MedicalAlert.pdf
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- MedicalAlert.pdf
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DICAL
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this issue sponsored by
Philip Morris Companies Inc. and
Ross Products Division of Abbott Laboratories
ISSUE ONE 1998
Standards Set for the Treatment of
HIV in Children
Guidelines for the treatment of HIV infection in children were recently released by the U.S. Department of Health
and Human Services. The guidelines were developed by the Working Group on Antiretroviral Therapy and Medical
Management of HIV-infected Children convened by the National Pediatric and Family HIV Resource Center and
sponsored by the Health Resources and Services Administration. These guidelines are intended to be general
recommendations to physicians caring for HIV-infected infants, children and adolescents and serve as a companion
to the Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents that were released in November
1997 (See November/December is.sue of Medical Alert).
The following is a brief summary of the guidelines. Copies of the complete guidelines are available from the
National AIDS Clearinghouse (800-458-5231)
Important concepts influencing these antiretroviral guidelines include:
1. Identification of HIV infected women before or during pregnancy is critical to providing optimal therapy for both
infected women and their children and preventing perinatal transmission.
2. Determination of HIV RNA copy number and CD4 + lymphocyte levels are essential for monitoring and
modifying antiretroviral treatment in infected children and adolescents as they are valuable prognostic markers.
(see tables I and 2)
3. Viral replication is continuous and maximal viral suppression, preferably to undetectable levels, is the optimal
goal of antiretroviral therapy.
4. The choice of antiretroviral regimens for children and adolescents should take into consideration factors
influencing adherence to therapy, including: a) availability and palatability of pediatric formulations; b) impact of
the medication schedule on quality of life, including number of medications, and need to take with or without
food; c) ability of the child's caregiver or the adolescent to administer complex drug regimens and availability of
resources might be effective in facilitating adherence; d) the potential for drug interactions; and e) the potential
for the development of antiretroviral resistance.
continued on page 14
Table I
1994 Revised Pediatric HIV Classification System:
Immunologic Categories Based on Age-Specific
CD4+ Lymphocyte Count and Percentage
Managing Pain in
HIV Disease
An Update from the
16th Annual Scientific Meeting of the
American Pain Society
by A. Cornelius Baker
For some it can be a raging headache that comes from
nowhere and goes in a snap, for others the constant
tingling sensation in the feet or fingers caused by
peripheral neuropathy and for still others it can be a
severe burning in a throat coated with thrush. Each of
these experiences of pain commonly occur in people
with advanced HIV disease, or AIDS. Studies suggest
that 40% to 60% of people with AIDS are likely to be
in pain and that this condition also effects about one
third of people with early stage HIV disease.
Pain in people with HIV is similar to, and occasionally
stronger than, pain in people with cancer. Clinicians
should follow the same core principles for the
management and treatment of pain in both groups. The
World Health Organization (WHO) guidelines for
management of cancer pain have been endorsed by the
U.S. Public Health Service (PHS)'s Agency for Health
Care Policy and Research (AHCPR) and by clinical
experts in AIDS care. Treatment should be based on
WHO's analgesic ladder, and the selection of
analgesics (pain relievers) should be based on the
severity and mechanism of pain. Opioid analgesics are
the most powerful and effective pain relievers for
treating severe pain. The most common side effects of
pain medication are constipation, nausea, vomiting,
drowsiness and slowed breathing. Counter-measures
can be taken to prevent or treat these side effects in
order to ease unnecessary pain in people with
HIV/AIDS.
Age of Child
Immune Category
Category 1:
No suppression
Category 2:
Moderate suppression
Category 3:
Severe suppression
under 12 mos
number/µL (%)
<! 1,500 (<! 25%)
1-5 yrs
6-12 yrs
number/µL (%)
number/µL (%)
<! 1,000 (<! 25%)
750-1,499 (15-24%)
500-999 (15-24%)
<! 500(<!25%)
The American Pain Society 16th Annual Scientific
Meeting held in New Orleans, October 23 - 26, 1997
offered participants current information about the
diagnosis, treatment, and management of acute pain,
chronic cancer and noncancer pain, and recurrent pain.
