hiv medications

1.  CCR5  receptor antagonist  also known  as entry inhibitors

• Maraviroc :- Tablets  and oral solutions form  

20-mg/ml oral solution

25-mg  tab.

75-mg  tab.

150-mg  tab.

300–mg  tab.

Note : It should be taken with combination with others HIV medications. swallow the tablet whole not chew it. Take a missed dose  as soon as patient remember it and take next schedule dose as its regular time.

Side effects:- Liver problems, skin  reactions, allergic reactions, vomiting ,abdominal pain.

2) HIV fusion inhibitor 

Binds to gp41 preventing the creation of and entery pore for the capsid of virus, that’s keep it out of cell.

• Enfuvirtide:-  For adult - 90 mg SC twice  daily administered into upper arm, abdomen ,or anterior thigh.

(6 yr-16 yr ) 2mg/kg SC twice daily administer into upper arm, abdomen ,or anterior thigh. Maximum dose 90 mg SC twice daily. 

Side effects:- skin infections, or nerve irritation, Diarrhea, nausea, fatigue, wt. loss, cough, aches and pains, flue like symptoms.

3) Nucleoside reverse transcriptase inhibitors (NRTIs):

• Zidovudine- usual dose 200 mg 8  hourly oraly.

Side effects: anemia (macrocytosis) neutopenia ,hepatotoxicity, cardiac and skeletal myopathy, suppression of bone marrow, insomnia ,headache.

• Didanosine- less than 6o kg- 250 mg orally once a day.60 kg or more 400 mg orally once a day.

Side effect- GID, pancreatitis, Dry mouth,  hepatitis, hyperuricemia , renal failure, rash, seizures.

• Zalcitabine- 0.75 mg orally every  8  hours.

Side effects- GID, PN(20 %), apthous ulcers, hepatitis,pancreatitis(1%).

• Lmivudine

• Abacavir

4) Protease inhibitors (PI):

• Ritonavir- initial dose 300 mg orally twice a day; increase by 100 mg twice a day every 2 to 3 days to the full maintenance dose – 600 mg orally twice a day.

Side effect-  GID  ,kidney stone, hyperbilirubinemia , taste distortion.

• Indinavir:  800 mg  orally every 8 hr indinavir 800 mg  + ritonavir 100 – 200 mg orally every 12 hr.

Side effect- GID, kidney stones,  taste distortion ,hyperbilirubinemia.

• Nelfinavir-  its side effects  are Diarrhoea, rash ,hepatotoxicity
• Amprenavir-  its side effects  are GID , rash, peritoneal parasthenia.

5) Non – nucleotide reverse transcriptase inhibitors (NNRTI):

• Nevirapine- Initial dose  200mg orally once a day for 14 days. Maintenance dose 200mg orally twice a day.

Side effects- rash (common) , GID,  headache, hepatotoxicity

• Delaviridine: 400 mg orally 3 times a day.

Side effects- rash(common), GID, headache

6) Integrase  Inhibitors:

• Raltegravir- comes in following forms and strengths

- 400mg film-coated tab.

- 25mg and 100 mg chewable tab.

- 100 mg single use chewable for oral suspension.

Side effects- skin reaction, allergic reactions  and liver problems.

Regime-

• Always  3 or 4 drugs
• should always  include 2 NRTIs         
• 3^rd can be either PI or and NNRTI

Note: Efavirenz not  in pregnant women.

-May use 2 NNRTIs and 2 PIs .

• This combination therapy known as Highly Active

Antiretroviral  Therapy (HAART)

Note: zidovudine is given to all  HIV pregnant women as soon as she became pregnant .The additional 2 drugs for HAART should start at 14 weeks gestation. Baby should  be on zidovudine for at least 6 weeks , monitored until 18 months.