New York/New Jersey AIDS Education Helpful HIV Medication Tables for Pharmacists & Training Center
Nucleoside/Nucleotide Reverse Transcriptase Inhibitors
www.nynjaetc.org
Patient Counseling Points - Food Effect and Adverse Effects
Abacavir Food Effect – Take without regard to meals. Adverse Effects – Patients should be warned about the abacavir
hypersensitivity reaction (HSR) which is characterized by fever, rash, nausea, vomiting, malaise or fatigue, loss of appetite, sore throat, cough, shortness of breath. Fatalities associated with the HSR have been reported, especially ifpatients are rechallenged. *
Didanosine Food Effect – Take 1/2 hour before or 2 hours after a meal. Adverse Effects – Peripheral neuropathy, pancreatitis and nausea. *
<60kg – 250mg once daily; withtenofovir give 200mg once daily
Emtricitabine Food Effect – Take without regard to meals. Adverse Effects – Minimal; Hyperpigmentation/skin discoloration Lamivudine Food Effect – Take without regard to meals. Adverse Effects – Minimal; pancreatitis has been reported. * Stavudine Food Effect – Take without regard to meals. Adverse Effects – Peripheral neuropathy, lipodystrophy, hyperlipidemia,
pancreatitis. Rare, rapidly ascending neuromuscular weakness. *
Tenofovir Food Effect – Take without regard to meals. Adverse Effects – Asthenia, headache, diarrhea, nausea, vomiting, Zidovudine Food Effect – Take without regard to meals. Adverse Effects – Bone marrow suppression (macrocytic anemia,
neutropenia), headache, insomnia, gastrointestinal intolerance, asthenia. *
* Lactic acidosis with hepatic steatosis is a rare, potentially life-threatening adverse event with the use of Nucleoside/Nucleotide Reverse Transcriptase Inhibitors.
Non-Nucleoside Reverse Transcriptase InhibitorsMedication
Patient Counseling Points - Food Effect and Adverse Effects
Delavirdine Food Effect – Take without regard to meals. Adverse Effects – rash, increased liver function tests, headache.
(Rescriptor®) Efavirenz Food Effect – Take on an empty stomach. Adverse Effects – Rash, central nervous system symptoms, lasting for
approximately the first 2-4 weeks, including abnormal dreams, dizziness, somnolence and euphoria; increased liverfunction tests, false-positive cannabinoid test, teratogenic (Pregnancy Category D). Nevirapine Food Effect – Take without regard to meals. Adverse Effects – Rash, including Stevens-Johnson Syndrome;
symptomatic hepatitis, including fatal hepatic necrosis reported. Higher frequency of hepatic events reported in treatment naïve females with CD4 >250 cells/mm3, and treatment naive males with CD4 >400 cells/mm3.
Patient Counseling Points - Food Effect and Adverse Effects
Atazanavir Food Effect – Take with food. Adverse Effects – Indirect hyperbilirubinemia; prolonged PR interval, (use with caution
in patients with underlying conditions or concomitant medications that can cause PR prolongation); hyperglycemia, fat
with Efavirenz or tenofovir: 300mg maldistribution, possible increased bleeding episodes in patients with hemophilia. with ritonavir 100mg once dailyNo data with nevirapine.
Darunavir Food Effect – Take with food. Adverse Effects – Skin rash (7%) including Stevens-Johnson Syndrome and erythrema
multiforme reported, caution in sulfa allergic patients, as darunavir contains a sulfonamide moiety; diarrhea, nausea, headache, hyperlipidemia, increased liver function tests, hyperglycemia, fat maldistribution, possible increased bleedingepisodes in patients with hemophilia.
Fosamprenavir Food Effect – Take without regard to meals. Adverse Effects – Skin rash (19%) including Stevens-Johnson Syndrome,
caution in sulfa allergic patients, as fosamprenavir contains a sulfonamide moiety; diarrhea, nausea, vomiting,
headache, hyperlipidemia, increased liver function tests, hyperglycemia, fat maldistribution, possible increased
bleeding episodes in patients with hemophilia.
100mg twice daily If taken with Efavirenz: 1400mg with ritonavir 300mg once daily* or 700mg with ritonavir 100mg twice daily *Once daily dosing is not recommended in ARV experienced patients. No data with nevirapine. Indinavir Food Effect – Reqires 1.5 liters of fluid daily. Without ritonavir – Take 1 hour before or 2 hours after meals; may take
with skim milk or low fat meal. With ritonavir – Take with or without food. Adverse Effects – Nephrolithiasis,
GI intolerance, nausea, indirect hyperbilirubinemia, hyperlipidemia, headache, asthenia, blurred vision, dizziness, rash, metallic taste, thrombocytopenia, alopecia, hemolytic anemia, hyperglycemia, fat maldistribution, possible increased bleeding episodes in patients with hemophilia.
