2017 HIV Treatment Guide by Pride Media

BECAUSE YOU’RE MORE THAN YOUR STATUS

OUR 5TH ANNUAL HIV & HEP C TREATMENT GUIDE

MR. MAJORS HE WENT FROM BASKETBALL TO BEYONCÉ VIDEOS. NOW ACTOR DEMARCO MAJORS IS OPENING UP ABOUT HIS BIGGEST LIFE CHANGE.

JULY/AUGUST 2017 www.hivplusmag.com

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JULY / AUGUST 2017

our 5th annual hiv treatment guide For 2017, Plus has put together our most up-to-date and comprehensive look at the medications approved by the Food and Drug Administration for the treatment of HIV and opportunistic infections in this easy to pull out section. research by mary r. ladd

Editorâ&#x20AC;&#x2122;s note: This info was culled from the National Institutes of Healthâ&#x20AC;&#x2122;s drug database, the FDA, and individual pharmaceutical companies. HIVPLUSMAG.COM

PROTEASE INHIBITORS

Help prevent replication of HIV; drugs in this class block activation of protease, an enzyme HIV needs to reproduce. medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

APTIVUS

500 mg (two 250 mg capsules or 5 ml of oral solution) with 200 mg (two 100 mg capsules/tablets or 2.5 ml of solution) of Norvir, twice daily. If taken with Norvir capsules or solution, may be taken with or without meals; if taken with Norvir tablets, must be taken with meals.

For treatment-experienced patients, in combination with at least two other anti-HIV drugs. Do not use with other protease inhibitors. Do not take with Rifadin, ergot derivatives (Dihydroergotamine, ergonovine, ergotamine, methylergonovine), St. John’s Wort, Versed, Latuda, Cisapride, Revatio, Uroxatral, Altoprev, Mevacor, Orap, Zocor, Halcion, or certain anti-arrhythmic drugs (Amiodarone, bepridil, flecainide, propafenone, quinidine). If taking birth control pills, switch to another method of contraception. Use with caution with Flonase, Viagra, Cialis, Levitra, or Seroquel; or if taking certain antiseizure medications. Use with caution if you have hemophilia or other conditions that increase the chance of bleeding; or liver disorders.

most serious: severe or fatal liver disease, severe bleeding in the brain, new or worsened diabetes and hyperglycemia other: diarrhea, nausea, fever, vomiting, tiredness, headache, stomach pain, rash, increased sun sensitivity, increased blood fat (lipid) levels, changes in body fat

CRIXIVAN

800 mg, taken every eight hours, with water or other beverage, without food (one hour before or two hours after a meal) or with a light meal.

Do not take with oral Versed, Propulsid, Zocor, Mevacor, Latuda, Orap, Cordarone, Hismanal, Halcion, Xanax, Revatio, Uroxatral, Rifadin, Rimactane, Rifamate, Rifater, St. John’s Wort, Wigraine, Cafergot, D.H.E. 45, Migranal, Ergotrate, Methergine, or Reyataz. Use with caution with Viagra, Cialis, Levitra, Lipitor, Seroquel, Crixivan, and Crestor. Drink plenty of fluids and do not take the drug with meals that are high in calories, fat, and protein.

most serious: liver failure, kidney stones, changes in body fat, diabetes, anemia, severe pain, muscle weakness other: abdominal pain, fatigue or weakness, low red blood cell count, flank pain, painful urination, feeling unwell, nausea, upset stomach, diarrhea, vomiting, acid regurgitation, increased or decreased appetite, back or shoulder pain, headache, dizziness, taste changes, rash, itchy skin, yellowing of the skin and/or eyes, upper respiratory infection, dry skin, sore throat

INVIRASE

1,000 mg (five 200-mg capsules or two 500mg tablets), in combination with 100 mg of Norvir, twice daily, at least two hours after a meal.

Do not use with CYP3A substrates (dapsone, disopyramide, quinine), Aptivus-Norvir combination, Uroxatral, Cordarone, Vascor, Cisapride, Tikosyn, Tambocor, intravenous lidocaine, Rythmol, Quinidine, Propulsid, ergot medications (Parlodel, Migranal, Ergonovine, Bellamine, Cafergot, Ergomar, Methergine, or Permax), oral Versed, Orap, Rifadin, Revatio (when used to treat pulmonary hypertension), Mevacor, Advicor, Zocor, Juvisync, Simcor, Vytorin, Desyrel, Oleptro, Halcion, St. John’s Wort, Trazodone, garlic capsules, fusidic acid products, or drugs that both increase saquinavir plasma concentrations. Use with caution with Reyataz, Crixivan, Kaletra, Viracept, Rescriptor, Viramune, Lipitor, Crestor, Viagra, Levitra, Cialis, Adcirca, Seroquel, hormonal contraceptives, certain sedatives and hypnotics, certain calcium channel blockers, certain antibiotics and antifungals, some antipsychotics or antidepressants, proton pump inhibitors. Do not use if you have complete atrioventricular block without implanted pacemakers, or are at high risk of complete AV block; have severe liver problems, low potassium or low magnesium, Long QT Syndrome, refractory hypokalemia or hypomagnesemia. Use caution if you have other heart or liver problems, hemophilia, or diabetes.

most serious: worsening of heart and or liver problems; increased bleeding with hemophilia; diabetes or high blood sugar, elevated cholesterol or triglycerides; or changes in body fat, immune system, or heart rhythm other: nausea, vomiting, diarrhea, fatigue, dizziness, fainting, abdominal pain

KALETRA

800 mg, typically four tablets, once daily; or 400 mg, typically two tablets, twice daily. Swallow tablets whole; do not chew, break, or crush. An oral solution is available: it should be taken with food.

Do not take with Halcion, midazolam oral syrup, certain steroids, Incivek, Orap, Mevacor, Zocor, Rimactane, Rifadin, Rifater, Rifamate, Revatio (when used to treat pulmonary arterial hypertension), Stendra, Uroxatral, Victrelis, Xarelto, St. John’s Wort, dihydroergotamine (D.H.E. 45 and others), ergonovine (Ergotrate), methylergonovine (Methergine), or ergot-containing medicines, including ergotamine (Cafergot and others). Use with caution with Viagra, Cialis, Levitra, Adcirca, Tasigna, Sprycel, Lipitor, Crestor, Atripla, Crixivan, Sustiva, Viramune, Lexiva, Viracept, Viramune, Viread, Videx, Selzentry, Dilantin, Tegretol, Mycobutin, Flonase, Serevent, Advair, Colcrys, Tracleer, Duragesic, Ionsys, Fentora, Deltasone, Depakote, Lamictal, Seroquel, drugs containing budesonide, methadone, birth control pills, or contraceptive patches containing estrogen.

most serious: changes in heart rhythm, immune system, or body fat; severe liver problems; pancreatitis; new or worsened diabetes; elevated triglyceride or cholesterol levels other: diarrhea, nausea, stomach pain, vomiting, weakness, headache

generic name: Tipranavir maker: Boehringer Ingelheim

generic name: Indinavir maker: Merck

generic name: Saquinavir mesylate maker: Hoffmann-La Roche

generic name: Lopinavir and ritonavir maker: AbbVie

JULY / AUGUST 2017

medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

LEXIVA

For those used to protease inhibitors, 700 mg plus a 100 mg capsule of Norvir, twice daily. For those new to therapy, 1,400 mg twice daily, sometimes paired with Norvir. Available in tablets or oral solution; tablets can be taken with or without food, oral solution without food. Reduced dosage recommended for patients with liver impairment.

Do not take with Incivek, Victrelis, Rescriptor, Uroxatral, Rifadin, Rimactane, St. John’s Wort, certain arrhythmia medications, ergotbased medications, Propulsid, Zocor, Mevacor, Orap, Revatio (when used to treat pulmonary arterial hypertension), Versed, or Halcion. If you take oral contraceptives, consider alternative birth control methods. Do not take with Viramune unless also taking Norvir. Use with caution with Seroquel, H2 blockers, and calcium channel blockers. Do not use if you have Stevens-Johnson syndrome or if you take drugs that use the enzyme CYP3A4 to metabolize.

most serious: severe skin reactions including StevensJohnson syndrome, new or worsened diabetes, redistribution of body fat, elevated cholesterol, anemia, spontaneous bleeding, kidney stones other: diarrhea, rash, nausea, vomiting, headache

NORVIR

600 mg (six 100 mg tablets), twice daily, with a meal. Swallow tablets whole with water; do not chew, break, or crush. Also available in capsules or oral solution. Reduced dosage recommended for people taking other protease inhibitors.

Do not take with Xatral, Cordarone, Tambocor, Vascor, Rythmol, Fucidin, Hismanal, Seldane, Orap, Propulsid, Cafergot, Migranal, D.H.E. 45, Ergotrate, Maleate, Vfend, Mevacor, Zocor, Halcion, Versed, Advair, Serevent, Levitra, Revatio (if used for pulmonary arterial hypertension), St. John’s Wort. Do not take with both Invirase and any version of rifampin (Rimactane, Rifadin, Rifater, or Rifamate), and use with caution with either drug separately. Use with caution with Seroquel, Olysio, Lipitor, Crestor, Viagra, Levitra, Cialis, Adcirca, Tracleer, Rapamune, Flonase, Crixivan, Viracept, Videx, Mycobutin, Aptivus, Rescriptor, Reyataz, Celsentrin, Telzir, Prezista, Tiazac, Adalat, Isoptin, Nizoral, Sporanox, Demerol, Tegretol, Dilantin, phenobarbital, Mycobutin, Biaxin, Duragesic, theophylline, Colcrys (used for treatment of gout), certain anticancer medications, certain antidepressants. Use with caution if you have other liver problems or diabetes.

most serious: worsening of liver disease, pancreatitis, diabetes or high blood sugar, elevated cholesterol or triglycerides, changes in body fat, increased bleeding among hemophiliacs, severe skin reactions other: rash, abdominal pain, diarrhea, feeling weak or tired, headache, nausea, vomiting, changes in taste, loss of appetite, dizziness, tingling feeling or numbness (on hands, feet, or around the lips)

PREZISTA

One 800 mg tablet with one 100 mg Norvir capsule, once daily, with food; or one 600 mg tablet with one 100 mg Norvir tablet or capsule taken twice daily, with food for those with drug resistance.