200-499 (15-24%)
Pain is Undertreated in Most People with HIV
< 750(<15%)
< 500 (<15%)
< 200 (<15%)
Modified from Centers for Disease Control. 1994 Revised Classification System for Human Immunodeficiency Virus Infection in
Children Less than 13 Years of Age. MMWR 1994;43 (No. RR-12): 1- 10
According to William Breithart, MD of Memorial
Sloan-Kettering Cancer Center in New York
(212.639.2000) pain in AIDS is much less adequately
INSIDE:
Getting What You Need: Annual Health Care Access Guide
Produced with support from the U.S. Health Resources and Services Administration (HRSA)
continued on page 3
ON the PULSE...
NIH Study on Mouth Sores
To the Reader:
NAPWA was founded 15 years ago with the belief
that people with AIDS would survive this
epidemic by equipping themselves with
information about the virus and sharing it with
others. We still hold this to be true.
Since 1992, Medical Alert has been one of the
tools NAPWA has used to provide you and others
with life saving information. From reader
responses and the number of request we get daily
from new people wanting to join the mailing list
we know its value to you. AIDS, or HIV disease,
has changed dramatically over the last year and it
has evolved into an even more complex health
condition. Because of this, our strategies are
changing to meet new challenges.
The National Institute of Dental Research and the
Clinical Center at NIH are looking for patients age
18 and older to take part in a study of a promising
new treatment for mouth sores associated with
HIV and AIDS. Those who qualify receive care
by some of the nation's leading experts in the field.
The study medication, a gel applied directly to the
sores, is provided at no cost. Participants can stay
on their regular course of medical treatment for
HIV or AIDS while participating in this study.
People or their doctors can contact NIH's Patient
recruitment and Referral Center for more
information: (Interested deaf or hard-of-hearing
callers should use their state relay services to
contact these telephone numbers) at 800.4 I 1.1222
or E-Mail: prrc@nih.gov. Patients living outside
the Washington, DC metropolitan area should ask
about compensation for travel expenses.
New Cytovene Capsule on the Market
Beginning with this issue, Medical Alert will be
published four times a year on a quarterly basis.
We believe this publication schedule better
reflects the flow of new scientific information and
medical advances. Our focus will also expand
slightly to provide more information on health
care access and quality of care, including working
with your physician, AIDS service organization,
and managed care provider to advocate for your
needs. Our Education staff will continue to assist
you in finding up-to-date information and linking
you to other national and local organizations
meeting your special needs.
NAPWA also takes this opportunity to welcome
Charles Nelson, our new Associate Director for
Health Education. Charles, a graduate in biology
from Morehouse College, is an African-American
gay man living with HIV who has long been
involved in treatment education and advocacy.
He has also been a member of the National Task
Force on AIDS Drug Development, convened by
the U.S. Department of Health and Human
Services and the Working Group on Guidelines
for the Prevention of AIDS related Opportunistic
Infections, convened by CDC, NIH and the
Infectious Disease Society of America. We look
forward to his leadership as editor of this
publication.
Thank you for your continued support. Together,
we will continue to learn and do what we must
to survive.
A. Cornelius Baker
Executive Director
2
Hoffmann-La Roche has introduced a new 500 ~g
capsule of CYTOVENE (ganciclovir) for
maintenance treatment of CMV retinitis, the most
common manifestation of CMV disease.
The company has also received approval from
the FDA to market the new capsule for use in
the prevention of CMV disease in people with
advanced HIV (AIDS). The new Cytovene capsule
will reduce a person's daily pill count of
ganciclovir in half-from 12 capsules to six per day.
