Pregnancy Risk Category C
How supplied
Capsules: 200 mg, 400 mg
Action
Inhibits HIV protease, enzyme required for the proteolytic cleavage of viral polyprotein precursors into individual functional proteins found in infectious HIV. Indinavir binds to the protease active site and inhibits activity of the enzyme, preventing cleavage of the viral polyproteins and resulting in formation of immature noninfectious viral particles.
Indications & dosage
HIV infection when antiretroviral therapy is warranted-
Adults: 800 mg P.O. q 8 hours.
Adjust-a-dose: For patients with mild to moderate hepatic insufficiency due to cirrhosis, reduce dosage to 600 mg P.O. q 8 hours.
Adverse reactions
CNS: headache, insomnia, dizziness, somnolence, asthenia, malaise, fatigue.
CV: chest pain, palpitations.
EENT: blurred vision, eye pain or swelling.
GI: abdominal pain, nausea, diarrhea, vomiting, acid regurgitation, anorexia, dry mouth, taste perversion.
GU: nephrolithiasis, hematuria.
Hematologic: decreased hemoglobin, platelet, or neutrophil count.
Hepatic: elevation in ALT, AST, and serum amylase levels.
Metabolic: hyperbilirubinemia, hyperglycemia.
Musculoskeletal: back pain.
Other: flank pain.
Interactions
Drug-drug. Midazolam, triazolam: possible inhibition of the metabolism of these drugs because of competition for CYP3A4 by indinavir, creating potential for serious or life-threatening events, such as arrhythmias or prolonged sedation. Don't administer concurrently.
Clarithromycin: increased serum levels of both drugs. Monitor closely.
Didanosine: possible degradation of didanosine, formulated with buffering agents to increase pH. If administered with indinavir, administer at least 1 hour apart on an empty stomach. Normal gastric pH (acidic) may be necessary for optimum absorption of indinavir but rapidly degrades didanosine.
Ketoconazole: increased plasma level of indinavir. Consider dosage reduction of indinavir to 600 mg P.O. q 8 hours when coadministered.
Rifabutin: increased plasma levels. Reduce dosage of rifabutin by 50% if administered with indinavir.
Rifampin: markedly diminished plasma levels of indinavir. Avoid concomitant administration of indinavir and rifampin.
Ritonavir: increased indinavir levels. Monitor closely.
Drug-food. Any food: substantially decreased absorption of oral indinavir. Don't give together.
Effects on diagnostic tests
None reported.
Contraindications
Contraindicated in patients with hypersensitivity to any component of drug.
Nursing considerations
Patient teaching
*Liquid contains alcohol. **May contain tartrazine. †Canada ‡Australia §U.K. OTCOver the counter
Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE-THREATENING