Do not take with Uroxatral, Victrelis, D.H.E. 45, Embolex, Migranal, Cafergot, Ergomar, methylergonovine, Propulsid, Orap, oral midazolam, Halcion, St. John’s Wort, Mevacor, Altoprev, Advicor, Zocor, Simcor, Vytorin, Rifadin, Rifater, Rifamate, Rimactane, Revatio (when used to treat pulmonary arterial hypertension), Crixivan, Kaletra, Invirase, Eliquis, Pradaxa, Xarelto, Vfend, Priftin, dexamethasone, Olysio, Afinator, Serevent, Stendra, or Incivek. Colchicine (Colycris, Mitigare) is contraindicated in patients with liver or kidney problems. Use caution if taking Viagra, Revatio, Levitra, Staxyn, Cialis, Adcirca, Lipitor, Crestor, Pravachol, Seroquel, Col-Probenecid, Coartem, or Riamet. May reduce birth control pills’s efficacy; take other precautions.

most serious: severe liver disease, severe rash or pustules, high blood sugar or diabetes, changes in body fat or immune system other: diarrhea, nausea, mild rash, headache, stomach pain, vomiting

REYATAZ

300 mg, in capsule form, taken with 100 mg of Norvir, once daily, with food. For adults unable to tolerate Norvir: 400 mg of Reyataz with food. Take at the same time every day.

Do not take with Versed, Halcion, Cafergot, Migranal, D.H.E. 45, Methergine, other ergot medicines, Orap, Camptosar, Crixivan, Mevacor, Zocor, Uroxatral, Revatio, Rimactane, Rifadin, Rifater, Rifamate, St. John’s Wort, Viramune, Diskus, or Advair. Do not take Vfend or Victrelis if you are taking Reyataz and Norvir; and do not take Tegretol, Dilantin, or drugs containing phenobarbital with Reyataz alone. If you are taking Videx, Videx EC, or antacids, take Reyataz two hours before or one hour after those medicines. Use with caution if taking drugs for indigestion, heartburn, or ulcers; depression; allergies or asthma; abnormal heart rhythm; blood clots; cholesterol; erectile dysfunction; gout; and certain other conditions. If taking Reyataz with Norvir and also taking Lamictal, dosage of the latter may need to be adjusted.

most serious: severe rash, yellowing of skin or eyes, diabetes, kidney stones, worsening liver disease, increased bleeding problems, gallbladder disorders, changes in body fat, immune system, or heart rhythm other: nausea, headache, stomach pain, vomiting, diarrhea, depression, fever, dizziness, trouble sleeping, muscle pain, numbness, tingling, or burning of hands or feet

VIRACEPT

1,250 mg (five 250 mg tablets or two 625 mg tablets), twice daily; or 750 milligrams (three 250 mg tablets), three times daily. Each dose should be taken with a meal. An oral powder is also available.

Do not take with Cordarone, Orap, Quinidine, Quinaglute, Cardioquin, Quinidex, D.H.E. 45 Injection, Ergomar, Migranal, Wigraine, Cafergot, Methergine, Halcion, Versed, Revatio (if used for pulmonary arterial hypertension), Uroxatral, Prilosec, Rimactane, Rifadin, Rifater, Rifamate, St. John’s Wort, Mevacor, Zocor, or Serevent. Use caution with Seroquel, Lipitor, Crestor, Pravachol, Lescol, Viagra, Levitra, Cialis, Adcirca, or Tracleer. If also taking Videx, take Viracept with food one hour after or more than two hours before Videx. May reduce effectiveness of birth control pills, so use alternative forms of contraception. Doses of Crixivan, Norvir, Invirase, Fortovase, Mycobutin or Dilantin may need to be adjusted. Rescriptor may lower the amount of Viracept in the blood or vice versa. Do not take if you have moderate to severe liver impairment.

most serious: diabetes and high blood sugar, high blood pressure, changes in body fat or immune system other: diarrhea, nausea, rash

generic name: Fosamprenavir maker: ViiV Healthcare

generic name: Ritonavir maker: AbbVie

generic name: Darunavir maker: Janssen

generic name: Atazanavir maker: Bristol-Myers Squibb

generic name: Nelfinavir maker: ViiV Healthcare

HIVPLUSMAG.COM

ENTRY AND FUSION INHIBITORS

Help prevent replication of HIV; drugs in this class help block HIV from entering T cells. They are always taken with other HIV medications. medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

FUZEON

Injection of 90 mg in the upper arm, upper leg, or stomach, twice daily.

Some people use the Biojector 2000, a needle-free device, to administer Fuzeon, but it can cause nerve pain, tingling, bruising, and collection of blood under the skin.

most serious: cutaneous amyloidosis at injection site; itching, swelling, redness, pain or tenderness; hardened skin, bumps at the site of injection; allergic reactions; bacterial pneumonia other: pain and numbness in feet or legs, loss of sleep, depression, decreased appetite, sinus problems, enlarged lymph nodes, weight decrease, loss of strength, muscle pain, constipation, pancreas problems

REBETOL

800 to 1,400 mg daily, based on patient’s weight, by oral solution, taken with food. Capsule version no longer manufactured. Usually prescribed in combination with PegIntron.

Do not take if you use Videx or Videx EC; have cirrhosis or will be having a liver transplant; have autoimmune hepatitis, certain blood disorders, or severe kidney disease; or if you are pregnant or if you or your partner plan to become pregnant. Use caution when taking with NRTIs such as Combivir, Epivir, Epzicom, Retrovir, or Trizivir.

most serious: severe eye, lung, or blood problems; pancreatitis; severe depression, anorexia, homicidal, or suicidal thoughts; fetal death, birth defects, or pediatric growth inhibition; skin problems (some fatal); anemia other: dental problems caused by dry mouth, less serious mood changes, flu-like symptoms, headache, fever, stiffness, injection site reaction, neutropenia

SELZENTRY

300 mg twice daily; or 150 mg twice daily if taken with potent CYP3A inhibitors; or 600 mg twice daily if taken with potent CYP3A inducers.

Do not take St. John’s Wort, Prezista, Kaletra, Reyataz, Sustiva, Atripla, which may affect the amount of Selzentry in the blood. Tell your doctor if you have a history of hepatitis B or C, have heart or kidney problems, or if you have low blood pressure or take medication to lower it.

most serious: heart or liver disorders, lowered blood pressure when standing, increased risk of cancer and infections, changes in immune system, severe rash, allergic reaction leading to hepatotoxicity other: cough, fever, dizziness, headache, lowered blood pressure, nausea, bladder irritation, upper respiratory infection

generic name: Enfuvirtide maker: Roche Laboratories (Fuzeon); Trimeris (Generic)

generic name: Ribivarin maker: Schering, Merck

generic name: Maraviroc maker: ViiV Healthcare

INTEGRASE INHIBITORS

Help prevent replication of HIV; drugs in this class block integrase, an enzyme HIV needs to reproduce. They are always taken with other HIV medications. medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

ISENTRESS

One 400 mg tablet, twice daily. Available in oral suspension or chewable tablet for children, with dosage varying by weight.

Do not take with antacids that contain aluminum or magnesium hydroxide. Tell your doctor if you take the tuberculosis medication rifampin, or if you have liver problems or phenylketonuria. If you miss a dose, skip the missed dose and go back to your regular schedule. Do not double your next dose.

most serious: severe skin reactions and allergic reactions, liver problems, immune system changes other: headache, trouble sleeping, nausea, tiredness, weakness, stomach pain, dizziness, depression, suicidal thoughts and actions

TIVICAY

One 50 mg tablet, once daily for those new to integrase inhibitors or antiretroviral drugs; twice daily for those who take certain other antiretrovirals, have taken integrase inhibitors previously and may have resistance to such drugs, or are also taking rifampin, a drug that treats tuberculosis and other infections. Tivicay may be taken with or without food.

Do not take if you have ever had an allergic reaction to a medicine that contains dolutegravir (Tivicay, Triumeq). Do not take with dofetilide (Tikosyn), oxcarbazepine, phenytoin, phenobarbital, carbamazepine, or St. John’s Wort. Do not take with etravirine (Intelence) without coadministration of ritonavir (Norvir) and either atazanavir (Reyataz), darunavir (Prezista), or lopinavir (or Kaletra a combination of ritonavir and lopinavir). Take two hours before or six hours after antacids, laxatives, or other medicines that contain aluminum, magnesium, sucralfate (Carafate), or buffered medications. Multivitamins, oral iron, or calcium supplements may be taken at the same time if taken with food. If you are starting or stopping the diabetes drug metformin at the same time as Tivicay, you should be monitored closely; dosage of metformin may need to be adjusted. Take during pregnancy only if potential benefit outweighs risk.

most serious: hypersensitivity reactions characterized by rash, constitutional findings, organ dysfunction (including liver injury); worsening of hepatitis B or C; accumulation or redistribution of body fat; immune system changes other: insomnia, nausea, headache

generic name: Raltegravir maker: Merck

generic name: Dolutegravir maker: GlaxoSmithKline

JULY / AUGUST 2017

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIs)

Help prevent replication of HIV; drugs in this class block reverse transcriptase, an enzyme HIV needs to reproduce. medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

COMBIVIR

One tablet, containing 150 mg of lamivudine and 300 mg zidovudine (both NRTIs), twice daily.