Lopinavir/rtv Food Effect – Take with or without food. Adverse Effects – GI intolerance, nausea, vomiting, diarrhea, asthenia,
hyperlipidemia (especially hypertriglyceridemia), increased liver function tests, hyperglycemia, fat maldistribution,
possible increased bleeding episodes in patients with hemophilia.
200mg (4 tablets) once daily * If taken with Efavirenz or Nevirapine: Lopinavir 600mg/ ritonavir 150mg (3 tablets) twice daily (for therapy experienced patients) *Once daily dosing is not recommended in ARV experienced patients. Nelfinavir Food Effect – Take with meal or snack. Levels increased 2-3 fold. Adverse Effects – Diarrhea, hyperlipidemia,
hyperglycemia, fat maldistribution, increased liver function tests, possible increased bleeding episodes in patients with hemophilia.
Ritonavir Food Effect – Take with food to improve tolerability. Adverse Effects – GI intolerance, nausea, vomiting, diarrhea,
circumoral and extremity parasthesias, hyperlipidemia (especially hypertriglyceridemia), hepatitis, asthenia, taste
perversion, hyperglycemia, fat maldistribution, possible increased bleeding episodes in patients with hemophilia.
Saquinavir Food Effect – Take within 2 hours of a meal when taken with ritonavir. Adverse Effects – GI intolerance, nausea,
diarrhea, headache, elevated liver function tests, hyperlipidemia, hyperglycemia, fat maldistribution, possible increased bleeding episodes in patients with hemophilia.
Tipranavir Food Effect – Take with food. High fat meals increase bioavailability. Adverse Effects – Rash, caution in sulfa
allergic patients, as tipranavir contains a sulfonamide moiety; hepatotoxicity incing hepatic decompensation reported, especially in patients with underlying liver disease; hyperlipidemia, hyperglycemia, fat madistribution, rare cases of fatal and non-fatal intracranial hemorrhages, possible increased bleeding episodes in patients with hemophilia.
Patient Counseling Points - Food Effect and Adverse Effects
Enfuvirtide Food Effect – N/A. Adverse Effects – Local injection site reactions – pain, erythema, induration, nodules and cysts,
pruritis, ecchymosis, bacterial pneumonia, hypersensitivity reaction (<1%) which includes rash, fever, nausea, vomiting, chills, rigors, hypotension, or increased liver function tests. Rechallenge not recommended.
Developed 5/2007 PAGE 1 of 2 New York/New Jersey AIDS Education Helpful HIV Medication Tables for Pharmacists & Training Center www.nynjaetc.org
Combination Reverse Transcriptase InhibitorsMedication
Patient Counseling Points - Food Effect and Adverse Effects
Efavirenz, Food Effect – Take on an empty stomach. Adverse Effects – Rash, central nervous system symptoms, lasting for Tenofovir, and
approximately the first 2-4 weeks, including abnormal dreams, dizziness, somnolence and euphoria; increased liver
Emtricitabine
function tests, false-positive cannabinoid test, teratogenic (Pregnancy Category D), asthenia, headache, diarrhea,
nausea, vomiting, flatulence, renal insufficiency, skin hyperpigmentation. *
Zidovudine and One tablet twice daily Food Effect – Take without regard to meals. Adverse Effects – Bone marrow suppression (macrocytic anemia, Lamivudine
neutropenia), headache, insomnia, gastrointestinal intolerance, asthenia, rare pancreatitis.*
(Combivir®) Abacavir and Food Effect – Take without regard to meals. Adverse Effects – Patients should be warned about the abacavir Lamivudine
hypersensitivity reaction (HSR) which is characterized by fever, rash, nausea, vomiting, malaise or fatigue, loss of
appetite, sore throat, cough, shortness of breath. Fatalities associated with the HSR have been reported, especially if patients are rechallenged, rare pancreatitis.*
Abacavir, Food Effect – Take without regard to meals. Adverse Effects – Patients should be warned about the abacavir Zidovudine, and
hypersensitivity reaction (HSR) which is characterized by fever, rash, nausea, vomiting, malaise or fatigue, loss of
Lamivudine
appetite, sore throat, cough, shortness of breath. Fatalities associated with the HSR have been reported, especially if
patients are rechallenged. Bone marrow suppression (macrocytic anemia, neutropenia), headache, insomnia, gastrointestinal intolerance, asthenia, rare pancreatitis.*
Tenofovir and Food Effect – Take without regard to meals. Adverse Effects – asthenia, headache, diarrhea, nausea, vomiting, Emtricitabine
flatulence, renal insufficiency, skin hyperpigmentation. *
(Truvada®)* Lactic acidosis with hepatic steatosis is a rare, potentially life threatening adverse event with the use of Nucleoside/Nucleotide Reverse Transcriptase Inhibitors.
