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Crixivan ???
Oct 15, 1996

Good morning and thank you for all of your good work in helping PLWA & HIV, may God always bless you and keep you well for your unconditional help. I am sero-negative however my long time companion of 18 years (very short time). My lover has being advised to take Crixivan (Indinavir) could you be so kind as to let me know All the aspect of this new medication.Is it cover by the government either Federal or provincial? I believe it was just approved. thank you for you answer. Blessings A.C.-B.

Response from Dr. Cohen

Thanks for your kind words. I can't personally fax you information on Crixivan, but I'll try to give you some information. If your lover will be taking this drug, he will no doubt be obtaining it through Stadtlanders Pharmacy, and will be provided with information when he gets the drug.

Crixivan is the trade name for indinavir, a highly potent protease inhibitor manufactured by Merck. It was the third protease inhibitor to be approved by the FDA, after saquinavir (Invirase) and ritonavir (Norvir). The usual dose is 800 mg every eight hours, and the capsules should be taken on an empty stomach, at least one hour before meals and two hours after. It is also acceptable to take the drug with a light non-fat snack.

The most common side effects associated with indinavir are gastrointestinal (upset stomach or nausea), but they are usually mild. The most important side effect is nephrolithiasis, or kidney stones. You can lower your risk of getting kidney stones by drinking a lot of fluids: at least two to three quarts per day. The symptoms of kidney stones include severe back or flank pain and blood in the urine. Indinavir also causes an elevation of the indirect bilirubin (a blood test) but this is harmless.

Indinavir should be taken in combination with one or two other antiretroviral drugs. Otherwise the virus will rapidly become resistant to it. If possible, these other drugs should be drugs that you are not already resistant to. This is why we advocate changing several drugs at once rather than simply adding indinavir or other protease inhibitors to the drugs you've been taking for some time.

As with any protease inhibitor, the only way to sustain the benefit of indinavir is to take it religiously. Missing doses, taking them on an erratic schedule, or taking less than the recommended dose, will cause resistance to occur much more rapidly.

In the United States, the drug is covered by Medicaid and by ADAP programs in some states. Since it is an FDA-approved drug and considered standard-of-care, it should also be covered by private insurance companies and by health maintenance organizations. I do not know about access in Canada, however.



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