Do not take with other medicines containing lamivudine, zidovudine, or emtricitabine (Epivir, Epivir-HBV, Retrovir, Epzicom, Trizivir, Atripla, Emtriva, Truvada). Use caution if taking interferon alfa, ribavirin, doxorubicin, or ganciclovir. Tell your doctor if youâ&#x20AC;&#x2122;ve previously had any kidney or liver problems (such as hepatitis or cirrhosis), pancreatitis, or low red/white blood cell counts.

most serious: low white and red blood cell counts, serious allergic reactions, buildup of lactic acid in blood, liver toxicity, worsening liver disease, pancreatitis, muscle disorders, inflammation, flare-up of hepatitis B after discontinuation, or changes in body fat or immune system other: headache, nausea, fatigue, diarrhea, cough, stuffy nose, general discomfort

EMTRIVA

One 200 mg capsule or 240 mg of oral solution, once daily.

Do not use with other drugs containing emtricitabine, such as Atripla, Complera, Truvada, or Stribild.

most serious: buildup of lactic acid in blood, liver problems, flare-up of hepatitis B after discontinuation other: headache, diarrhea, nausea, fatigue, dizziness, depression, insomnia, abnormal dreams, rash, abdominal pain, asthenia, cough, rhinitis

EPIVIR

300 mg daily, in one or two doses, in tablets or oral solution.

Do not take with Emtriva, Combivir, Epzicom, Trizivir, Atripla, Truvada, Stribild, or Complera. Epivir is not recommended for use in combination with zalcitabine. There is risk of severe liver decomposition if you take combination antiretroviral therapy and interferon alfa drugs for hepatitis C.

most serious: buildup of lactic acid, severe liver problems, changes in body fat, or immune system changes other: headache, nausea, malaise, fatigue, nasal problems, diarrhea, cough

EPZICOM

One tablet, containing 600 mg of abacavir sulfate and 300 mg of lamivudine (both NRTIs), once daily.

Do not take if you have kidney problems or are prone to heart disease. Use with caution if you take Atripla, Combivir, Emtriva, Epivir, Trizivir, Truvada, Ziagen, methadone, or medicines used to treat hepatitis. If you have hep B, do not run out of or stop taking Epzicom without consulting your doctor. Your general health, blood tests, and liver functions should be monitored if you stop taking Epzicom. Do not take if you have moderate to severe liver problems, or are breastfeeding.

most serious: severe allergic reactions, buildup of lactic acid in the blood, liver problems other: insomnia, depression, headache, tiredness, dizziness, nausea, diarrhea, rash, fever

RETROVIR

600 mg a day, taken in divided doses, in tablets, capsule, or syrup. Can also be given as an intravenous infusion, 1 mg per kg of body weight, over one hour, every four hours.

Do not take with other medicines that contain the same active ingredients, including Combivir and Trizivir. Not recommended for use with hepatitis drugs (Copegus, Rebetol, RibaTab, Ribasphere). Use with caution if taking ganciclovir or interferon alfa (Pegasys, PegIntron). Do not use with stavudine or doxorubicin.

most serious: low white and red blood cell counts, myopathy and myositis (muscle disorders and inflammation), buildup of lactic acid in blood, severe liver problems, immune system or body fat changes other: headache, malaise, nausea, anorexia, vomiting

TRIZIVIR

One tablet, containing 300 mg of abacavir sulfate, 150 mg of lamivudine, and 300 mg of zidovudine (all NRTIs), twice daily.

Do not take if you have certain liver problems or weigh less than 90 pounds. Take with caution if you have the gene variation HLA-B*5701, hepatitis B, kidney or heart problems, low blood cell counts, high blood pressure, high cholesterol, or diabetes. Use with caution if you take Bactrim, Septra, Cytovene, DHPG, interferon-alfa (Pegasys, PegIntron), Adriamycin, Copegus, Rebetol, Virazole, Atripla, Combivir, Complera, Emtriva, Epivir or Epivir-HBV, Epzicom, Retrovir, Truvada, Zerit, Ziagen, or bone marrow suppressive or cytotoxic medicines.

most serious: severe or fatal allergic reactions, heart attack, buildup of lactic acid, liver disorders, blood problems, muscle weakness, body fat or immune system changes, hepatitis B flare-up other: nausea, vomiting, headache, weakness, diarrhea, fever or chills, depression, muscle and joint pain, skin rashes, cold symptoms, nervousness, ear, nose, and throat infections

generic name: Lamivudine and zidovudine maker: ViiV Healthcare (Combivir); Hetero Labs, Aurobindo, Teva Pharmaceuticals (Generic)

generic name: Emtricitabine maker: Gilead Sciences

generic name: Lamivudine or 3TC maker: ViiV Health

generic name: Abacavir sulfate and lamivudine maker: ViiV Healthcare

generic name: Zidovudine or AZT maker: ViiV Healthcare

generic name: Abacavir sulfate, lamivudine, and zidovudine maker: ViiV Healthcare

HIVPLUSMAG.COM

NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NRTIs)

Help prevent replication of HIV; drugs in this class block reverse transcriptase, an enzyme HIV needs to reproduce. medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

TRUVADA

For HIV Treatment: One tablet, containing 200 mg of emtricitabine and 300 mg of tenofovir disoproxil fumarate. Once daily for adults and children weighing at least 17 kg, with or without food. Always used in combination with other HIV medications. For HIV prevention: One tablet once daily taken orally with or without food. Must be paired with regular HIV tests and safer sex practices.

Do not take with Hepsera, Atripla, Combivir, Complera, Descovy, Emtriva, Epivir or Epivir-HBV, Epzicom, Genvoya, Stribild, Trizivir, or Viread. You may need to adjust dosage if also taking Videx, Reyataz, or Kaletra. If you have had kidney problems or take other drugs that can cause kidney problems, have regular blood tests.

most serious: buildup of lactic acid in blood, serious liver problems, flare-up of hep B, kidney problems, thinning bones, changes in body fat, inflammation other: diarrhea, dizziness, nausea, vomiting, headache, fatigue, abnormal dreams, sleeping problems, rash, depression, pain, weakness, skin discoloration, headache, abdominal pain, weight loss

VIDEX EC

400 mg in enteric-coated capsules, once daily, for individuals weighing 132 pounds or more. 250 mg, once daily, for adults weighing less than 132 pounds. Take on an empty stomach, swallow capsules whole; do not chew, break, crush, or dissolve. A powder form may be mixed with water for children.

Do not take with Lopurin or Zyloprim (used to treat gout and kidney stones), or hepatitis drugs (Copegus, Rebetol, RibaTab, Ribasphere). Use caution with methadone, ganciclovir, or any drugs that may cause toxicity to the pancreas or nervous system. If also taking Viread, reduce Videx EC dose.

most serious: pancreatitis, buildup of lactic acid in blood, liver disorders, vision problems, immune system or body fat changes, peripheral neuropathy other: diarrhea, nausea, vomiting, headache, stomach pain, skin rash

VIREAD

One 300 mg tablet, once daily with or without food. Adults unable to swallow tablets may take 7Â˝ scoops of Viread oral powder. If you have kidney problems (CrCl<50ml/min) dose adjustments are recommended. Viread is used in combination with other antivirals to treat HIV-1 infection. Also used to treat hepatitis B. (HIV testing recommended for HBV patients before starting Viread.)

Do not take Viread if you are taking other medicines that contain tenofovir disoproxil fumarate (Atripla, Complera, Truvada, Stribild), tenofovir alafenamide (Descovy, Genvoya, Odefsey), or adefovir (Hepsera). Dosages may need to be adjusted if you are taking Videx EC, Reyataz, or Kaletra.

most serious: buildup of lactic acid in blood, severe liver problems, changes in immune system, body fat, or bones other: nausea, rash, diarrhea, headache, pain, depression, weakness

ZERIT

For individuals weighing 132 pounds or more, 40 mg, in capsules or oral solution, twice daily; for patients weighing less than 132 pounds, 30 mg twice daily.

Do not take with zidovudine-containing drugs (Retrovir, Combivir Trizivir). Do not take with hydroxyurea (Droxia, Hydrea). Use caution with Videx EC, Adriamycin, Rubex, Copegus, Rebetol, Ribasphere, Virazole, Roferon-A, and Intron-A. Use caution if you have liver, pancreas, or kidney problems; peripheral neuropathy; or gallstones. Dosing adjustments may be needed if you have renal impairment or are undergoing hemodialysis. Do not drink alcohol while on the drug.

most serious: buildup of lactic acid in blood, serious liver problems, pancreatitis, changes in immune system or body fat, peripheral neuropathy other: headache, diarrhea, rash, nausea, vomiting

ZIAGEN

600 mg in tablets daily, administered as either 300 mg twice daily or 600 mg once daily. Also available as an oral solution. Individuals with mild liver impairment should take 200 mg twice daily.

