Drug Guide

Generic Name

Indinavir sulfate

Brand Names Crixivan

Classification

Therapeutic: Antiretroviral, protease inhibitor

Pharmacological: Protease inhibitor

FDA Approved Indications

  • Treatment of HIV-1 infection in combination with other antiretroviral agents

Mechanism of Action

Indinavir inhibits the HIV-1 protease enzyme, preventing the cleavage of viral polyprotein precursors into mature, infectious viral particles, thereby inhibiting viral replication.

Dosage and Administration

Adult: Typically 800 mg every 8 hours, with or without food, as part of combination antiretroviral therapy.

Pediatric: Dosage determined by body weight, under specialist supervision.

Geriatric: Adjustments based on renal function and tolerability.

Renal Impairment: Use with caution; dosage adjustment may be necessary.

Hepatic Impairment: No specific adjustment; use with caution.

Pharmacokinetics

Absorption: Well absorbed orally; food may delay absorption but does not reduce overall absorption.

Distribution: Widely distributed; highly protein-bound (~60-65%).

Metabolism: Primarily hepatic via CYP3A4.

Excretion: Feces (main route), small amount in urine.

Half Life: Approximately 2-4 hours.

Contraindications

  • Known hypersensitivity to indinavir or component ingredients.

Precautions

  • Use with caution in patients with renal impairment, hepatic impairment, or kidney stones.

Adverse Reactions - Common

  • Nephrolithiasis (kidney stones) (Less frequent; monitor renal function)
  • Hyperbilirubinemia (Common)
  • Rash (Common)
  • Lipodystrophy, hyperlipidemia, elevated liver enzymes, nausea, diarrhea. (Variable)

Adverse Reactions - Serious

  • Immune reconstitution syndrome (Rare)
  • Stevens-Johnson syndrome and toxic epidermal necrolysis (Very rare)
  • Hepatotoxicity (Rare)
  • Acute renal failure (due to nephrolithiasis) (Less frequent)

Drug-Drug Interactions

  • Ritonavir (potentiates indinavir levels), other CYP3A4 inhibitors or inducers, drugs affecting renal function.

Drug-Food Interactions

  • High-fat meals may delay absorption; take consistently with or without food as advised.

Drug-Herb Interactions

  • St. John’s Wort (may decrease efficacy).

Nursing Implications

Assessment: Monitor renal function, liver function, lipid profile, and presence of renal stones.

Diagnoses:

  • Risk for renal stones, altered renal function, hyperlipidemia.

Implementation: Administer as prescribed; ensure adequate hydration to prevent kidney stones; monitor for adverse effects.

Evaluation: Assess renal function, adherence, and effectiveness of viral suppression.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Maintain adequate hydration (at least 48 ounces of water daily).
  • Report signs of kidney stones (flank pain, blood in urine).
  • Adhere to regular monitoring appointments.
  • Be aware of potential side effects and drug interactions.

Special Considerations

Black Box Warnings:

  • Risk of nephrolithiasis; recommend hydration and monitoring of renal function.

Genetic Factors: None specified.

Lab Test Interference: May slightly increase bilirubin levels without jaundice.

Overdose Management

Signs/Symptoms: Nausea, vomiting, dizziness, hypotension.

Treatment: Supportive care; no specific antidote; monitor renal function; provide hydration and symptomatic treatment.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable under recommended conditions for shelf life indicated in packaging.

This guide is for educational purposes only and is not intended for clinical use.