Antiretroviral Drugs asthenia by benbenzhou

VIEWS: 21 PAGES: 6

More Info
									                         Antiretroviral Drugs

                      Kowloon Bay Integrated Treatment Centre

                                       2005




2005/8/03 (Revised)                      1                PA/AA4/05-1(E)HIV-DRU
(A) Nucleoside/Nucleotide Reverse Transcriptase Inhibitors (NRTI)

      Drug                 Dosage         Potential side effects                     Remarks
Zidovudine            200mg            Anaemia                                  If nausea, take after meal
(AZT)                 3 times/day      Neutropenia
Retrovir              or               G I intolerance
100mg/cap             300mg            Headache
250mg/cap             2 times/day      Insomnia
                                       Asthenia
                                       Lactic acidosis with hepatic steatosis
                                       (rare): fatigue, severe vomiting,
                                       dyspnoea

Didanosine (ddI) 125mg or 200mg        Peripheral neuropathy                    Chewed/crushed/dis-
Videx            2 times/day           Pancreatitis                             solved
25mg/tab                               Nausea                                   Take on empty stomach
100mg/tab                              Diarrhoea                                Take with IDV at least 1
                                       Lactic acidosis with hepatic steatosis   hr apart
                                       (rare): fatigue, severe vomiting,
                                       dyspnoea

Didanosine EC         250mg or 400mg   Peripheral neuropathy                    Take on empty stomach
(ddIEC)               daily            Pancreatitis                             Take with IDV at least
Videx EC                               Nausea                                   1 hr apart
250mg/tab                              Diarrhoea                                Take with meal if take
400mg/tab                              Lactic acidosis with hepatic steatosis   TDF together
                                       (rare): fatigue, severe vomiting,
                                       dyspnoea

Zalcitabine (ddC) 0.75 mg              Peripheral neuropathy
Hivid             3 times/day          Stomatitis
0.75mg/tab                             Pancreatitis
                                       Lactic acidosis with hepatic steatosis
                                       (rare): fatigue, severe vomiting,
                                       dyspnoea

Stavudine(d4T)        30mg or 40mg     Peripheral neuropathy
Zerit                 2 times/day      Lipodystrophy
30mg/cap                               Lactic acidosis with hepatic steatosis
40mg/cap                               (rare): fatigue, severe vomiting,
                                       dyspnoea
                                       Pancreatitis
                                       Rapidly progressive ascending
                                       neuromuscular weakness (rare)

Lamivudine            150mg            Minimal toxicity                         Rapid emergence of
(3TC)                 2 times/day      Lactic acidosis with hepatic steatosis   resistant strains if
Epivir                                 (rare): fatigue, severe vomiting,        non-adherent
150mg/tab                              dyspnoea




2005/8/03 (Revised)                                2                            PA/AA4/05-1(E)HIV-DRU
      Drug                  Dosage             Potential side effects                       Remarks
Combivir (CBV) 1 tab                        Anaemia
150mg 3TC +    2 times/day                  Neutropenia
300mg AZT/tab                               Headache
                                            G I intolerance
                                            Insomnia
                                            Asthenia
                                            Lactic acidosis with hepatic steatosis
                                            (rare): fatigue, severe vomiting,
                                            dyspnoea

Abacavir (ABC)        300mg                 Hypersensitivity reaction                  If there is fever , rash ,
Ziagen                2 times/day           (5% of people) symptoms may                report to health care
300mg/tab                                   include fever, rash, nausea,               workers at once
                                            vomiting, malaise ,fatigue or
                                            loss of appetite, respiratory
                                            symptoms such as sore throat,
                                            cough, shortness of breath

Kivexa (KVA)          1 tablet once daily   Hypersensitivity reaction which can
                                            be fatal, symptoms may include
Epzicom
                                            fever, rash, nausea, vomiting,
ABC 600mg +                                 malaise or fatigue, loss of appetite,
3TC 300mg/tab                               respiratory symptoms such as sore
                                            throat, cough, shortness of breath

