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Rescriptor

March/April 2012

Rescriptor

Brand name: Rescriptor

Generic name: delavirdine, or DLV

Class: Non-nucleoside reverse transcriptase inhibitor (non-nucleoside, NNRTI, or non-nuke)

Manufacturer: ViiV Healthcare, www.viivhealthcare.com, (877) 844-8872

AWP: $381.89/month for 200 mg tablets

Standard Dose: Two 200 mg tablets or four 100 mg tablets three times a day (every 8 hours). Only the 100 mg tablets can be dissolved in liquid; however, avoid grapefruit juice. Take with or without food, but again, avoid grapefruit juice. Take missed dose as soon as possible, unless it is closer to the time of your next dose. Do not double up on your next dose.

Potential side effects and toxicity: Most common side effects are elevated liver enzymes and itchy skin or rash. A serious side effect of the NNRTI class is rash, which can be life threatening. Most rashes occur one to three weeks after starting Rescriptor. If you experience blistering, mouth lesions, conjunctivitis (redness or inflammation of the eye, which if untreated may result in permanent vision loss), swelling, muscle or joint aches, fever, or malaise (general ill feeling), you should stop the medication, and seek medical attention right away. See chart for potential drug class side effects.

Potential drug interactions: Non-nukes interact with many other drugs. See package insert for the most complete list. Tell your provider or pharmacist about all medications, herbs, and supplements you are taking or thinking of taking, prescribed or not. You should not take Rescriptor with Halcion (triazolam), migraine medicines in any form, Orap (pimozide), oral Versed (midazolam), Xanax (alprazolam), or the herb St. John's wort. Do not use Mevacore, Vitorin, or Zocor cholesterol (lipid) lowering meds; suggested alternatives are Lescol (fluvastatin), Lipitor (atorvastatin), and Pravacol (pravastatin). Liver enzymes should be checked regularly if you are on these cholesterol meds, as they can increase risk for liver toxicity with Rescriptor. Rescriptor needs stomach acid in order to be absorbed correctly. Over-the-counter antacids, like Tums or Maalox, decrease absorption of Rescriptor, so take it one hour apart from these remedies. Other acid-reducing drugs (like Zantac, Tagamet, and Prilosec) may also reduce absorption of Rescriptor -- try not to take them together for long periods of time. People with low stomach acid should take Rescriptor with acidic beverages (orange or cranberry juice, etc.) to increase acidity. Certain amphetamines and antiarrhythmic drugs should not be used with Rescriptor -- therefore, inform your health care provider if you have a history of heart or blood pressure problems. Dose adjustment may be needed when taken with Biaxin (clarithromycin) if you have decreased kidney function. Rescriptor should be used with caution with Procardia or Adalat (nifedipine), Norvasc (amlodipine), Plendil (felodipine), Coumadin (warfarin), and quinidine. Use caution with anti-convulsants: Tegretol (carbamazepine), phenobarbital, and Dilantin (phenytoin). Mycobutin (rifabutin) and Rifadin (rifampin), used to treat tuberculosis, decrease Rescriptor levels. Rescriptor is not recommended with either rifampin or Mycobutin. Rescriptor increases levels of protease inhibitors Crixivan, Lexiva, Invirase, Kaletra, Norvir, and Viracept, as well as immunosuppressants (including transplant drugs), birth control pills (ethinyl estradiol), and methadone, so caution is advised if using together. Cialis, Levitra, and sildanafil (Viagra) levels are increased by Rescriptor; doses should not exceed 10 mg Cialis or 2.5 mg Levitra per 72 hours, or 25 mg Viagra per 48 hours. Also, increased levels of trazodone can occur with Rescriptor and therefore should be used with caution. Increased levels of the inhaled and nasal sprays that contain fluticasone, a steroid for asthma or allergies (found in Advair, Flonase, and Flovent) can occur with Rescriptor which can result in Cushing's syndrome (increased fat in the abdomen, fatty hump between the shoulders, rounded face, red/purple stretch marks on the skin, bone loss, possible high blood pressure, and sometimes diabetes), and therefore should not be used unless no other options are available.

More information: Very rarely used due to its three-times-a-day dosing, it has not been compared to the newer NNRTIs and the studies done with Rescriptor included the older NRTIs (Retrovir, Videx, Hivid, Epivir) with only 45% of patients achieving a viral load of less than 400 copies/mL. Research demonstrates that smaller doses of Rescriptor increase blood levels of some protease inhibitors, making it unique among the NNRTIs. Some people who cannot tolerate Norvir (ritonavir) are successfully using Rescriptor instead to boost their protease inhibitor. Studies of this use, however, have not been published. A new booster medication for HIV drugs is on the way; see cobicistat. See package insert for more complete information on potential side effects and interactions.


Doctor's Comments

It's the rare patient who takes Rescriptor anymore, not that it was ever a widely used drug. It may be less potent than other NNRTIs, was never extensively studied, and has to be taken three times a day. It was sometimes used in patients with unusual NNRTI mutations that caused resistance to Viramune and Sustiva but not to Rescriptor, but most of those patients are now taking Intelence. As with any NNRTI, Rescriptor can cause rash. It has drug interactions that are different from those of other NNRTIs: It increases levels of protease inhibitors rather than decreasing them. It was once suggested as an alternative PI booster for that reason, but no one was excited about taking a booster three times a day.

-- Joel Gallant, M.D., M.P.H.


Activist's Comments

I've never met a single person on this drug, and I don't have much to say about it. Relegated to the dark dusty corners of the HIV regimen history books, I guess. Next!

-- Joey Wynn


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This article was provided by Positively Aware. It is a part of the publication Positively Aware. Visit Positively Aware's website to find out more about the publication.
 
See Also
The 16th Annual HIV Drug Guide
More on HIV Medications
More on Rescriptor (Delavirdine)

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