Do not take if you have moderate to severe liver impairment. If you have a severe allergic reaction, do not resume taking Ziagen or any other abacavir-containing drug (Epzicom, Trizivir). Risk of allergic reaction is higher if you have the gene variation HLA-B*5701. Do not take if you are pregnant or plan on becoming pregnant; do not take if you breastfeed or plan on breastfeeding.

most serious: severe allergic reaction, buildup of lactic acid in blood, changes in body fat or immune system, severe liver problems, increased risk of heart attack especially with other risk factors (smoking, etc) other: shortness of breath, cough, sore throat, nausea, vomiting, fatigue, headache, diarrhea, stomach pain, rash, trouble sleeping, fever or chills, loss of appetite, tiredness, achiness

generic name: Emtricitabine and tenofovir disoproxil fumarate maker: Gilead Sciences

generic name: Didanosine maker: Bristol-Myers Squibb

generic name: Tenofovir disoproxil fumarate maker: Gilead Sciences

generic name: Stavudine or D4T maker: Bristol-Myers Squibb

generic name: Abacavir maker: GlaxoSmithKline

JULY / AUGUST 2017

NONNUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS (NNRTIs)

Help prevent replication of HIV; drugs in this class attack the same enzyme NRTIs do, but in a different way. medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

EDURANT

One 25 mg tablet, once daily, with a meal. For those who haven’t previously taken antiretroviral drugs and have a viral load of 100,000 copies per milliliter of blood or less. It is always taken with other antiretrovirals.

Do not take with other NNRTIs; antiseizure drugs (Luminal, Tegretol, Trileptal, Dilantin); antituberculosis medicines (Rifadin, Rimactane, Priftin); proton pump inhibitors (Nexium, Vimovo, Prevacid, Prilosec, Protonix, Aciphex); more than one dose of dexamethasone; or St. John’s Wort. Use caution with antifungals (Sporanox, Diflucan, Nizoral, Noxavil); Vfend taken orally; antibiotics (Mycobutin, Biaxin, and Ketek); methadone; or protease inhibitors. Take H2 blockers (Tagamet, Pepcid, Zantac)—or antacids containing aluminum, magnesium hydroxide, or calcium carbonate—at least 12 hours before or four hours after Edurant.

most serious: depression or mood changes, including suicidal thoughts; changes in body fat or immune system, severe skin rash and allergic reactions, and liver problems. 0ther: insomnia, headache, rash

INTELENCE

200 mg (one 200 mg tablet or two 100 mg tablets), twice daily. Always take after a meal and swallow the pill with a full glass of water; do not chew. Tablet may also be dispersed in a full glass of water.

Do not take with other NNRTIs; Aptivus, Lexiva, or other protease inhibitors without ritonavir; epilepsy and seizure medicines (Tegretol, Carbatrol, Luminal, Dilantin, Phenytek); St. John’s Wort; or antibacterial drugs (Mycobutin, Rifadin, Rifater, Rifamate, Priftin). Use caution with Tivicay, Triumeq, Coartem, Sporanox, Diflucan, Nizoral, Noxavil, Vfend, dexamethasone, Neoral, Sandimmune, Prograf, Rapamune, or drugs that inhibit or induce the genetic features CYP3A, CYP2C9, and/or CYP2C19.

most serious: severe skin reactions such as StevensJohnson syndrome, changes in immune system or body fat other: changes in body shape, tingling or pain in the hands or feet, numbness

RESCRIPTOR

400 mg (two or four tablets) three times daily.

Do not take Versed, Halcion, Xanax, D.H.E. 45 Injection, Ergomar, Migranal, Wigraine, Cafergot, Orap, Propulsid, Hismanal, Seldane, rifampin, phenobarbital, Dilantin, Tegretrol, St. John’s Wort, Mevacor, or Zocor. Talk to your doctor if you have liver or kidney disease, or before taking Viagra, Lipitor, Baycol, or Lescol. If taking Videx or antacids, take an hour before or an hour after taking Rescriptor. Doses of protease inhibitors Crixivan, Invirase, Fortovase, Kaletra, Norvir, and Viracept may need to be adjusted.

most serious: severe skin rash accompanied by blisters, fever, joint or muscle pain, redness or swelling of the eyes, mouth sores other: headache, nausea, diarrhea, tiredness

SUSTIVA

600 mg (three capsules at once or one tablet), taken daily. Take Sustiva on an empty stomach, preferably at bedtime, with water.

Do not take with other NNRTIs, Atripla, Vascor, Propulsid, Versed, Orap, Halcion, Victrelis, Olysio; ergot medications (like Wigraine, Cafergot); Mepron or Paludrine. The following medicines may need to be replaced with others while taking Sustiva: Fortovase, Invirase, Biaxin, Carbatrol, Tegretol, Noxafil, Sporanox, and Reyataz. Change in doseage may be required of either Sustiva or these medicines: Cardizem, Tiazac, Covera HS, Isoptin SR, Lipitor, Pravachol, Zocor, Crixivan, Kaletra, methadone, Mycobutin, Reyataz, Rifadin, Rifamate, Rifater, Selzentry, Vfend, Gengraf, Neoral, Sandimmune, Prograf, Rapamune, Wellbutrin, Zoloft, and Zyvan. If taking Sustiva and Reyataz, you should also be taking Norvir. Tell your doctor if you have had hepatitis or other liver problems, mental illness, or seizures.

most serious: severe liver problems, rashes, skin reactions other: changes in immune system or body fat, dizziness, nausea, headache, insomnia, tiredness

VIRAMUNE

One 200 mg tablet daily for first 14 days, then one 200 mg twice daily. Also available in oral suspension; 100 mg tablet for children; or an extended-release formulation, for which dosage is one 200 mg tablet of immediaterelease Viramune once daily for 14 days, followed by one 400 mg tablet of Viramune XR once daily.

Do not take with St. John’s Wort, Sustiva, Atripla, Kaletra, Lexiva, Reyataz, Nizoral, Sporanox, Rifadin, Rifamate, Rifater, Victrelis, Incivek, or birth control pills. Tell your doctor if you’re taking Biaxin, Diflucan, Crixivan, methadone, Viracept, Mycobutin, Coumadin, Jantoven, or Invirase. Discontinue immediately if you develop signs of hepatitis, severe skin reactions, or rash with systemic symptoms.

most serious: severe psychiatric problems, including suicidal thoughts; liver disorders; severe rash other: dizziness, nausea, vomiting, diarrhea, rash, sleep disturbances, drowsiness, trouble concentrating, unusual dreams

generic name: Rilpivirine maker: Janssen

generic name: Etravirine maker: Janssen

generic name: Delavirdine maker: ViiV Healthcare

generic name: Efavirenz maker: Bristol-Myers Squibb

generic name: Nevirapine maker: Boehringer Ingelheim

HIVPLUSMAG.COM

COMBINATION DRUGS

Help prevent replication of HIV; drugs in this class combine two or more drugs that attack HIV in different ways. medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

ATRIPLA

One tablet, once daily on an empty stomach, preferably at bedtime (600 mg of efavirenz, 200 mg emtricitabine, and 300 mg of tenofovir disoproxil fumarate). Efavirenz is an NNRTI, the other components NRTIs.

Do not take with medicines that contain lamivudine (Epivir, Epivir-HBV, Epzicom, Combivir, Trizivir), other HIV antiretroviral medications, drugs to treat seizures or tuberculosis, adefovir (Hespera), St John’s Wort, sofosbuvir/velpatasvir (Epclusa), or more than one dose of dexamethasone. Use caution with antidepressants, antifungals, antimalarials, birth control, blood thinner (warfarin), high blood pressure medication (calcium channel blockers), and methadone. If taken with Harvoni, you should be monitored.

most serious: buildup of lactic acid in blood, severe liver problems, kidney damage, hepatitis B flare-up, depression, bone thinning, changes in immune system other: dizziness, headache, trouble sleeping, drowsiness, trouble concentrating, abnormal dreams, rash

COMPLERA

One tablet (200 mg of emtricitabine, 25 mg of rilpivirine, and 300 mg of tenofovir disoproxil fumarate), once daily, with a meal. Rilpivirine is an NNRTI, the other components NRTIs. Complera is for those who are new to antiretroviral drugs and have viral loads of 100,000 copies/ml or less.; or as a replacement regimen for individuals with a viral load of 50 copies/ml or less and no resistance to any components.

Do not take with medicines that contain lamivudine (Epivir, Epivir-HBV, Epzicom, Combivir, Trizivir), other antiretroviral medications, antiseizure or antituberculosis drugs, proton pump inhibitors (Kapidex, Dexilant), adefovir (Hespera), St John’s Wort, or more than one dose of dexamethasone. Use caution with antacids, antifungal medications, H2-receptor antagonists, antibiotics, or methadone. If taken with Harvoni, you should be monitored.

most serious: buildup of lactic acid in blood, severe liver problems, kidney damage, hepatitis B flare-up, depression, bone thinning, changes in immune system other: insomnia, headache, rashes, diarrhea, nausea, fatigue, dizziness, depression, abnormal dreams, vomiting, stomach or other pain, weight gain

EVOTAZ

One tablet (300 mg atazanavir and 150 mg cobicistat) once daily with food, in combination with other antiretroviral drugs. Atazanavir (Reyataz) is a protease inhibitor and cobicistat (Tybost) a boosting agent.

Do not take with protease inhibitors, roxatral, Propulsid, Propulsid Quicksolv, Mitigare, Colcrys, Multaq, D.H.E. 45, Embolex, Migranal, Cafergot, Migergot, Ergomar, Ergostat, Medihaler, Wigraine, Wigrettes, Ergotrate, Methergine, Crixivan, Camptosar, Advicor, Altoprev, Mevacor, Latuda, Versed, Viramune, Viramune XR, Orap, Ranexa, Rimactane, Rifadin, Rifater, Rifamate, Revatio (when used for lung problems), Zocor, Vytorin, Simcor, Halcion, or St John’s Wort. Use with caution if you have heart, liver, or kidney problems; diabetes; hemophilia; or if you are pregnant, plan to become pregnant, or are using hormonal birth control. Do not breastfeed.

most serious: heart rhythm changes, kidney or gallbladder problems, worsening liver problems, severe skin rash, diabetes or worsening diabetes, increased bleeding with hemophilia, changes in body fat or immune system other: nausea, yellowing of the skin or whites of the eyes

GENVOYA

One tablet (150 mg of elvitegravir, 150 mg of cobicistat, 200 mg of emtricitabine, and 10 mg of tenofovir alafenamide) once daily, with food. For those 12 or older who weigh at least 35 kg and are new to antiretroviral therapy; or as replacement therapy for those virologically suppressed for at least 6 months, with no previous virologic failure, and no drug resistance to the components of Genvoya.

