100 mg tablets, 80 mg/ml Oral Solution Abbott
Ritanovir is a peptidomimetic inhibitor of both the HIV-1 and HIV-2 proteases. The drug is indicated in combination with nucleoside analogues or as monotherapy for the treatment of HIV infection.
The most common occurring side effects of ritonavir are gastrointestinal and neurological disturbances including nausea, diarrhea, vomiting, anorexia, abdominal pain, taste pervasion, and circumoral and peripheral paraesthesias. Ritonavir has high affinity for several cytochrome P450 (CYP) isoenzymes including CYP3A, CYP2D6, and CYP2C9. Drugs that increase CYP3A activity (phenobarbital, carbamazepine, dexamethasone, phenytoin, rifampin, rifabutin) are expected to increase the clearance of ritonavir resulting in decreased ritonavir concentrations. Large dose reductions (>50%) and therapeutic drug concentration monitoring is recommended when drugs extensively metabolized are used concomitantly with ritonavir. Meperidine, quinidine, clarithromycin, terfenadine, astemizole, cisapride, fluoxetine, clozapine and benzodiazepines are commonly prescribed medications metabolized by these isoenzymes.
The recommended dosage of ritonavir is 600 mg twice daily. The dose may be escalated over one week starting at 200 mg twice daily for patients who develop gastrointestinal side effects at the initial target dosage. Ritonavir carries a KUMC Cost Code Index of F.
| Ritonavir should be given with meals to increase bioavailability. |
200mg Capsules Roche Labs
Saquinavir is a highly specific inhibitor of HIV-1 and HIV-2 proteases and prevents the cleavage of viral polypeptides. In combination with nucleoside analogues (zalcitabine and zidovudine), saquinavir is indicated for the treatment of HIV infection in selected patients.
The most common side effects are gastrointestinal in nature including diarrhea, abdominal discomfort, and nausea. Other commonly reported side effects include paraesthesia, extremity numbness, musculoskeletal pain, asthenia and headaches.
Saquinavir may alter laboratory results with increases in serum alanine transference or CPK, high and low phosphates, hypocalcemia, and hypokalemia.
Simultaneous administration with drugs metabolized by the cytochrome CYP3A4 pathway (i.e. rifampin, phenytoin, phenobarbital, carbamazepine, or dexamethasone, calcium channel blockers, clindamycin, dapsone, quinidine, triazolam) may reduce saquinavir plasma concentrations. However, saquinavir may increase plasma concentrations of medications metabolized by the CYP3A4 pathway.
Co-administration with terfenadine or astemizole may lead to increased plasma concentrations of either drug which may prolong the QT interval. Alternative antihistamines should be used in patients who require such medications.
Co-adminstration of saquinavir with ketoconazole resulted in a three fold increase in the AUC and peak plasma concentrations of saquinavir. Ketaconazole is unaffected by saquinavir administration.
Concomitant administration of saquinavir with zidovudine and zalcitabine as triple combination therapy does not effect the absorption, metabolism or elimination of any of these drugs.
The recommended dosage of saquinavir is three 200 mg capsules three times daily two hours after a full meal. The recommended doses of zalcitabine or zidovudine as part of combination therapy are 0.75 mg TID and 200 mg TID, respectively. Saquinavir carries a KUMC Cost Code Index of F.
| On the average, the plasma concentrations approximately doubled after a high calorie, high fat meal as opposed to a low calorie, fat meal. Therefore, it is recommended to administer squinavir with a high calorie/fat meal. |
LAMIVUDINE (EPIVIR) 150mg Tablets, 10mg/ml Oral Solution Glaxo Wellcome
Lamivudine inhibits HIV reverse transcription via viral DNA chain termination. In combination with zidovudine, lamivudine is indicated for the treatment of HIV infection when antiretroviral therapy is warranted based on clinical and/or immunological evidence of disease progression.
In general, treatment with lamivudine was well tolerated. Diarrhea, headache, fatigue, nausea, and abdominal pain were reported most frequently and were usually mild.
No significant pharmacokinetics differences were noted with concomitant administration of lamivudine and zidovudine. However, when lamivudine and trimethoprim/sulfamethoxazole are coadministered, there may be an increase in lamivudine exposure.
The recommended oral dose of lamivudine for adults and adolescents is 150 mg twice daily administered in combination with zidovudine. For adults with low body weights (less than 50 kg), the recommended oral dose is 2mg/kg twice daily. The pediatric (3mo.-12yr) recommended oral dose of lamivodine is 4mg/kg twice daily with a maximum of 150 mg twice daily. Lamivudine carries a KUMC Cost Code Index of F.
500 mg Tablets Smith Kline Beecham
Famiciclovir is indicated for the treatment of acute herpes zoster and recurrent genital herpes. Its mechanism of action is similar to acyclovir.
The adverse drug reaction profile is also similar to acyclovir. The adverse reactions most frequently cited during treatment include headache, nausea, and abdominal pain. Other less common adverse reactions include fatigue, dizziness, diarrhea, and dyspepsia.
The recommended dosage regimen for famciclovir in adults with normal renal function is 500 mg orally three times a day for three to seven days. Therapy should be initiated when herpes is diagnosed within 72 hours after rash onset. The manufacturer recommends extending the dosing interval proportionally to reduced renal clearance: for CrCl > 60 ml/min the dose is 500 mg every 8 hours; 40-59 ml-min the dose is 500 mg every 12 hours; 20-39 ml/min the dose is 500 mg every 24 hours. Famciclovir carries a KUMC Cost Code Index of F.
| The administration of famciclovir with food decreases the rate of absorption but has not been shown to affect the bioavailability or elimination of the drug. Famciclovir may be taken without regard to meals. |
Changes in the KUMC Formulary since 1995-1996 Publications
| Acarbose (Precose) | Lansoprazole (Prevacid) |
| Alendronate (Fosamax) | Levomethadyl (Orlaam) |
| Amphotericin B Lipid Complex (Abelcet) -restricted to ID and Hematology | -restricted to methadone clinic Losartan (Cozaar) |
| Anastrozole (Arimidex) | Microemulsion Cyclosporine (Neoral) Calcitonin -Salmon Nasal Spray (Miacalcin) |
| Mycophenolate Mofetil (CellCept) | |
| Carteolol Ophthalmic solution (Ocupress) | Nefazodone (Serzone) |
| Cisatracurium (Nibex) | Phentermine (Adipex-P, Fastin) |
| Dalteparin (Fragmin) | -restricted to obesity clinic protocol |
| Dinoprostone Vaginal Insert (Cervidil) Sevoflurane (Ultrane) | |
| Dorzolamide 2% (Trusopt) | Sonicated Albumin 5% (Albunex) |
| Estradiol Transdermal System (Climara) | -restricted to cardiac catheterization lab |
| Fenfluramine (Pondimin) | Testosterone Patch (Androderm) |
| -restricted to obesity clinic protocol | Varicella Vaccine (Varivax) |
| Ipratroprium Bromide Nasal Spray (Atrovent) | |
| Tobramycin 0.1%, 0.3% and Dexamethasone (Tobradex) |
| Atracurium (Tracurium) | Enoxaparin (Lovenox) |
| Cefuroxime axetil (Ceftin) [suspension] | Estradiol Transdermal System (Estraderm) |
| Desflurane (Suprane) | Omeprazole (Prilosec) 20mg capsules |
| Dinoprostone Cervical Gel | |
| (Prepidil) Dexamethasone,Neomycin, Polymixin B Ophthalmic (Maxitol) | Testosterone Patch (Testoderm) |
