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Test Positive Aware Network
Crixivan (Indinavir Sulfate, IDV)
January/February 2008
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Brand Name: Crixivan
Common Name: indinavir sulfate (IDV)
Class: HIV protease inhibitor (PI)
Standard Dose: Rarely used by itself (two 400 mg capsules every eight hours with no food or a low-fat snack). Almost always boosted with Norvir, both twice daily: 400 mg Crixivan + 400 mg Norvir; 800 mg + 100 mg; or 800 mg + 200 mg (all combination doses taken with food, and with plenty of water to avoid kidney sludge or stones). Take missed dose as soon as possible, but do not double up on your next dose. Also available in 100 mg, 200 mg and 333 mg capsules.
AWP: $548.12/month for 400 mg, 180 capsules
Manufacturer contact: Merck and Co.,
www.crixivan.com, 1 (800) 850–3430
AIDSInfo: 1 (800) HIV–0440 (448–0440), www.aidsinfo.nih.gov
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| Potential side effects and toxicity: |
Headache, fatigue or weakness, malaise (general ill feeling), nausea, diarrhea, stomach pains, loss of appetite, yellowing of skin/eyes, changed skin color, dry mouth/sore throat, taste changes, painful urination, indigestion, joint pain, hives, and liver toxicity. Itchy/dry skin, ingrown toe nails and hair loss are unique to Crixivan. Kidney stones, which may lead to more serious problems, can also occur. If pain develops in the middle to lower stomach or the back, or if there is blood in the urine call your healthcare provider immediately. An increase in bilirubin (a test of liver function) has been reported, but it is not associated with liver problems. It may sometimes cause yellowing of the skin or eyes. As seen with other protease inhibitors, there can be increased levels of cholesterol and triglycerides (except possibly unboosted Reyataz) which may be associated with an increased risk of heart disease. Other possible side effects seen with protease inhibitors are lipodystrophy (body fat changes, including thinning of the face, arms and legs, with or without fat accumulation in the stomach, breasts and sometimes the upper back), onset of new cases or worsening of diabetes (see your doctor promptly) and increased bleeding in hemophiliacs. Immune Reconstitution Inflammatory Syndrome (IRIS) may occur as the immune system regains strength; report symptoms of illness, such as shingles and TB, to health care provider.
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| Potential drug interactions: |
Do not take with Tambocor (flecainide), Rythmol (propafenone), Cordarone (amiodarone), midazolam, triazolam, rifampin, pimozide, ergot derivatives (such as Cafergot, Wigraine, Methergine, and D.H.E. 45), garlic supplements, or the herb St. John's wort. Do not use simvastatin, Vytorin, or lovastatin; lipid-lowering alternatives are Lipitor, Lescol, and pravastatin, but they should be used with caution due to potential for liver toxicity.
Not recommended in combination with Reyataz. Reduce Crixivan to 600 mg every eight hours when taken with Rescriptor. Reduce Crixivan to 600 mg every eight hours when taken with itraconazole (200 mg twice-a-day) or ketoconazole (200 mg once-a-day). The dose of Mycobutin should be reduced by 50% and increase Crixivan dose to 1,000 mg every eight hours when taken together.
Cialis, Levitra, and Viagra levels are increased; doses should not exceed 10 mg Cialis per 72 hours, 2.5 mg Levitra per 24 hours, or 25 mg Viagra per 48 hours.
Effectiveness of birth control pills may be decreased; consider the use of alternative or additional contraception. Additional monitoring may be required when taking Coumadin (warfarin), immunosuppressants, or calcium channel blockers (such as Norvasc, Procardia, and others). Tegretol (carbamazepine), Dilantin (phenytoin), or phenobarbital may decrease Crixivan, so alternate seizure medications should be used. Crixivan may decrease levels of methadone but withdrawal rarely occurs and methadone doses may need to be increased. Also, increased levels of trazodone (Desyrel) can occur with Crixivan. Increased levels of the inhaled and nasal sprays with fluticasone, a steroid for asthma or allergies (found in Advair, Flonase, and Flovent) can occur with Crixivan and therefore should be used with caution.
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| Tips: |
Drink at least 48 oz. of fluids daily, preferably water or clear liquids (soda pop doesn't count!) to decrease the chances of a kidney stone. Don't forget to drink more water in summer or with increased sweating. Large amounts of coffee or alcohol can increase risk of stones due to increased dehydration. Stones may continue after stopping Crixivan. Grapefruit juice decreases Crixivan blood levels. Store in original container and keep dry. Please see package insert for more complete potential side effects and interactions.
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| Doctor |
| In the early years of the HAART era, when people mentioned "The Cocktail," they were often referring to a combination of Combivir and Crixivan, a regimen that saved countless lives in the late '90's. Today, that "cocktail" is as out of fashion as the Harvey Wallbanger. Looking back, I find it incredible that so many people could take it correctly, but those were desperate times. If you did things right, you took five rigidly-timed doses per day: one capsule of Combivir twice a day, usually with food to decrease side effects, and two capsules of Crixivan every eight hours on an empty stomach, at least a half hour before and two hours after eating. You also had to drink water all day to avoid kidney stones. The compulsive folks who were able to do this right did well, but they were slaves to the clock. Crixivan also caused dry skin, ingrown toenails, chapped lips, hair loss, diabetes, and even rare cases of kidney failure. Crixivan is seldom used anymore, and when it is, it's boosted with Norvir, which simplifies the dosing schedule but doesn't eliminate the side effects. Since it's rare to have a virus that's susceptible only to Crixivan, I don't come across many reasons to use this drug anymore, though I'm grateful for all the lives it saved. -- Joel Gallant, M.D. |
| Activist |
| being very difficult to use. The two alternatives had even worse problems. Crixivan had to be taken three times a day, eight hours apart, without food, and with several glasses of water. Even when used with care, the drug often resulted in kidney stones. Once Viracept came along with simpler dosing and a side effect profile largely limited to diarrhea, sales of Crixivan collapsed and never recovered. Despite this, the drug is still used by a small number of people today, largely because it worked well for them and their doctors discouraged them from changing. Merck demonstrated a great sense of civic responsibility in the pricing of Crixivan, charging a price that was more than $2,000 per year below that of competing PIs. Unfortunately, the company got little credit or acknowledgement for this and therefore didn't repeat the act the next time they got a drug approved, nor did any other company follow Merck's lead. -- Martin Delaney |
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This article was provided by Test Positive Aware Network. It is a part of the publication Positively Aware.
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