Do not use with other HIV drugs containing tenofovir alafenamide (Odefsey, Descovy), the HBV drug Vemlidy, HIV drugs containing emtricitabine or tenofovir disoproxil fumarate (Atripla, Complera, Stribild, Emtriva, Truvada, Viread), drugs containing lamivudine (Combivir, Epivir, Epivir-HBV, Epzicom, Trizivir), ritonavir or other drugs containing cobicistat (Evotaz, Prezcobix), Revatio, Hepsera, alfuzosin, rifampin, cisapride, lurasidone, pimozide, St John’s Wort, ergot derivatives (dihydroergotamine, ergotamine, methylergonovine), HMG-CoA Reductase inhibitors (lovastatin, simvastatin), anticonvulsants (carbamazepine, phenobarbital, phenytoin), or sedative hypnotics. Avoid if taking Quetiapine for schizophrenia. Not FDA approved for hepatitis B treatment. Not recommended if you have a creatinine clearance below 30 ml/minute.

most serious: buildup of lactic acid in blood; severe liver or kidney problems, which could lead to fatal renal failure; thinning bones; changes in immune system other: nausea, diarrhea

generic name: Efavirenz, emtricitabine, and tenofovir disoproxil fumarate maker: Gilead Sciences

generic name: Emtricitabine, rilpivirine, and tenofovir disoproxil fumarate maker: Gilead Sciences

generic name: Atazanavir and cobicistat maker: Bristol-Myers Squibb

generic name: Elvitegravir, cobicistat, emtricitabine, tenofovir alafenamide maker: Gilead Sciences

JULY / AUGUST 2017

medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

ODEFSEY

One tablet (200 mg of emtricitabine, 25 mg of rilpivirine, and 25 mg of tenofovir alafenamide), once daily, with a meal . Rilpivirine is an NNRTI, the other components NRTIs. Odefsey is for those new to antiretroviral drugs, who have a viral load of 100,000 copies/ml or less; or can be used as a replacement regimen for individuals with a viral load of 50 copies/ml or less.

Do not take with medicines that contain lamivudine (Epivir, EpivirHBV, Epzicom, Combivir, Trizivir), other antiretroviral medications, antiseizure or antituberculosis medicine, proton pump inhibitors (Kapidex, Dexilant), adefovir (Hespera), St John’s Wort, or more than one dose of dexamethasone. Use caution when taking antacids, antifungal medications, H2-receptor antagonists, antibiotics, or methadone. If taken with Harvoni, you should be monitored.

most serious: buildup of lactic acid in blood, severe liver problems, hepatitis B flare-up, depression, changes in immune system other: insomnia, headache, rashes, diarrhea, nausea, fatigue, dizziness, depression, abnormal dreams, vomiting, stomach or other pain, weight gain

PREZCOBIX

One tablet (800 mg of darunavir and 100 mg of cobicistat), once daily with food. Darunavir (Prezista) is a protease inhibitor and cobicistat (Tybost) a boosting agent.

Do not take with Eliquis, Pradaxa, Xarelto, Trileptal, Aptiom, Vfend, Priftin, dexamethasone, Olysio, Afinator, Serevent, Sustiva, Atripla, Intelence, Viramune, Stendra, Vitekta, Stribild, other protease inhibitors, Uroxatral, Propulsid, Propulsid Quicksolv, Multaq, D.H.E.45, Embolex, Migranal, Cafergot, Ergomar, Ergostat, Medihaler, Migergot, Wigraine, Wigrettes, Methergine, Altoprev, Advicor, Mevacor, Latuda, Versed, Orap, Ranexa, Rifadin, Rifater, Rifamate, Rimactane, Revatio (when used for pulmonary arterial hypertension), Simcor, Vytorin, Zocor, St John’s Wort, or Halcion. Use with caution with Viagra, Revatio, Levitra, Staxyn, Cialis, Adcirca, Lipitor, Crestor, Pravachol, Seroquel, Coartem, or Riamet. Colchicine Colcrys, Mitigare contraindicated in those with liver or kidney problems. Use with caution if you have liver or kidney problems, or if you are pregnant, breastfeeding, or plan to become pregnant or breastfeed.

most serious: liver problems, severe or life-threatening skin rashes or reactions, high blood sugar, diabetes or worsening diabetes, increased bleeding with hemophilia, changes in body fat or immune system, new or worsening kidney problems (when taken with certain other medicines) other: diarrhea, nausea, rash, headache, abdominal pain, vomiting

STRIBILD

One tablet (150 mg of elvitegravir, 150 mg of cobicistat, 200 mg of emtricitabine, and 300 mg of tenofovir disoproxil fumarate) once daily, with food. For those 12 or older, who weigh at least 35 kg, and are new to antiretroviral therapy; or as a replacment regimen for those virologically suppressed on their current regimen for at least 6 months, who have no previous virologic failures, and no drug resistance to Stribild components.

Do not use with other HIV drugs containing emtricitabine or tenofovir disoproxil fumarate (Atripla, Complera, Emtriva, Truvada, Viread), lamivudine, ritonavir (Combivir, Epivir, Epivir-HBV, Epzicom, Trizivir), or tenofovir alafenamide (Genvoya, Odefsey, Descovy); the HBV drug Vemlidy; ritonavir or other drugs containing cobicistat (Evotaz, Prezcobix); or Revatio, Hepsera, alfuzosin, rifampin, cisapride, lurasidone, pimozide, St John’s Wort; ergot derivatives (dihydroergotamine, ergotamine, methylergonovine), HMG-CoA Reductase inhibitors (lovastatin, simvastatin), anticonvulsants (carbamazepine, phenobarbital, phenytoin); or with sedative hypnotics. Avoid if taking Quetiapine for schizophrenia or Ledipasvir for hepatitis C treatment. Not FDA approved for hepatitis B treatment. Not recommended if you have a creatinine clearance below 70 ml/minute.

most serious: buildup of lactic acid in blood; severe liver or kidney problems, which could lead to potentially fatal renal failure; thinning bones; changes in immune system other: nausea, diarrhea

TRIUMEQ

One tablet (50 mg of dolutegravir, 600 mg of abacavir, and 300 mg of lamivudine), once daily, with or without food. Dolutegravir (Tivicay) is an integrase strand transfer inhibitor, the other two components (Ziagen and Epivir), both NRTIs .

Do not take with Epzicom, Trizivir, Ziagen, Combivir, Epivir, EpivirHBV, Emtriva, Atripla, Complera, Stribild, Truvada, Tikosyn, Viramune, Carbatrol, Epitol, Equetro, Tegretol, Trileptal, Dilantin, or St John’s Wort. Do not take if you have the HLA-B*5701 gene variation or moderate to severe liver problems. Use with caution if you have hepatitis B or C; or are taking interferon, ribavirin, Sustiva, Norvir combined with Lexiva or Aptivus, Rifadin, Glumetza, Fortamet, Glucophage, or Riomet. Take two hours before or six hours after iron or calcium supplements, certain antacids, or buffered medications.

most serious: worsening of hepatitis B or C, changes in body fat or immune system, increased risk of heart attack other: trouble sleeping, headache, fatigue

generic name: Emtricitabine, rilpivirine, and tenofovir alafenamide maker: Gilead Sciences

generic name: Darunavir and cobicistat maker: Janssen

generic name: Elvitegravir, cobicistat, emtricitabine, tenofovir disoproxil fumarate maker: Gilead Sciences

generic name: Dolutegravir, abacavir sulfate, and lamivudine maker: ViiV Healthcare

HIVPLUSMAG.COM

DRUGS THAT TREAT HIV-RELATED CONDITIONS medication

traditional dosage

what it treats, precautions, and recommendations

side effects

AMBISOME, AMPHOTEC, ABELCET, AMPHOCIN

No more than 1.5 mg per kg of body weight, administered intravenously, once daily.

what it does: Treats fungal infections (including cryptococcal meningitis), which are more common in people with HIV. what to know: Individuals who cannot normally take traditional amphotericin B because it causes damage to their kidneys may be able to take the formulations in AmBisome, Abelcet, or Amphotec.

most serious: allergic reaction, kidney problems, rash, irregular heartbeat, muscle cramps or pain, weakness, bleeding, hearing loss, blurred vision, hepatitis other: fever, shaking, chills, weight loss, nausea, headache, jaundice

ANDROGEL

In amount and frequency determined by physician, applied topically. Comes in 1 percent and 1.62 percent concentrations, in packets or bottles. Apply AndroGel 1 percent only to shoulders, upper arms, and stomach area (abdomen); 1.62 percent only to shoulders and upper arms.

what it does: Treats low testosterone, which can be a complication of HIV, especially for men over 50. what to know: Apply at same time every day, after bathing or showering, to clean, dry skin. Wash hands immediately after applying. Cover application area with clothing after gel dries. Avoid letting others, especially women and children, have skin-to-skin contact with application area; if they do, they should wash the contact area right away. Tell your doctor about all your health conditions, especially if you have breast or prostate cancer; difficulty in urination due to enlarged prostate; heart, kidney, or liver problems; or sleep apnea. Tell your provider the other drugs you are taking, especially insulin, corticosteroids, or medicines that decrease blood clotting.