Drug to Treat Crypto on Fast Track
The FDA has granted priority review status to
Unimed Pharmaceuticals, Inc. new drug
application (NDA) to market NTZ (nitazoxanide)
for the treatment of cyrptosporidial diarrhea in
people with HIV disease. This NDA is the first
application for treatment of the diarrhea associated
with cyrptosporidiosis. In immunocompromised
patients, crypto is a serious medical condition that
can be fatal without effective treatment. An FDA
priority review ensures that a NDA will be
completely reviewed and acted upon within six
month of receipt. Unimed holds an exclusive
license to develop and market oral dosage forms
of NTZ for human use in the U.S.
Regain Strength and Restore EnergyAnabolic Treatment for Anemia
In a recently published study by the CDC's
National Center for HIV, STD, and TB Prevention,
anemia, or a low number of red blood cells, is
indicated as a frequent complication of HIV
infection. According to the study, people who
developed anemia but never recovered had a
170% greater risk of death than people who
developed anemia but later recovered.
Chronically ill patients now have an additional
tool to help combat the debilitating effects of
anemia. Anadrol®-50 (oxymetholone) -- 50 mg
tablets -- is the only oral anabolic-androgenic
hormone indicated for the treatment of anemia.
National Association of People with AIDS
Anadrol®-50 helps people suffering from anemia
by stimulating red blood cell production by
enhancing the release of the body's own
erythropoietin, as well as directly signaling the
stem cells within the bone marrow to produce red
blood cells. Unimed Pharmaceuticals, Inc. has
established a Patient Assistance Program and
Reimbursement Hotline: 1-800-256-8918.
Drug Shown to Reduce Shedding of Herpes
Virus in People Living with HIV
The University of Minnesota recently released
results from a study led by Dr. Timothy Schaker
showing that Famciclovir (Famvir.., SmithK.Iine
Beecham Consumer Healthcare) when taken daily
significantly reduces asymptomatic shedding, the
time when the herpes virus is contagious but there
are no signs or symptoms, in HIV-infected patients
with genital herpes. Herpes simplex virus
infection is one of the most common infections
among people living with HIV. This study is
important because genital herpes outbreaks in
people living with HIV occur more frequently; are
especially severe; and can lead to life-threatening
complications. For more information, contact Dr.
Timothy Schacker, Assistant Professor of
Medicine at the University of Minnesota, at 1-612624-9955, or call Clara Morris at 1-212-598-2807.
Crixivan® Receives Full Approval by the FDA
The U.S. Food and Drug Administration (FDA)
recently granted traditional approval to Crixivan ..,
Merck & Company's HIV protease inhibitor,
based on the results from two studies that confirm
the clinical benefits of combination therapy with
Crixivan reduces AIDS-defining illnesses or death
and produces prolonged suppression of
HIV/RNA. Merck has developed, with the
American Dietetic Association, a list of foods,
light meals or snacks that can be taken with
Crixivan. For more information visit Merck's new
website www.crixivan.com.
NAPWA is committed to your survival.
For 24 hour confidential toll-free
information on CMV call the
National
CMV
HOTLINE
800·838-9990
(
Managing Pain
cantmued from page 1
treated than cancer pain. Recent studies cited by Dr. Breithart, during his keynote address, suggest that "only
6% of AIDS patients with severe pain are prescribed a strong opioid like morphine, despite the fact that the
WHO Analgesic Ladder suggests that clinicians consider using strong opioids in all patients with severe pain."
Using the Pain Management Index as a measure of adequacy of analgesic therapy, only 15% of AIDS patients
with pain receive adequate analgesic therapy, compared to almost 60% of cancer pain patients. Dr. Breithart
has also found that women with AIDS-related pain are twice as likely to be undertreated than men. People
with less formal education and those who contracted HIV through injection drug use are also more
undertreated for pain.