Tenofovir (TDF) 300mg daily                 Asthenia                                   Take with meal
Viread                                      Headache                                   Dosage adjustment in
300mg/tab                                   G I intolerance                            renal insufficiency
                                            Flatulence
                                            Lactic acidosis with hepatic steatosis
                                            (rare): fatigue, severe vomiting,
                                            dyspnoea
                                            Rare report of renal insufficiency

Emtricitabine         200mg once daily      Minimal toxicity
(FTC)                                       Lactic acidosis with hepatic steatosis
Emtriva                                     (rare): fatigue, severe vomiting,
200mg/cap                                   dyspnoea

Truvada (TRV)         1 tablet once daily   Minimal toxicity
FTC 200mg +                                 Lactic acidosis with hepatic steatosis
TDF 300mg/tab                               (rare): fatigue, severe vomiting,
                                            dyspnoea

Trizivir              1 tab                 Anaemia                                    If there is any flu like
(ABC + AZT +          2 times/day           Neutropenia                                symptom fever, rash,
3TC)                                        G I intolerance                            report to health care
                                            Headache                                   workers at once
                                            Insomnia
                                            Asthenia
                                            Lactic acidosis with hepatic
                                            steatosis: fatigue, severe vomiting,
                                            dyspnoea
                                            Hypersensitivity reaction


2005/8/03 (Revised)                                   3                              PA/AA4/05-1(E)HIV-DRU
(B) Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTI)

      Drug                 Dosage             Potential side effects                       Remarks
Nevirapine            200mg daily for 2    Rash                                       Anti-TB drugs and oral
(NVP)                 weeks,               Symptomatic hepatitis                      contraceptive pills should
Viramune              then 200mg                                                      be used with caution
200mg/tab             2 times/day                                                     Rapid emergence of
                                                                                      resistant strains if
                                                                                      non-adherent

Efavirenz (EFZ)       600mg daily          Rash                                       Decrease CNS symptoms
Stocrin, Sustiva      (preferably at bed   CNS symptoms:                              if take at bed time
200mg/cap             time)                dizziness, somnolence, insomnia,           Pregnancy is
600mg/tab                                  drowsiness, nightmares,                    contraindicated
                                           hallucinations, poor concentration
                                           (usually subside in 2-4 weeks if
                                           really appear)
                                           Increased transaminase levels



(C) Protease Inhibitors (PI)

      Drug                 Dosage             Potential side effects                       Remarks
Indinavir (IDV)       800mg Q8h            Nephrolithiasis                            Take with empty stomach
Crixivan              (3 times/day)        G I intolerance                            Drink water ≥ 1.5
200mg/cap                                  Increased indirect bilirubinemia           litre/day
400mg/cap                                  Misc.: headache, asthenia, blurred         Avoid grapefruit juice
                                           vision, dizziness, rash, metallic taste,
                                           thrombocytopenia, alopecia and
                                           hemolytic anaemia
                                           Fat redistribution
                                           Lipid abnormalities
                                           Hyperglycemia

Saquinavir (SQV)      Invirase             Headache                                   Take after meal,
Invirase (hard        600mg                G I intolerance                            preferably fatty to
gel)                  3 times/day          Elevated transaminase enzymes              increase absorption
200mg/cap             Fortovase            Hyperglycemia                              Rifampicin & Rifabutin
Fortovase (soft       1200mg               Fat redistribution                         are contraindicated with
gel) (FTV)            3 times/day          Lipid abnormalities                        SQV
200mg/cap                                  Possible increased bleeding episodes       Fortovase (soft gel)
                                           in patients with hemophilia                should be refrigerated or
                                                                                      stored at room
                                                                                      temperature <25ºC (up to
                                                                                      3 months)