most serious: enlarged prostate, increased risk of prostate cancer, lowered sperm count, enlarged or painful breasts, sleep apnea, blood clots in legs or lungs, swelling of ankles, feet, or body other: increased prostatespecific antigens, mood swings, high blood pressure, increased red blood cell count, skin irritation, more frequent or longer-lasting erections

AXIRON

30, 60, 90, or 120 mg, as determined by your physician, and with frequency determined by doctor. Apply only under the arms.

what it does: Treats low testosterone, which can be a complication of HIV, especially for men over 50 what to know: Wash hands immediately after applying. Cover application area with clothing after the solution dries. Avoid letting others, especially women and children, have skin-to-skin contact with application area; if they do, they should wash the contact area right away. Tell your doctor about all your health conditions, especially difficulty in urination due to enlarged prostate; heart, kidney, or liver problems; or sleep apnea. Should not be used if you have breast or prostate cancer. Tell your provider the drugs you are taking, especially insulin, corticosteroids, or medicines that decrease blood clotting.

most serious: enlarged prostate, increased risk of prostate cancer; lowered sperm count, enlarged or painful breasts; sleep apnea; blood clots in legs or lungs; swelling of ankles, feet, or body other: increased prostatespecific antigens, increased red blood cell count, skin irritation or redness, headache, diarrhea, vomiting, more frequent or longer-lasting erections

BACTRIM, SEPTRA, SULFATRIM

400 mg (two or four tablets) three times daily.

what it does: Treats and helps prevent recurrence of Pneumocystis carinii pneumonia (PCP) in HIV-positive patients; also used on other bacterial infections. what to know: Take at the same time every day. Try not to miss a dose. Consult with doctor if pregnant, as there is chance of fetal damage.

most serious: skin rash, joint or muscle aches, sore throat or fever, unusual bleeding or bruising other: dizziness, nausea, vomiting, diarrhea, loss of appetite, fatigue, headache, low blood sodium

BARACLUDE

0.5 or 1.0 mg, once daily, in tablet form or oral solution. Should be taken without food, on an empty stomach at least two hours after a meal and two hours before the next meal.

what it does: Treats chronic hepatitis B. May also help inhibit HIV replication, although this use has not been confirmed. what to know: People with HIV should be on antiretroviral treatment as well, as resistance to HIV drugs may develop otherwise. May affect concentration of drugs that reduce kidney function or vice versa. Those with decreased kidney function may need to reduce dosage.

most serious: worsening of hepatitis B after discontinuation, liver problems, buildup of lactic acid in blood other: headache, fatigue, dizziness, nausea

BIAXIN

500 mg, 2 or 3 times daily, depending on infection. Available in immediate release tablets, extended release tablets, and granules.

what it does: Fights bacterial infections, especially Mycobacterium avium complex (MAC). what to know: There have been life-threatening interactions with Colcrys and serious interactions with Altacor, Altoprev, Mevacor, Zocor, Lipitor, and blood pressure drugs. Use caution when taking Viagra or Quetiapine. Increased exposure to Quetiapine toxicities including drowsiness, hypotension, and neuroleptic malignant syndrome (which can be fatal).

most serious: abdominal pain, fever, nausea, vomiting, bleeding or bruising, diarrhea, colitis, liver failure, hepatitis other: headache, change in taste

generic name: Amphotericin B maker: Astellas, Alkopharma, Sigma-Tau, Pfizer

generic name: Testosterone gel maker: AbbVie

generic name: Testosterone topical solution maker: Lilly

generic name: Sulfamethoxazole/ trimethoprim maker: Various (see HIVPlusMag.com)

generic name: Entecavir maker: Bristol-Myers Squibb

generic name: Clarithromycin maker: AbbVie

JULY / AUGUST 2017

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DRUGS THAT TREAT HIV-RELATED CONDITIONS medication

traditional dosage

what it treats, precautions, and recommendations

side effects

CRESEMBA

Initial loading dose of 372 mg every eight hours for six doses, through intravenous infusion or two capsules 186-mg taken orally, followed by maintenance dose of two capsules once daily or one 372 mg infusion daily, beginning 12 to 24 hours after loading dose. Capsules can be taken with or without food.

what it does: Treats rare fungal infections, invasive aspergillosis and invasive mucormycosis, which are more common in people with HIV. what to know: Do not take with Norvir, the antiseizure medicine carbamazepine, the tuberculosis drug rifampin, St. John’s Wort, or long-acting barbiturates.

most serious: liver problems, infusion reactions, severe allergic and skin reactions other: nausea, vomiting, diarrhea, headache, abnormal liver blood tests, low potassium levels, constipation, shortness of breath, coughing, tissue swelling

CYTOVENE-IV, VITRASERT

For Cytovene-IV, dosages vary but should not exceed 6 mg per kg of body weight. Vitrasert, surgically implanted in the eye, consists of a 4.5 mg pellet of ganciclovir coated with polymers.

what it does: Treats the eye infection cytomegalovirus retinitis in transplant recipients and people with weakened immune systems. what to know: Do not take with blood dyscrasia-causing medications, bone marrow depressants, radiation therapy, nephrotoxic medications, or Retrovir. Dosage may need adjustment if you have kidney problems or take Videx or Videx EC. Use caution if you take other HIV medications containing zidovudine or didanosine.

most serious: blood disorders, black or tarry stools, cough, sore throat, fever or chills, pain, painful urination, unusual bleeding, tiredness, weakness, seeing flashes, spots, partial veil other: abdominal pain, changes in behavior, diarrhea, headache, increased sweating, loss of appetite, vomiting, weight loss

DAUNOXOME

Injected intravenously at a strength of 40 mg per square meter of body surface area every two weeks.

what it does: Treats advanced HIV-related Kaposi’s sarcoma what to know: Do not use if you have less than advanced KS. You should have regular blood counts on Daunoxome.

most serious: suppression of the bone marrow’s production of blood cells and platelets other: back pain, flushing, chest tightness

DIFLUCAN

Doses vary based on targeted infection. Available as tablets, powder to mix with water, or an injection formula.

what it does: Treats fungal infections, including AIDS-related Candida oral, esophageal, urinary, or vaginal yeast infections. what to know: Do not take with Quinaglute, Quinidex, Hismanal, Propulsid, Orap, or erythromycin. Use with caution with antidiabetic agents, anticonvulsants, blood pressure medications, immunosuppressive drugs, protease inhibitors, blood thinners, and vitamin A. Use caution if pregnant (miscarriage risk) or you have heart or kidney problems. Do not take if you have sugar intolerance.

most serious: liver problems, potentially severe allergic reaction, seizures other: rash, nausea, headache, vomiting, diarrhea, dizziness, abdominal pain

DOXIL

20 mg per square meter of body surface, every three weeks by intravenous infusion.

what it does: Treats AIDS-related Kaposi’s sarcoma in patients who cannot tolerate other medicines or whose disease is advanced. what to know: Dose may need to be adjusted if you have liver problems. Do not use if you are pregnant or plan to be pregnant.

most serious: congestive heart failure, decrease in blood cells, secondary oral cancers, handfoot syndrome other: tingling or burning, swelling, blisters, mouth sores, fever, nerve damage, fatigue, vomiting, more (see HIVPlusMag.com)

EGRIFTA

2 mg injected subcutaneously (just below the skin), once daily.

what it does: Reduces HIV-related excess belly fat by encouraging the body to produce natural growth hormones. what to know: Do not take if you have or had pituitary gland issues, if you have active cancer, or if you are pregnant or breastfeeding.

most serious: severe allergic reaction, fluid retention, injection site reactions, increase in glucose intolerance, diabetes other: pain, swelling, muscle soreness, tingling, numbness and pricking, nausea, vomiting, rash, itching

EPOGEN, PROCRIT

100 units per kg body weight, three times a week, given intravenously. Single-dose vials: 2,000, 3,000, 4,000, and 10,000 units/1 ml. Multidose vials containing benzyl alcohol: 20,000 units/2 ml and 20,000 units/1 ml.

what it does: Treats anemia that results as a side effect of Retrovir. what to know: Do not take if you have uncontrolled high blood pressure or have had a type of anemia called pure red cell aplasia. Iron supplements may be needed for patients who undergo blood transfusions. Talk to your doctor if you have cancer, as there is an increased risk of tumor progression or shortened survival.

most serious: high blood pressure, seizures, development of antibodies against the drug, severe allergic reactions other: joint, muscle, or bone pain, fever, cough, rash, nausea, vomiting, soreness of mouth, itching, headache, pain at injection site

generic name: Isavuconazonium sulfate maker: Astellas

generic name: Ganciclovir maker: Roche Laboratories (Cytovene-IV), Bausch and Lomb (Vitrasert), Pharmaforce (generic)

generic name: Daunorubicin liposomal maker: Galen

generic name: Fluconazole maker: Pfizer

generic name: Doxorubicin, Liposomal maker: Janssen

generic name: Tesamorelin maker: EMD Serono and Theratechnologies

generic name: Epoetin Alfa maker: Amgen (Epogen), Janssen (Procrit)

JULY / AUGUST 2017

medication

traditional dosage

what it treats, precautions, and recommendations

side effects

ERAXIS

For esophageal candidiasis 100 mg by injection the first day, followed by 50 mg daily dose thereafter for 14 days; for candidemia and Candida infections, 200 mg by injection first day, followed by 100 mg daily dose. Eraxis comes as a powder that is mixed with sterile water for infusion.