The following chart provides information on opioid analgesics:
Opioid Analgesics
Drug
Length of Effectiveness
Other Information
Morphine
Intravenous or intramuscular-2 to 3 hours
By mouth-3 to 4 hours
Sustained release~ to 12 hours
Starts to work quickly. Oral form can be very
effective for cancer pain
Codeine
By mouth-3 to 4 hours
Less potent than morphine. Sometimes taken with
aspirin or acetaminophen
Meperidine
Intravenous or intramuscular-3 hours
By mouth_:_not very effective
Can cause seizures, tremors, and muscle spasms
Methadone
By mouth-4 to 6 hours, sometimes longer
Also used to treating heroin withdrawal
Propoxyphene
By mouth-3 to 4 hours
Generally taken with aspirin or acetaminophen to
treat mild pain
Levorphanol
Intravenous or intramuscular-4 hours
By mouth-about 4 hours
Oral form is strong. Can be used instead of morphine
Hydromorphone
Intravenous or intramuscular-2 to 4 hours
By mouth-2 to 4 hours
Rectal suppository-4 hours
Begins wto work quickly. Can be used instead of
morphine. Helpful for cancer pain
Oxymorphone
Intravenous or intramuscular-3 to 4 hours
Rectal suppository-4 hours
Starts to work quickly
Oxycodone
By mouth-3 to 4 hours
Usually combined with aspirin or acetaminophen
Pentazocine
By mouth-up to 4 hours
Can block painkilling action of other opioids. About
as strong as codeine. Can cause confusion and
anxiety, especially for the elderly.
Source: The Merck Manual of Medical Infonnation Home Edition, Merck Research Laboratories, 1997
The Women, Suffer...
April Hazard Vallerand, Ph.D., R.N. , University of Pennsylvania School of Nursing in Philadelphia
(732.780.6224) reported the findings of a pilot study to assess the relationship of pain to functional status and
quality of life in women with HIV/AIDS. A sample of 25 women with HIV infection or AIDS with pain
complaints in a primary care clinic dedicated to the care of people with HIV were asked to complete several
assessment tools including the Brief Pain Inventory (BPI), the Inventory of Functional Status - Chronic Pain
(IFS-CP), the Functional Assessment of HIV Infection (FAHi) quality of life instrument, and a demographic
data sheet. The majority of participants had severe pain in the past week. Adequacy of analgesic therapy was
assessed using the Pain Management Index and the type and frequency of analgesics prescribed for pain.
Based on the PMI, 79% of the women reporting severe pain were receiving inadequate pain relief therapy. Of
the 12 participants reporting severe pain, 7 were receiving no analgesic therapy, while only 2 were prescribed
a strong opioid. The women with pain were found to have decreased functional status. Lower quality of life
scores were also found in those women with lower functional status.
Dr. Vallerand acknowledges in her conclusion a need for more information on the effects of pain and its
relationship to function status in women. But given previous data on the lack of effective pain medication
being offered to women, improving the management of pain in women should be a priority for clinicians.
Hospitalized Persons with AIDS). For this study, data
was gathered from audiotape, open-ended interviews
with eleven hospitalized people, film, literature, firstperson accounts and clinical observations. The
evaluative criteria of trustworthiness was applied to
assure rigor. The participants interviewed were a
mixed group: 8 men and 3 women, ages 28-44. Of
these 7 were white, 2 black, and 2 Latino. Eight
individuals had a history of chemical dependence
(either alcohol and/or cocaine and/or heroin).
From the interviews and other data five themes were
identified, four of which were common among all
participants: knowing pain, battling pain, pain's
influence and having AIDS. The fifth theme,
being a drug user, was found only among the
chemically dependent.
Theme 1 ("Knowing Pain") is focused on the difficult
task of describing pain and its impact on the body.
According to the study, participants often described
pain using metaphors, such as "It feels like someone
poking you with needles." Theme 2 (Battling Pain)
centers on the strategies adopted by individuals for
addressing pain and the barriers to pain relief.
Barriers include nurses, family members, friends and
patients themselves who do not take episodes of pain
seriously, especially among those with histories drug
addiction. Interestingly, Dr. Newshan reports that
participants both fought for and feared 'the big guns,'
or strong opiates. One participant described the
experience of opiates for pain management as "It's
like pulling teeth to get them" while another said the
morphine caused him/her "to feel like a zombie -- it
was scary." Under theme 3 (Pain's Influence) all of
the participants described the limitations placed on
their lives due to pain and, often, the greater
spirituality they gained.
