, which contains dessicant see footnote 2 for concurrent drug contraindication s... 

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/Crixivan (IDV) 200, 333, or 400mg capsules 800 mg q. 8h or 800 mg b.i.d. with ritonavir Nephrolithiasis, Gl intolerance, hyperbihrubinemia, metabolic complications 108... 

Indinavir causes nephrolithiasis as a result of precipitation of indinavir crystals in the urinary tract (12,13). It is dose-related and can be prevented by adequate hydration. In 615 patients (18 864 person-years of follow-up) who did not have risk factors for nephrolithiasis, the incidence was 8.6 episodes per 1000 person-years (14). 

The results of a questionnaire survey of 878 people with HIV infection treated with antiretroviral drugs confirmed the risk of arthralgias in patients taking indinavir. The authors suggested that crystal deposition in joints, analogous to the crystalluria with nephrolithiasis that indinavir and other protease inhibitors can cause, might be responsible. 

In a French analysis of 22 510 nrinary calcnh performed by infrared spectroscopy, dmg-indnced nrolithiasis was divided into two categories first, stones with dmgs physically embedded (n — 238 1.0%), notably indinavir monohydrate (n = 126 53%), followed by triamterene (n = 43 18%), snlfonamides (n — 29 12%), and amorphons silica n = 24 10%) secondly, metabolic nephrolithiasis... 

Example A study in 1,219 patients of the ATHENA (AIDS Therapy Evaluation National Centre) cohort of patients infected with HIV receiving antiretroviral therapy in the Netherlands showed a frequency of urological symptoms (including nephrolithiasis, renal colic, flank pain, hematuria, renal insufficiency, or nephropathy) of 8.3 per 100 treatment-years for indinavir compared to 0.8 per 100 treatment-years for other HIV protease inhibi-... 

Valencia ME J-NI, Rodriguez-Rosado R, SorianoV, Carrillo deAlbornoz ME, Gonzalez Lahoz J. Incidence of nephrolithiasis in HIV infected patients under indinavir treatment, [abstract 448]. Sixth European Conference on Clinical Aspects and Treatment of HIV Infection October 1997 Hamburg October 1997. 

Brodie SB, Keller MJ, Ewenstein BM, Sax PE. Variation in incidence of indinavir-associated nephrolithiasis amount FllV-positive patients. AIDS 1998 12 2433-2437. 

Berns JS, Cohen RM, Silverman M, Turner J. Acute renal failure due to indinavir crystalluria and nephrolithiasis report of two cases. Am J Kid Dis 1997 30 558-560. 

Indinavir 800 mg q. 8 hr 10% No data 100% No data 100% No data 100% Adverse effects nephrolithiasis and acute renal failure due to crystalluria or tubulointerstitial nephritis NC No data dose for GFR <10 ml/min No data... 

Indinavir Metabolism hepatic CYP3A4 Nephrolithiasis (hydration essential)... 

Indinavir For use with zidovudine and lamivudine in cases where there is an increased risk for HIV transmission (i.e., source has high viral titer or large volume exposure) Expanded regimen Zidovudine 300 mg BID, lamivudine 150 mg BID, and indinavir 800 mg TID for 28 days Dose-related hyperbilirubinemia, nephrolithiasis, metallic taste, rash, dry mouth/ mucous membranes Hepatic elimination Give with water at least 1 hr prior, or 2 hr after a meal food will substantially reduce bioavailability Minimum of 48 oz fluids daily to reduce nephrolithiasis Numerous drug interactions... 

An AIDS patient who is being treated with multiple drugs, including AZT, lamivudine, indinavir, ketoconazole, and TMP-SMX, develops breast hypertrophy, central adiposity, hyperlipidemia, insulin resistance, and nephrolithiasis. If these changes are related to his drug treatment, the most likely cause is... 

Answer B. AIDS patients being treated with protease inhibitors (e.g., indinavir) have developed a syndrome involving derangement of lipid and CHO metabolism. Changes in lipid metabolism and distribution occur quite commonly, and type 2 diabetes has also been reported. Indinavir is also notable for its tendency to precipitate in the urinary tract, causing nephrolithiasis unless the patient is maintained in a high state of hydration. 

Indinavir 800 mg qShrs <20% 100% 100% 100% May cause nephrolithiasis Require adequate hydration... 

A unique and common adverse effect of indinavir is crystalluria and nephrolithiasis. This stems from the poor solubility of the drug, which is lower at pH 7.4 than at pH 3.5. Precipitation of indinavir and its metabolites in urine can cause renal colic, and nephrolithiasis occurs in... 

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