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Confused about how to take Viracept
May 26, 1997

Your column has been so helpful to me, I am hoping that you can answer my qu estion. I am just starting a regiman of AZT, 3TC, and Viracept, but I can't seem to get any consistant information on how to take the Viracept. My Infectious Disease doctor says I should take it every 8 hours exactly. But I have read that this drug just needs to be taken 3 times a day and that food increases absorption by 2-3 times. However, my pharmacist said that taking it with meals only prevents GI problems. What does all this mean? If I take it with meals, it would be 8:00 am, 1:00 pm, 7:00 pm, 3 times a day, but certainly not every 8 hours. If I take it every 8 hours, it would be 8:00, 4:00, and midnight, but this would not be with meals. So if I do need to take it with a meal, what (or how many calories) constitutes a meal? Is it ok to just take it with, say, an orange or a bagel? And how many hours between doses is acceptable? Thank you very much!

Response from Dr. Cohen

When it comes to these kind of questions, it's unlikely that I'll be able to tell you more than you already know, since we all get our information from the manufacturer. Agouron says that Viracept (nelfinavir) should be taken with "food," not "meals." By that I assume they mean that the big, fatty meals that increase the absorption of Invirase (saquinavir) and that decrease the side-effects of Norvir (ritonavir) are not necessary. I tell my patients to take it with meals or with a snack. A bagel is probably fine, an orange perhaps a little too insubstantial, but that's just my interpretation of the recommendations.

As for timing, Viracept has a longer half-life than Crixivan (indinavir). That means that it stays around in the blood longer. For that reason, it is usually given "three times a day" rather than "every eight hours." I couldn't tell you how much leeway there is in terms of dosing intervals. I usually tell my patients taking Crixivan that every eight hours really means every eight hours, whereas those taking Viracept can probably get away with anything between 6 and 10 hours. Again, that's my interpretation of the recommendations, and is not to be taken as gospel.



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