Components of an ARV Regimen Not RecommendedRegimen/Medication
Atazanavir + Indinavir Didanosine + Stavudine
High incidence of toxicities – peripheral neuropathy, pancreatitis, and hyperlactatemia. Reports of serious, even fatal, cases of lactic acidosis with hepatic steatosis with or without pancreatitis in pregnant women. Use only when no other antiretroviral options are available and potential benefits outweigh the risks. Efavirenz in pregnancy
Teratogenic in humans and in nonhuman primates. Use only when no other antiretroviral options are available and potential benefits outweigh the risks. Emtricitabine + lamivudine
Similar resistance profile, no potential benefit. Nevirapine initiation in treatment-naïve women Higher incidence of symptomatic (including serious and even fatal) hepatic events in these with CD4 >250 cells/mm3 or in treatment-naïve
patient groups. Use only if the benefits clearly outweigh the risks. men with CD4 >400 cells/mm3 Saquinavir as single protease inhibitor
Poor oral bioavailability (4%). Inferior antiretroviral activity when compared with other protease inhibitors. Stavudine + zidovudine
Concurrent Medications to be Avoided with Protease Inhibitors or Non-Nucleoside Reverse Transcriptase InhibitorsMedication or Class
Amiodarone
Avoid with indinavir, ritonavir and tipranavir
Astemizole
Avoid with all Protease Inhibitors, delavirdine and efavirenz
Benzodiazepines –
Avoid with all Protease Inhibitors, delavirdine and efavirenz
Midazolam and triazolam Bepridil
Avoid with amprenavir, fosamprenavir, atazanavir, ritonavir, tipranavir
Cisapride
Avoid with all Protease Inhibitors, delavirdine, and efavirenz
Ergot Alkaloids –
Avoid with all Protease Inhibitors, delavirdine, and efavirenz
Dihydroergotamine, ergotamine, ergonovine, methylergonovine Flecanide
Avoid with lopinavir/ritonavir, ritonavir, and tipranavir
Fluticasone
Avoid with all Protease Inhibitors except unboosted indinavir and nelfinavir
Garlic supplements Irinotecan Pimozide Propafenone
Avoid with lopinavir/ritonavir, ritonavir, and tipranavir
Proton pump inhibitors Quinidine Rifampin
Avoid with all Protease Inhibitors, nevirapine and delavirdine. Can be used with efavirenz; consider EFV dosage increase to 800mg daily. St. Johns Wort
Avoid with all Protease Inhibitors and all Non-Nucleoside Reverse Transcriptase Inhibitors
Terfenadine
Avoid with all Protease Inhibitors, delavirdine and efavirenz
Simvastatin and lovastatin
Avoid with all Protease Inhibitors and delavirdine
Reference:Guidelines for the Use of Antiretroviral Agents in HIV-Infected Adults & Adolescents. October 10, 2006. Available at: http://www.aidsinfo.nih.gov. Accessed March 5, 2007. John J. Faragon, PharmD Marshall J. Glesby, MD, PhD Douglas G. Fish, MD Christopher D. Miller, PharmD, BCPS
If you are interested in HIV pharmacy trainings such as clinical consultations,
Visit the AETC’s National Resource Center Website at www.aids-etc.org. This
lectures, workshops or preceptorships, please contact John Faragon, PharmD,
website provides a central repository of training materials developed within the
the Regional Pharmacy Director for the New York/New Jersey AETC at
AETC network, including resources for pharmacists.
faragoj@mail.amc.edu or 518.262.6864. You will be referred to the appropriatetraining site in your region.
Several pharmacy education materials are available from the New York/New Jersey AETC at no charge. Visit www.nynjaetc.org or call 212.304.5530. Developed 5/2007 PAGE 2 of 2
PATIENT INFORMATION LEAFLET Pregnancy and breast-feeding Ask your doctor or pharmacist for advice before taking any medicine. Salamol Easi-Breathe® Salamol Easi-Breathe should only be used if recommended by a doctor. 2. Hold the inhaler upright and open it by folding down the cap which fits over the mouthpiece. 100 micrograms/actuation Inhaler Driving and using machines
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