Theme 4 (Having AIDS) related pain to the "uckky"
experience of having AIDS. And theme 5 (Being a
drug User) captures the very real experience of people
living with AIDS who have histories of drug use. For
these individuals pain management is made especially
hard because of the high tolerance to the effects of
opiates that their bodies have developed and the bias
of many healthcare providers in prescribing pain
medication to current or former drug users.
The participants of the study who all experience
multiple sources of pain which influences all of their
lives, and often feel unheard recommended the
following for clinicians:
I.
2.
3.
4.
5.
Listen to me.
Do not abandon me.
Keep trying.
Keep me informed.
Do not judge me.
Dr. Newshan concludes, "as healthcare givers, we
must ask [ourselves], 'Am I listening?"'
Duragesic: Another Route to Pain Relief
... While Drug Users Struggle
In a poster session Dr. Gayle Newshan, Ph.D., NP, St. Vincent's Hospital in New York City (212.604.7465)
reported on her study designed to increase understanding of the lived experience of pain in hospitalized people
with AIDS using a qualitative perspective (Is Anybody Listening? A Phenomenological Study of Pain in
Medical Alert • Issue One 1998
In another study conducted by Dr. Newshan with
Matthew Lefkowitz, MD, State University of New
York, Health Science Center at Brooklyn, New York
continued an page 11
3
(
Anyone can get HIV. Everyone should be
able to fight back.
Introducing VIRACEPT. A potent new protease inhibitor for children and adults.
The worrisome news is that women and children are
inhibitors. (The clinical significance of laboratory studies of
the fastest-growing groups becoming infected with HIV.
protease inhibitor resistance and changes in viral RNA
But now, treatments to combat the virus have shown
levels in blood has not been established for VIRACEPT.
promising results. VIRACEPT is a powerful new protease
The virus may still be present in other organ systems.)
inhibitor now available for the treatment of HIV infection
People treated with VI RACE PT may experience
in children (ages 2-13) and adults when anti-HIV drug
some side effects; the most common is diarrhea in
therapy is warranted.
approximately 200/o of people in clinical trials. There
VI RACE PT is available in tablets and a pleasant
are some common medications and some AIDS-related
tasting oral powder that can be mixed with water, formula,
medications you should not take with VIRACEPT. It
or dairy products. VIRACEPT is generally well-tolerated, is
is important to discuss with your doctor all other
taken three times a day with normal meals or light snacks,
medications that you or your child are taking.
and requires no special dietary restrictions.
We still can't make any long-term promises, since
Most importantly, VIRACEPT is effective. In many
it is not yet known whether taking VIRACEPT will help
adult patients, VIRACEPT lowered the amount of HIV in
you or your child live longer or reduce the number
the blood to levels below the limit of detection of the test
of infections or other illnesses that can occur with HIV.
used, and substantially increased CD4 cell counts after
But if you're ready to fight back, talk to your doctor
24 weeks of triple combination therapy. And in laboratory
about VIRACEPT. Or for more details, call toll free
studies, HIV obtained from five patients that became
1-888-VIRACEPT or visit www.agouron.com.
resistant to VI RACE PT was not resistant to other protease
VIRACEPT.
nelfinavir mesylate
Refer to the important information on the next page.
ff!l!!1f!!!'
Agouron_
Pharmaceuticals re
~
4
1997 Agouron Pharmaceuticals, Inc.
National Association of People with AIDS
(
5
Medical Alert • Issue one 1998
(
VIRACEPT
nelfi navi r rnesylate
Information for Patients About VIRACEPT" (Vl-ra-cept)
Generic Name: nelfinavir (nel-FIN-na-veer) mesylate
For the Treatment of Human Immunodeficiency Virus (HIV) Infection
Please read this information carefully before taking VIRACEPT. Also, please read this leaflet each time
rgruar~~~:;uttdif~~~~r~t~ttti~~~i:1loa;t~~1o~i~~l:6~rhd~~t~~- ~h~~I~
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ig~:
0JJcri~e
when taking
WHAT IS VIRACEPT AND HOW DOES IT WORK?