what it does: Treats esophageal candidiasis, candidemia, and other Candida infections. what to know: Effects on women who are pregnant or breastfeeding have not been studied, discuss possibility of pregnancy with your doctor.

most serious: abnormal liver function, anaphylactic shock other: nausea, diarrhea, vomiting

ETOPOPHOS

Dosages vary for small cell lung cancer and testicular cancer, used in combination with other chemotherapeutic agents.

what it does: Treats various types of cancer; currently being tested for treatment of non-Hodgkinâ&#x20AC;&#x2122;s lymphoma and Kaposiâ&#x20AC;&#x2122;s sarcoma. what to know: High-dose cyclosporine and drugs such as levamisole hydrochlor can cause interactions. Use of a live virus vaccine could be complicated by weakened immune mechanisms. Do not deliver by bolus intravenous injection. Women are advised to avoid pregnancy and take contraception for at least six months after final dose.

most serious: severe allergic reaction, hair loss, chills or fever, nausea, constipation, abdominal pain, infertility or lack of menstruation other: rash, unusual tiredness

FAMVIR

500 mg twice daily for seven days; tablets come in 125, 250, or 500 mg strengths.

what it does: Treats recurrent episodes of orolabial herpes (cold sores) or genital herpes. what to know: Dosage may need to be reduced for patients with kidney impairment. The gout drugs Benemid and Probalan may increase levels of Famvir in the body, so level should be monitored.

most serious: acute kidney failure other: headache, nausea, skin or subcutaneous tissue disorders, heart palpitations

FORTESTA

Initial dose is 40 mg of gel, applied to the thighs once daily, in the morning; amount may be adjusted by your physician. Apply at same time every day, after bathing or showering, to clean, dry skin.

what it does: Treats low testosterone, which can be a complication of HIV, especially for men over 50. what to know: Wash hands immediately after applying. Cover the application area with clothing after gel dries. Avoid letting others, especially women and children, have skin-to-skin contact with application area; if they do, they should wash the contact area right away. Tell your doctor about your health conditions, especially breast or prostate cancer; difficulty in urination due to enlarged prostate; heart, kidney, or liver problems; or sleep apnea. Tell your provider what medications you are taking, especially insulin, corticosteroids, or medicines that decrease blood clotting.

FOSCAVIR

Initial dose of the liquid solution, is an intravenous infusion of 90 mg per kg of weight every 12 hours or 60 mg/kg every 8 hours for 2 to 3 weeks, followed by a maintenance dose of 90 mg/kg to 120 mg/kg daily. Dosage should be individualized according to your kidney function but should not exceed the recommended amount or frequency.

what it does: Treats Cytomegalovirus retinitis, a viral eye infection of the retina. what to know: May be used in combination with ganciclovir drugs in patients who have relapsed after treatment with either drug by itself, but no other drug should be delivered in the same infusion. Use with caution with intravenous pentamadine.

most serious: impairment of kidney function, electrolyte abnormalities, seizures, anemia other: headache, nausea, vomiting, diarrhea, fever

GAMIMUNE N, GAMUNEX, GAMMAGARD, GAMUNEX-C

300 to 600 mg per kg of body weight, every three to four weeks, administered intravenously.

what it does: Treats primary humoral immunodeficiency and bacterial infection, primarily in children and teens with HIV. what to know: May interfere with immune response to live-virus vaccines for measles, mumps, or rubella.

most serious: depression, suicidal behavior, severe pain, difficulty breathing, vision problems, high fever, bleeding, bruising other: headache, nausea, diarrhea, chills, fatigue

generic name: Anidulafungin maker: Pfizer

generic name: Etoposide maker: Bristol-Myers Squibb

generic name: Famciclovir maker: Novartis

generic name: Testosterone gel maker: Endo Pharmaceuticals

generic name: Foscarnet sodium maker: Hospira

generic name: Immune globulin maker: Bayer Biological, Talecris Biotherapeutics, Baxter Healthcare, Grifols Therapeutics

HIVPLUSMAG.COM

DRUGS THAT TREAT HIV-RELATED CONDITIONS medication

traditional dosage

what it treats, precautions, and recommendations

side effects

HEPSERA

One 10 mg tablet daily.

what it does: Treats chronic hepatitis B infection. what to know: Do not take with Viread, Atripla, Truvada, Complera, or Stribild. Use caution when taking with other NRTIs or drugs that affect kidney function or are eliminated by the kidneys.

most serious: buildup of lactic acid in blood, kidney impairment, worsening of hepatitis B, or hep B resistance in treatment-experienced CHB or HIV/HBV coinfected patients other: weakness, headache, abdominal pain, nausea, diarrhea, indigestion, gas, increased creatinine and hypophosphatemia

INTRON A

30 million international units (IUs) per square meter of body surface, subcutaneously or intramuscularly, three times a week for Kaposi’s sarcoma; 3 million IUs three times a week for chronic hepatitis C.

what it does: Treats AIDS-related Kaposi’s sarcoma and hepatitis infection, especially hepatitis C. what to know: Use caution if taken with Retrovir, theophylline, or Tyzeka. Do not take if you have autoimmune hepatitis, decompensated liver disease, thalassemia major, sickle-cell anemia, or problems with creatinine clearance. Use with caution if you have history of cardiovascular or cerebrovascular diseases.

most serious: depression, suicidal thoughts, severe flu-like symptoms, increased risk of lifethreatening liver disease other: difficulty sleeping, nervousness, muscle pain or numbness, blood in urine or stools, painful urination, chest pain, fever, chills, unusual bleeding or bruising, suicidal or homicidal thoughts.

MARINOL

Usually starts with one 2.5-mg capsule taken twice daily, before lunch and dinner. Also available in 5-mg or 10-mg capsules. Take the capsules whole; do not crush or chew.

what it does: A man-made form of cannabis, it is used to stimulate the appetite of people living with HIV. what to know: Can interact dangerously with alcohol, Valium, Librium, Seconal, Xanax, or Nembutal. Do not smoke marijuana, as this can cause an overdose. Can become habit-forming.

most serious: amnesia, confusion, delusions, mood changes, hallucinations, depression, nervousness, anxiety, rapid heartbeat other: clumsiness, dizziness, drowsiness, euphoria, trouble thinking, nausea, vomiting

MEGACE ES

625 mg (one teaspoon), once daily.

what it does: Treats appetite loss, severe malnutrition, or unexplained, significant weight loss. what to know: May decrease effectiveness of Crixivan (indinavir). May cause fetal harm when administered to a pregnant woman. If you have a history of blood clots, check with your doctor before taking.

most serious: Cushing’s syndrome, development or worsening of diabetes other: decreased sexual desire or performance, flatulence, rash, high blood pressure, insomnia, upset stomach, increased blood sugar, between-period bleeding

MEGACE ORAL SUSPENSION

800 mg, once daily.

what it does: Treats severe malnutrition, appetite loss, or significant weight loss. what to know: May decrease effectiveness of Crixivan (indinavir). May cause fetal harm when administered to a pregnant woman. If you have a history of blood clots, check with your doctor before taking.

most serious: Cushing’s syndrome, diabetes other: decreased libido, flatulence, high blood pressure, insomnia, upset stomach, increased blood sugar, betweenperiod bleeding

MEPRON

Oral suspension 1,500 mg once daily with food for prevention of mild to moderate Pneumocystis pneumonia. 750 mg twice daily with food for 21 days for treatment of mild to moderate Pneumocystis pneumonia. Supplied in foil pouches and bottles. For a 5-ml dose, take entire contents by mouth either by dispensing into a spoon or cup or directly into the mouth. For a 10-ml dose, take 2 pouches.

what it does: Helps prevent and treat mild to moderate Pneumocystis pneumonia in patients who cannot tolerate other drugs. what to know: If taking rifampin (Rifadin), consider alternatives, as it reduces the amount of Mepron in the body. Use caution when taking with tetracycline, metoclopramide, or indinavir.

most serious: rash, diarrhea, nausea, headache, vomiting, fever

generic name: Adefovir dipivoxil maker: Gilead

generic name: Interferon Alfa-2B maker: Schering

generic name: Dronabinol maker: AbbVie

generic name: Megestrol acetate maker: Strativa

generic name: Megestrol acetate maker: Bristol-Myers Squibb

generic name: Atovaquone maker: GlaxoSmithKline

JULY / AUGUST 2017

medication

traditional dosage

what it treats, precautions, and recommendations

side effects

MEPRON

most serious: rash, diarrhea, nausea, headache, vomiting, fever

MYCOBUTIN

300 mg in capsules, once daily. If prone to nausea or vomiting, split into two doses daily, with food.

what it does: Helps prevent disseminated Mycobacterium avium complex (MAC) disease. what to know: Do not use with Rescriptor or Norvir. May reduce effectiveness of Sporanox, Biaxin, Fortovase, and Invirase as well as oral contraceptives. Cut dose in half if also taking Crixivan or Viracept. Do not take if you have active tuberculosis.

most serious: neutropenia (lowered white blood cell count) other: rash, gastrointestinal disorders, flu-like symptoms, eosinophilla (increased white blood cell count)

MYTESI

generic name: Crofelemer maker: Napo

One 125 mg delayed-release tablet, twice daily, with or without food. Tablets should be swallowed whole and not crushed or chewed

what it does: Relieves HIV-related diarrhea that is a side effect of antiretroviral drugs what to know: Formerly called Fulyzaq. You should be tested to make sure your diarrhea is not caused by an infection.

most serious: upper respiratory tract infection, bronchitis other: cough, flatulence, increased levels of the liver enzyme bilirubin

NEBUPENT

300 mg every four weeks, via oral inhalation.

