Buy Crixivan Online

Crixivan (indinavir sulfate)

THERAPEUTIC CLASS

Protease inhibitor

DEA CLASS

RX

INDICATIONS

Treatment of HIV infection in combination w/ other antiretroviral agents.

ADULT DOSAGE

HIV-1 Infection

Combination w/ Other Antiretrovirals:
800mg q8h

DOSING CONSIDERATIONS

Concomitant Medications
Delavirdine:
Consider dose reduction to 600mg q8h when administering delavirdine 400mg tid
Didanosine:
Administer at least 1 hr apart on an empty stomach
Itraconazole:
Reduce dose to 600mg q8h when administering itraconazole 200mg bid
Ketoconazole:
Reduce dose to 600mg q8h when administering ketoconazole
Rifabutin:
Reduce rifabutin dose to half the standard dose and increase indinavir dose to 1000mg q8h

Hepatic Insufficiency

Mild-to-Moderate Insufficiency Due to Cirrhosis:
Reduce dose to 600mg q8h

Adverse Reactions
Nephrolithiasis/Urolithiasis:
May temporarily interrupt (eg, 1-3 days) or d/c therapy

ADMINISTRATION

Oral route

Administer w/o food but w/ water 1 hr ac or 2 hrs pc
May administer w/ other liquids (eg, skim milk, juice, coffee, tea) or w/ a light meal
Drink at least 1.5L of liquids during the course of 24 hrs to ensure adequate hydration

HOW SUPPLIED

Cap: 200mg, 400mg

CONTRAINDICATIONS

Coadministration w/ CYP3A4 substrates for which elevated concentrations potentially cause serious or life-threatening reactions (eg, alfuzosin, amiodarone, dihydroergotamine, ergonovine, ergotamine, methylergonovine, cisapride, lovastatin, simvastatin, pimozide, sildenafil [for treatment of pulmonary arterial HTN], oral midazolam, triazolam, alprazolam).

WARNINGS/PRECAUTIONS

Nephrolithiasis/urolithiasis reported. Ensure adequate hydration in all patients. Acute hemolytic anemia, including cases resulting in death, reported; once a diagnosis is apparent, institute appropriate measures, including discontinuation of therapy. Hepatitis, including cases resulting in hepatic failure and death, reported. New onset or exacerbation of diabetes mellitus (DM), hyperglycemia, and diabetic ketoacidosis reported; initiation or dose adjustments of insulin or oral hypoglycemic agents may be required. Indirect hyperbilirubinemia reported frequently during treatment, and infrequently associated w/ increases in serum transaminases. Tubulointerstitial nephritis w/ medullary calcification and cortical atrophy observed in patients w/ asymptomatic severe leukocyturia (>100 cells/high power field); closely follow patients w/ asymptomatic severe leukocyturia and monitor frequently w/ urinalyses. Consider discontinuation of therapy in all patients w/ severe leukocyturia. Immune reconstitution syndrome reported. Autoimmune disorders (eg, Graves' disease, polymyositis, Guillain-Barre syndrome) reported in the setting of immune reconstitution and can occur many months after initiation of treatment. Spontaneous bleeding in patients w/ hemophilia A and B reported. Redistribution/accumulation of body fat reported. Caution in elderly.

ADVERSE REACTIONS

Nephrolithiasis/urolithiasis, hyperbilirubinemia, abdominal pain, headache, N/V, dizziness, pruritus, diarrhea, back pain.

DRUG INTERACTIONS

See Contraindications and Dose Modification. Caution w/ atorvastatin, rosuvastatin, parenteral midazolam, sildenafil (for treatment of erectile dysfunction), tadalafil, or vardenafil. Do not coadminister w/ rifampin. Not recommended w/ St. John's wort, atazanavir, salmeterol, or fluticasone (when indinavir is coadministered w/ a potent CYP3A4 inhibitor [eg, ritonavir]). Avoid w/ colchicine in patients w/ renal/hepatic impairment. May increase levels of CYP3A/CYP3A4 substrates, ritonavir, saquinavir, antiarrhythmics, trazodone, colchicine, quetiapine, dihydropyridine calcium channel blockers, clarithromycin, bosentan, atorvastatin, rosuvastatin, immunosuppressants, salmeterol, fluticasone, parenteral midazolam, rifabutin, sildenafil, tadalafil, and vardenafil. CYP3A/CYP3A4 inducers, St. John's wort, efavirenz, nevirapine, anticonvulsants, rifabutin, and venlafaxine may decrease levels. CYP3A/CYP3A4 inhibitors, delavirdine, nelfinavir, ritonavir, clarithromycin, itraconazole, and ketoconazole may increase levels. Refer to PI for dosing modifications when used w/ certain concomitant therapies.

PREGNANCY AND LACTATION

Category C, not for use in nursing.

MECHANISM OF ACTION

HIV-1 protease inhibitor; binds to the protease active site and inhibits the activity of the enzyme. This inhibition prevents cleavage of the viral polyproteins resulting in the formation of immature noninfectious viral particles.

PHARMACOKINETICS

Absorption: Rapid (fasted). Cmax=12,617nM; Tmax=0.8 hrs; AUC=30,691nM•hr. Distribution: Plasma protein binding (60%). Metabolism: Oxidation (via CYP3A4 [major]) and glucuronide conjugation. Elimination: Urine (<20%, unchanged); T1/2=1.8 hrs.

ASSESSMENT

Assess for hypersensitivity to drug, hepatic insufficiency, DM, hemophilia, pregnancy/nursing status, and possible drug interactions.

MONITORING

Monitor for nephrolithiasis/urolithiasis, hemolytic anemia, hepatitis, new onset or exacerbation of DM, hyperglycemia, diabetic ketoacidosis, hyperbilirubinemia, serum transaminase elevations, immune reconstitution syndrome, autoimmune disorders, fat redistribution/accumulation, and other adverse reactions. Closely follow patients w/ asymptomatic severe leukocyturia and monitor frequently w/ urinalyses. In patients w/ hemophilia, monitor for bleeding events.

PATIENT COUNSELING

Instruct to take drug ud. Inform that drug is not a cure for HIV-1 infection and that illnesses associated w/ HIV may continue. Advise to avoid doing things that can spread HIV to others. Instruct not to modify or d/c therapy w/o consulting physician. Instruct to report to physician the use of any other prescription/nonprescription medication or herbal products (eg, St. John's wort). Inform that fat redistribution/accumulation may occur. Instruct to notify physician if pregnant or nursing.

STORAGE

15-30°C (59-86°F). Protect from moisture.

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