VIRACEPT is used in the treatment of people with human immunodeficiency virus (HIV) infection.
Infection with HIV leads to the destruction of CD4 T cells, which are important to the immune system.
After a large number of CD4 cells have been destroyed, the infected person develops acquired immune
desi1~li%¥~;~k~ebt~Po~king HIV protease (a protein-cutting enzyme), which is required for HIV to
multiply. VIRACEPT has been shown to significantly reduce the amount of HIV in the blood. You should
be aware, however, that the effect of VIRACEPT on HIV in the blood has not been correlated with longterm health benefits. Patients who took VIRACEPT also had significant increases in their CD4 cell count.
VIRACEPT Is usually taken together with other antlretrovlral drugs such as Retrovi,. (zidovudine,
AZT), Epivi,. ~lamivud1ne, 3TC), or Zerit" 15tavudine, d4T). Taking VIRACEPT in combination with other
ang~xiE~r m~~gg;;~~ec;tta~~Ws~~~~fes~~~:~. ~;li~rd\~~aJ 1e~i t~~~:i~~so~~:.
younger than 2 years of age are now taking place.
i~i~~. in infants
DOES VIRACEPT CURE HIV OR AIDS?
VIRACEPT is not a cure for HIV infection or AIDS. The long-term effects of VIRACEPT are not known at
~~i:o~ii~:d ~~~l~~kl~fec~l::ci~~em;r t~~~e dg~~~rio~~p~~u~~!ii~~~i~~ioh~~p~~ ~~~~~ fn°f~~~1~~ns~
Mycobacterium avium complex (MAC) infections, and Kaposi's sarcoma.
It is not known whether VIRACtPT will help you live longer or reduce the number of infections or other
illnesses that may occur..
There is no proof that VIRACEPT can reduce the risk of transmitting HIV to others through sexual
contact or blood contamination.
WHO SHOULD OR SHOULD NOT TAKE VIRACEPT?
yo:~gJ;~fs\:'.~:Oof~\1g~f~~';,~g~1~:edc~n~~c~~:thether VIRACEPT is appropriate for you. In making
Allergies: II you have had a serious alle111lc reaction to VIRACEPT, you must not take VIRACEPT.
You should also inform your doctor, nurse, or pharmacist of any known allergies to substances such as
ot~e;:ue~~;inper;;g~~t fh:s:ne~~~eit Zii~~.CSEPT on pregnant women or their unborn babies are not
known. If you are pregnant or plan to become pregnant, you should tell your doctor before taking
VIRACEPT.
II you are breast-feeding: You should discuss with your doctor the best way to feed your baby. You
should be aware that if your baby does not already have HIV, there is a chance that it can be transmitted
th~i~rdhr!~'.t~~~ii~"Pis~~~:~1:~g~l~."t~~:r~::-~~~~i\~:~~y2
3 years of age with HIV. There
is a powder form of VIRACEPT that can be mixed with milk, baby formula, or toads like pudding.
Instructions on how to take VIRACEPT powder can be found in a later section that discusses how
~~~~"~~vi
vi,~:~~~!v~rri~:~dl~~a~~~~ldR~'W,'f~~~dnot been studied in people with liver disease. If you have liver
disease, you should tell your doctor before taking VIRACEPT.
Other medical problems: Certain medical problems may affect the use of VIRACEPT. Be sure to tell
your doctor if you have hemophilia types A and B, diabetes mellitus, or an increase in thirst and/or
frequent urination.
CAN VIRACEPT BE TAKEN WITH OTHER MEDICATIONS?