2005/8/03 (Revised)                                    4                              PA/AA4/05-1(E)HIV-DRU
      Drug                 Dosage           Potential side effects                    Remarks
Ritonavir (RTV)       600mg               Headache                               Capsules should be
Norvir                2 times/day         G I intolerance                        refrigerated. If stored at
100mg/cap                                 Paresthesias – circumoral and          room temperature <25ºC,
syrup 80mg/ml                             extremities                            it is stable for ≤ 30 days
                                          Hepatitis                              Take after meal to
                                          Pancreatitis                           improve tolerance
                                          Asthenia                               Need dosage adjustment if
                                          Taste perversion                       take with SQV
                                          Lab.: Triglycerides increase           Avoid self-prescribe drugs
                                          > 200%, transaminase elevation,        because of drug
                                          elevated CPK and uric acid             interaction
                                          Hyperglycemia
                                          Fat redistribution
                                          Lipid abnormalities
                                          Possible increased bleeding episodes
                                          in patients with hemophilia

Nelfinavir            750mg               Diarrhoea                              Take with meal
(NFV)                 3 times/day         Hyperglycemia
Viracept              or                  Fat redistribution
250mg/tab             1250mg              Lipid abnormalities
                      2 times/day         Serum transaminase elevation
                                          Possible increased bleeding
                                          episodes in patients with
                                          hemophilia

Kaletra (LPVr)  3 capsules                Diarrhoea                              Take with meal
Lopinavir       2 times/day               G I intolerance                        Use additional type of
(LPV) 133.3mg +                           Asthenia                               contraception since
Ritonavir (RTV)                           Elevated serum transaminases           Kaletra may reduce the
33.3mg/cap                                Hyperglycemia                          effectiveness of oral
                                          Fat redistribution                     contraceptives
                                          Lipid abnormalities                    Should be refrigerated. If
                                          Possible increased bleeding episodes   stored at room
                                          in patients with hemophilia            temperature <25ºC, it is
                                                                                 stable for 2 months

Atazanavir            400mg once daily    Indirect hyperbilirubinemia            Take with meal
(ATV)                 or 300mg once       Hyperglycemia                          Contraindications:
Reyataz               daily + Ritonavir   Fat maldistribution                    Midazolam, triazolam,
150mg/cap             (RTV) 100mg         Lipid abnormalities                    dihydroergotamine,
200mg/cap                                 Possible increased bleeding episodes   ergotamine, ergonovine,
                                          in patients with hemophilia            methylergonovine,
                                          Some patients may experience           cisapride and pimozide
                                          asymptomatic 1st degree
                                          Atrioventricular (AV) block            Caution: Patients with
                                                                                 hepatic insufficiency or
                                                                                 gastric ulcer

                                                                                 ATV without Ritonavir
                                                                                 (RTV) should not be
                                                                                 coadministered with
                                                                                 Efavirenz (EFZ) or
                                                                                 Tenofovir (TDF)



2005/8/03 (Revised)                                  5                           PA/AA4/05-1(E)HIV-DRU
      Drug                Dosage               Potential side effects                       Remarks
Fosamprenavir         1400mg BD             Skin rash (19%)                            Dosage adjustment in
(FPV) or                                    Diarrhoea, nausea, vomiting                hepatic insufficiency
(ƒAPV) Lexiva                               Headache                                   recommended
700mg/tab                                   Hyperlipidemia
                                            Transaminase elevation
                                            Hyperglycemia
                                            Fat maldistribution
                                            Possible increased bleeding episode
                                            in patients with hemophilia



(D) Fusion Inhibitor

      Drug                Dosage               Potential side effects                       Remarks
Enfuvirtide (T20) 90mg (1ml)                Local injection site reactions             Rechallenge is not
Fuzeon            subcutaneously            eg. pain, erythema, induration,            recommended if client has
                  (SC) 2 times/day          nodules and cysts, pruritus,               hypersensitivity reaction
                                            ecchymosis
                                            Increased rate of bacterial
                                            pneumonia
                                            Hypersensitivity reaction (<1%)
                                            symptoms may include rash, fever,
                                            nausea, vomiting, chills, rigors,
                                            hypotension, or elevated serum
                                            transaminases




Reference:

Department of Health, Guidelines for the Use of Antiretroviral Agents in HIV-I-Infected Adults and Adolescents.
Convened by DHHS. April, 2005. P.58-63




2005/8/03 (Revised)                                     6                             PA/AA4/05-1(E)HIV-DRU

								
To top