stopping indinavir/ nephrolithiasis
Oct 28, 1996
Question 1: my brother is taking azt, ddi, and crixivan, and recently had probable kidney stones, despite drinking large amounts of fluids. What will happen if he discontinues the drug? Can he go on a different protease inhibitor? Or will resistance have developed? Question 2: if you have flank pain from probable kidney stones on indinavir, is it the best course to discontinue that medication and begin another protease inhibitor, or do they all have that potential side effect?
Response from Dr. Cohen
Nephrolithiasis (kidney stones) is a potential side effect of indinavir (Crixivan), and although drinking lots of water (at least 2 quarts per day) will lower your chances of developing stones, it can still happen. Since this is not an allergic reaction but a side effect, people who develop kidney stones due to indinavir do not necessarily have to change therapy. Of course, the drug should be stopped until the kidney stone problem has resolved. But in some cases it is possible to go back on indinavir without ever developing another stone.
As far as resistance is concerned, stopping the drug completely for a period of time is much less of a problem than taking it eratically-- missing frequent doses, not taking a high enough dose, not taking it every 8 hours, etc. Resistance is only likely to occur if viral replication is taking place when there is a little bit of indinavir in the blood, but not enough to suppress the virus. If there is no indinavir hanging around (like when you stop "cold turkey") the virus will see no need to develop resistance mutations.
Of course, sometimes it will be necessary to change drugs. None of the other antiretrovirals, including the protease inhibitors, cause kidney stones, so none would be contraindicated for that reason.
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