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If the strong CYP3A4 inhibitor is discontinued, titrate the nilotinib dose upward to the recommended dose following a washout period. Nimodipine: Anti-retroviral protease inhibitors are CYP3A4 inhibitors and may decrease the hepatic metabolism of nimodipine, leading to increased plasma concentrations of nimodipine.
In addition, ritonavir and calcium channel blockers both prolong the PR interval and the manufacturer for ritonavir recommends caution during coadministration. Monitor therapeutic response and for adverse effects, such as hypotension. Nintedanib: Indinavir is a potent inhibitor of CYP3A4 and nintedanib is a minor CYP3A4 substrate. Coadministration may increase the concentration and clinical effect of nintedanib.
If concomitant use of indinavir and nintedanib is necessary, closely monitor for increased nintedanib side effects including gastrointestinal toxicity, elevated liver enzymes, and hypertension. A dose reduction, interruption of therapy, or discontinuation of therapy may be necessary. Nisoldipine: Anti-retroviral protease inhibitors may decrease the hepatic CYP metabolism of calcium-channel blockers mainly through CYP3A4 inhibition resulting in increased calcium-channel blocker concentrations.
Norethindrone: Many anti-retroviral protease inhibitors may interact with hormonal agents like norethindrone, due to their actions on CYP metabolism, particularly CYP3A4. Olaparib is a CYP3A4 substrate and indinavir is a strong CYP3A4 inhibitor.
Perform standard glucose screening in women receiving antiretroviral therapy at 24 to 28 weeks gestation, although it should be noted that some experts would perform earlier screening with ongoing chronic protease inhibitor-based therapy initiated prior to pregnancy, similar to recommendations for women with high-risk factors for glucose intolerance.
All pregnant women should be counseled about the importance of adherence to their antiretroviral regimen to reduce the potential for development of resistance and perinatal transmission. If a woman decides to discontinue therapy, a planned treatment interruption, taking into account the specific pharmacokinetic and administration parameters of each drug, should occur to avoid true or functional monotherapy and the development of resistance.
To reduce the risk of postnatal transmission, HIV-infected mothers within the United States are advised by the Centers for Disease Control and Prevention to avoid breast-feeding. This recommendation applies to both untreated women and women who are receiving antiretroviral therapy. Limited data suggest indinavir is excreted into breast-milk. Other antiretroviral medications whose passage into human breast milk have been evaluated include nevirapine, zidovudine, lamivudine, and nelfinavir.
The pharmacokinetic profiles of indinavir at this dose were not comparable to profiles previously observed in adults receiving the recommended dosage. Although viral suppression was noted in 32 of 70 children receiving this dosage through 24 weeks, a substantially higher incidence of nephrolithiasis was reported as compared to adults. Physicians considering the use of indinavir in pediatric patients with or without other protease inhibitors should be aware of the limited data available and increased risk of nephrolithiasis in this population.
Indinavir should be used cautiously in patients with hemophilia type A and B. There have been reports of increased bleeding, including spontaneous skin hematomas and hemarthrosis, in patients with hemophilia type A and B treated with protease inhibitors. Some patients required additional factor VIII.
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Coadministration is expected to substantially increase vardenafil plasma concentrations and may result in vardenafil-related adverse events including hypotension, visual changes, and priapism. In addition, indinavir exposure may be reduced. If used together, the vardenafil dose should not exceed 2.
Coadministration of indinavir 800 mg every 8 hours with a single dose of vardenafil 10 mg altered the pharmacokinetics of vardenafil with a 16-fold increase in AUC, a 7-fold increase in Cmax, and a 2-fold increase in half-life.
Vemurafenib: Concomitant administration of indinavir and vemurafenib may increase vemurafenib concentrations and alter indinavir concentrations.
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Olaparib is a CYP3A4 substrate and indinavir is a strong CYP3A4 inhibitor. Coadministration with itraconazole, another strong CYP3A4 inhibitor, increased the AUC and Cmax of olaparib by 2. Omeprazole: Omeprazole has been reported to decrease the oral bioavailability of indinavir. Oritavancin is a weak inducer of CYP3A4 and indinavir is a CYP3A4 substrate.
Orlistat: According to the manufacturer of orlistat, HIV RNA levels should be frequently monitored in patients receiving orlistat while being treated for HIV infection with anti-retroviral protease inhibitors.
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Regular monitoring of your blood to assess sugar levels and other measurements will help you and your doctor be aware of changes that might suggest problems with your blood sugar. Although the risk of developing diabetes is generally low, symptoms that may be related to diabetes increased thirst, increased urination, unexplained weight loss, fatigue and dry, itchy skin should be discussed with your doctor.
Lipodystrophy syndrome The HIV lipodystrophy syndrome is the name given to a range of symptoms that can develop over time when people use ART. Some features of the lipodystrophy syndrome include:The precise causes of the HIV lipodystrophy syndrome are not clear and are difficult to understand because in some people with HIV there may be one or more aspects of the syndrome taking place.
For instance, some people may experience fat wasting, others fat gain, and others may experience both fat gain and wasting.
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Terbinafine: Due to the risk for terbinafine related adverse effects, caution is advised when coadministering indinavir.
Trabectedin is a CYP3A substrate and indinavir is a strong CYP3A inhibitor.
Nicardipine: Anti-retroviral protease inhibitors may decrease the hepatic CYP metabolism of calcium-channel blockers mainly through CYP3A4 inhibition resulting in increased calcium-channel blocker concentrations.
Rifampin can decrease the amount of indinavir in your body.
Food: Administration with food high in calories, fat, and protein results in a decrease in the AUC and Cmax of indinavir. The pharmacokinetic parameters of anti-retroviral medications anti-retroviral non-nucleoside reverse transcriptase inhibitors NNRTIsanti-retroviral nucleoside reverse transcriptase inhibitors NRTIsanti-retroviral nucleotide reverse transcriptase inhibitors, and anti-retroviral protease inhibitors metabolized through the CYP isoenzyme system are slightly altered by smoked and oral marijuana.
Despite this interaction, marijuana is not expected to adversely affect anti-retroviral efficacy.
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However, it is now normal to prescribe HIV medicines for pregnant women with HIV.
Clinical studies of CRIXIVAN did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects.