Treatment Alert: How to Use Protease Inhibitors the Right Way

AUGUST 1997

UPDATE: HOW TO USE PROTEASE INHIBITORS THE RIGHT WAY
by Richard Chara translated by MoL&66 Agosto

his idaue oj NMAC's Treatment Alert i6 an updated verMion oj HOW TO USE PROTCASE INHIBITORS THE RIGHT WAY,
originally publidhed in the Fall ot 1996. Ad alwayd, we
encourage you to hare thid information with people living
with HIV dideade and use a6 a tool to didcumd treatment
optiond with dervice providers.
Protease inhibitors are a new class of drugs used to stop the production of HIV in the body. Currently, there are 4 protease inhibitors
available with a prescription: InviraseTM (saquinavir), NorvirTM
(ritonavir), CrixivanTM (indinavir), and ViraceptTM (nelfinavir).
It has been proven that using protease inhibitors, in combination
with other anti-HIV drugs, can drive viral load measurements to levels below detection and increase CD4 cells for a long period of time.
Studies are now being conducted to understand the best ways to
use this new class of anti-HIV drugs. These studies address when to
start treatment, when to switch treatment, which drugs are best for
starting treatment, and which drugs are best for switching in case
treatment fails. Even though there are still many questions about
using protease inhibitors, we do know that they are very potent and
effective drugs.
Like all drugs, each protease inhibitor has different "advantages,"
"disadvantages" and "special considerations." These may influence
your choice of treatment, and you should discuss them with a
doctor, case manager or treatment advocate. Before
choosing a protease inhibitor, or any anti-HIV drug, you
should think about which drugs will work best with
your lifestyle, eating habits, as well as in your work
and home environments.

take protease inhibitors and all anti-HIV drugs as prescribed. Never
take "drug holidays" or doses less than what was prescribed in order
to eliminate side effects. Do not skip doses. Taking less than the
prescribed dose or skipping doses will cause you problems, including developing drug resistance.
A successful regimen will be one to which you can adhere and one
with which you can live. If you find that you are unable to take any
drug because its side effects are too strong or because the schedule
is too difficult to maintain, let your doctor know right away so that
both of you can find a workable solution.
Manufacturer: Roche Laboratories
Call 1-800-910-4687 for general information about Invirase.
Call 1-800-526-6367 for physician information.
Call i-800-282-778o for patient assistance program information.
Dose: 6oo mg (3 capsules 200 mg each)
Dose Frequency: Every 8 hours (3 times per day)
Special Considerations: Invirase must be taken with a full meal high
in fat. Do not take Invirase on an empty stomach.
Side Effects: Invirase seems to have the least potential for side
effects. The side effects that have been observed in a few people
include diarrhea, nausea, stomach discomfort, and sores in the
mouth.
Drug Interactions - Do not take Invirase with:

* Calcium channel blockers
* Cleocin (clindamycin)
* Dapsone (dapsone)
* Halcion (triazolam)
* Hismanal (astemizole)

* Mycobutin (rifabutin)
* Propulsid (cisapride)
* quinidine
* rifampin (Rifadin, Rimactane,
Rifamate, and Rifater)
* Seldane (terfenadine)

It is very important that all
anti-HIV drugs be taken as
prescribed, both in terms of
doses and times. Always

Nizoral (ketoconazole) - Be aware that Nizoral will elevate blood
levels of Invirase. Consult with you doctor, if you are taking Invirase
and Nizoral.