VIRACEPT may interact with other drugs, including those you take without a prescription. You must
discuss with your doctor any drugs that you are taking or are planning to take before you take VIRACEPT.
Drugs you should nl!I take with VIRACEPT:
Seldane• (terfenadine, for allergies)
Hismana/9 (astemizole, for allergies)
Propulsid• (cisapride, for heartburn)
Cordarone•(amiodarone, for irregular heartbeat)
Quinidine (for irregular heartbeat), also known as Quinaglute~Cardioquin~Quinidex~and others
Ergot derivatives (Cafergot" and others, for migraine headache)
Halcion• (triazolam)
Versed" (midazolam)
Taking the above drugs with VIRACEPT may cause serious and/or life-threatening adverse events.
• Rifampin (for tuberculosis), also known as Rimactane•, Rifadin•, Rifater9, or Rifamate•
This drug reduces blood levels of VIRACEPT.
•
•
•
•
•
•
•
•
~~~~~~~~~l~~~euir~'.~:/IJ'tt)'.~~~
•
•
•
•
~~~~~:i!~~ a lower dose of Mycobutin.
A change ot therapy should be considered if you are taking VIRACEPT with:
Phenobarbital
Phenytoin (Dilantin• and others)
Carbamazepine (Tegretol• and others)
These agents may reduce the amount of VIRACEPT in your blood and make it less effective.
Oral contraceptives ("the pill")
U1~~;H~Tt~~~gr!~~g~ 1 ~~~ ~ff~~~i~~~~~~n;rgra1ycoounfr~~~~ti::. a different type of contraception since
HOW SHOULD VIRACEPT BE TAKEN WITH OTHER ANTI-HIV DRUGS?
Taking VIRACEPT together with other anti-HIV drugs increases their ability to fight the virus. It also
reduces the opportunity for resistant viruses to grow. Based on your history of taking other anti-HIV
medicine, your doctor will direct you on how to take VIRACEPT and other anti-HIV medicines. These
drugs should be taken in a certain order or at specific times. This will depend on how many times a day
each medicine should be taken. It will also depend on whether it should be taken with or without food.
Nucleoslde analogues: No drug interaction problems were seen when VIRACEPT was given with:
• Retrovir (zidovudine, AZT)
• Epivir (lamivudine, 3TC)
• Zerit,1.5tavudine, d4~
• ~i~~u ~~~d:an~~i;iot~ 1iidex (ddl) and VIRACEPT: Videx should be taken without food, on an empty
stomach. Therefore, you should take VIRACEPT with food one hour after or more than two hours before
you take Videx.
Nonnucleoside reverse transcriptase inhibitors (NNRTls):
When VIRACEPT is taken together with:
• Viramune• (nevirapine)
The amount of VIRACl:PT in your blood may be reduced. Studies are now taking place to learn about
• m~:~t~R~l~ombining VIRACEPT with Viramune.
VIRACEPT has not been studied with other NNRTls.
~~:~ ~~t:m+ni:it;:~~iogether with
6
• Crixivan• (indinavir)
The amount of both drugs in your blood may be increased. Currently, there are no safety and efficacy
data available from the use of this combination.
• Norvirr"" (ritonavir)
The amount of VIRACEPT in your blood may be increased. Currently, there are no safety and efficacy
data available from the use of this combinatmn.
• lnvirase• (saquinavir)
The amount of saquinavir in hour blood may be increased. If used in combination with saquinavir hard
~:~:ina~aJ:~\~!c~ ~~g ~v~~abi! ~~~:st~!i~Sen~f~~fse :i~;i~~fi~~- are needed. Currently, there are no
WHAT ARE THE SIDE EFFECTS OF VIRACEPT?
Like all medicines, VIRACEPT can cause side effects. Most of the side effects experienced with
VIRACEPT have been mild to moderate. Diarrhea is the most common side effect in people taking
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more loose stools a day. In most cases, diarrhea can be controlled using antidiarrheal medicines, such
~~:!te~~~t~i~