what it does: Helps prevent Pneumocystis pneumonia in patients with a history of the disease or low T-cell counts. what to know: Use with caution with aminoglycosides (a class of antibiotics), amphotericin B (antifungal drug), Platinol, Foscavir, or Vancocin. If breastfeeding, take only if doctor determines benefits outweigh risks.

most serious: acute pancreatitis other: night sweats, anemia, bronchitis, nonspecific herpes, herpes zoster, nonspecific influenza, oral Candida, pharyngitis, sinusitis, headache, chest pain, cough, wheezing

PANRETIN GEL

Topical gel initially applied twice a day to KS lesions, with frequency increased to 3 or 4 times a day, depending on tolerance, or reduced if skin is irritated or if there is a toxic reaction. Apply enough to cover the lesion thoroughly, but avoid getting on normal skin. Allow the gel to dry before covering the skin with clothing. Treatment can continue as long as needed.

what it does: Provides topical treatment for Kaposi sarcoma lesions. what to know: Avoid using with products that contain DEET, a common ingredient of insect repellents. Minimize skinâ&#x20AC;&#x2122;s exposure to sun.

most serious: toxic skin reactions

RADIESSE

Available in single-use vials with 0.3, 1, or 1.3 ml of calcium hydroxylapatite suspended in a water-based gel. Injected into the skin, and results can last up to a year. Injectible implant for use in hands.

what it does: Treats facial fat loss (lipoatrophy) and stimulates the bodyâ&#x20AC;&#x2122;s collagen production to combat HIV-related facial wasting. what to know: Users of blood thinners or aspirin may have bleeding or bruising at the injection site. For 24 hours after treatment, avoid significant movement, massage, sun exposure, or makeup use.

most serious: prolonged swelling, irritation, redness, swelling, itching, burning, or tenderness at the injection site

RIFADIN, RIFADIN IV

10 mg per kg of body weight, once daily, orally in capsule form (Rifadin) or intravenously (Rifadin IV). Daily dosage should not exceed 600 mg. Oral dosage should be 1 hour before or 2 hours after a meal with water.

what it does: Helps prevent or treat infections caused by certain type of bacterium, including the one that causes tuberculosis. what to know: Do not take if taking Reyataz, Prezista, Lexiva, Fortovase, Invirase, or Aptivus. Dosage of anticoagulant drugs should be adjusted. Use with caution if you have diabetes. Switch to nonhormonal contraceptives.

most serious: gastrointestinal distress, changes in liver function, headache, drowsiness, dizziness, menstrual irregularities, jaundice, darkened urine other: loss of appetite, fever, joint pain

generic name: Atovaquone maker: GlaxoSmithKline

generic name: Rifabutin maker: Pfizer (Mycobutin), Lupin Ltd. (Generic)

generic name: Pentamidine isethionate maker: APP Pharmaceuticals

generic name: Alitretinoin maker: Eisai

generic name: Calcium hydroxylapatite maker: Merz Aesthetics

generic name: Rifampin maker: Sanoifi-Aventis

HIVPLUSMAG.COM

DRUGS THAT TREAT HIV-RELATED CONDITIONS medication

traditional dosage

what it treats, precautions, and recommendations

side effects

SCULPTRA

Amount and frequency varies by patient; delivered by subcutaneous injection.

what it does: Helps restore or correct signs of facial fat loss (lipoatrophy). what to know: If you have an active skin infection or inflammation in or near the treatment area, do not use until this condition is under control. Minimize exposure to sunlight or sun lamps.

most serious: bruising, edema, hematoma, injection site reactions

SEROSTIM

0.1 mg per kg of body weight daily (up to 6 mg), injected subcutaneously at bedtime.

what it does: Treats wasting (HIV-related weight loss). what to know: Do not use if you are critically ill, following surgery, have serious injuries, or a severe breathing problem, or have cancer. Do not use if you have eye problems caused by diabetes or allergies to growth hormone.

most serious: musculoskeletal discomfort, swelling of the hands and feet, tingling and numbness, breast enlargement in men, nausea, extreme tiredness, nausea and vomiting. other: tumors or cancerous growths, high blood sugar (hyperglycemia/diabetes), headaches, changes in vision, serious allergic reactions, injection site reactions, abdomen pain and tenderness

SPORANOX

200 mg daily, in oral solution, for 1 to 2 weeks for oral candidiasis; 200 mg daily in capsule form, for other fungal infections, such as histoplasmosis and blastomycosis.

what it does: Treats fungal infections such as oral candidiasis (thrush). what to know: Do not take with methadone, disopyramide, dofetilide, dronedarone, quinidine, ergot alkaloids (dihydroergotamine), ergometrine (ergonovine), ergotamine, methylergometrine (methylergonovine), irinotecan, lurasidone, oral midazolam, pimozide, triazolam, felodipine, nisoldipine, ivabradine, ranolazine, eplerenone, cisapride, lovastatin, simvastatin, ticagrelor. If you have renal or hepatic impairment, do not take with colchicine, fesoterodine, telithromycin and solifenacin. Use caution if you have heart, lung, or kidney disease, or take protease inhibitors. Do not take capsules if you have or had congestive heart failure.

most serious: cardiac issues, including failure, liver failure, neuropathy, hearing loss other: nausea, diarrhea, vomiting, fever, respiratory disorders, rash, headache

TAXOL

135 mg per square meter of body surface, intravenously over three hours every 3 weeks, or 100 mg per square meter of body surface, intravenously over 3 hours every 2 weeks

what it does: Provides second-line treatment for Kaposiâ&#x20AC;&#x2122;s sarcoma. what to know: Use caution when taking with Versed, Buspar, Vansar, Plendil, Altocor, Altoprev, Mevacor, Zocor, Relpax, Revatio, Viagra, Halcion, Reyataz, Biaxin, Crixivan, Sporanox, Feoris, Nizoral, Serzone, Viracept, Norvir, and others. (See HIVPlusMag.com)

most serious: bone marrow disorders other: tiredness, weakness, shortness of breath, nausea, vomiting, diarrhea, unusual bleeding or bruising, joint pain or numbness, hair loss

TESTIM

50 mg in premeasured tube, applied to upper arms and shoulders, once daily. Apply at same time every day, after bathing or showering, to clean, dry skin.

what it does: Treats low testosterone, which can be a complication of HIV, especially for men over 50 what to know: Wash hands immediately after applying. Cover the application area with clothing after the gel dries. Avoid letting others, especially women and children, have skin-to-skin contact with application area; if they do, they should wash the contact area right away. Tell your doctor about your health conditions, especially if you have breast or prostate cancer; difficulty in urination due to enlarged prostate; heart, kidney, or liver problems; or sleep apnea. Tell your provider what drugs you are taking, especially insulin, corticosteroids, or medicines that decrease blood clotting.

most serious: enlarged prostate, prostate cancer, lowered sperm count, enlarged or painful breasts, sleep apnea, blood clots in legs or lungs, swelling of ankles, feet, or body other: skin irritation at application site, increased red blood cell count

TYZEKA

One 600-mg tablet, once daily, or 30 ml of oral solution for patients who have difficulty swallowing tablets.

what it does: Treats hepatitis B. what to know: Do not take with Pegasys. If using oral solution, close bottle and clean dosing cup immediately after dosing, keep cup dry between uses, and do not use for anything else.

most serious: buildup of lactic acid, severe liver problems, muscle pain or weakness, nerve problems, flare-up of hepatitis B after discontinuation other: diarrhea, abdominal pain or swelling, cough, headache, dizziness, sore throat, fever

generic name: Injectable Poly-L-Lactic Acid maker: Dermik Laboratories

generic name: Somatropin maker: EMD Serono

generic name: Itraconazole maker: Janssen

generic name: Paclitaxel maker: Bristol-Myers Squibb (Taxol); Teva Parenteral Medicines (Generic)

generic name: Testosterone gel maker: Endo Pharmaceuticals

generic name: Telbivudine maker: Idenix/Novartis

JULY / AUGUST 2017

medication

traditional dosage

what it treats, precautions, and recommendations

side effects

VALCYTE

Two 450 mg tablets, twice daily, for 21 days, then two tablets once daily.

what it does: Treats the eye infection cytomegalovirus retinitis. what to know: Do not take with Cytovene-IV. Use cautionwith Retrovir, CellCept, Myfortic, or Videx. Can cause seizures; do not drive until you know how the medication affects you. Do not use if you are pregnant or you or your partner are planning to become pregnant. Continue contraception during treatment and for 30 to 90 days after treatment.

most serious: anemia, thrombocytopenia, fertility impairment, lower sperm count, fetal abnormalities, kidney failure, graft rejection other: diarrhea, nausea, vomiting, fever, tremors, seizures, neutropenia, anemia, low blood cell counts

VFEND

For esophageal candidiasis, 200 mg in tablets or oral solution, every 12 hours, at least an hour before or after a meal. For other fungal infections, treatment starts with an intravenous infusion of 6 mg/kg weight every 12 hours for the first 24 hours, followed by a maintenance dose of either 4 mg/kg weight every 12 hours or 200 mg in tablets or oral solution every 12 hours. Duration of treatment varies.

what it does: Treats fungal infections, such as esophageal candidiasis. what to know: Do not use with Atripla or high-dose Norvir; use with caution with low-dose Norvir. Do not use with St. Johnâ&#x20AC;&#x2122;s Wort, ergot alkaloids, terfenadine, astemizole, cisapride, pimozide, quinidine, or rifabutin. Use with caution if you have a heart arrhythmia.

most serious: severe liver problems, heart arrhythmias, visual disturbances other: fever, nausea, rash, vomiting, chills, headache

ZITHROMAX

For treatment of Mycobacterium avium complex, one 600 mg tablet daily, with 15 mg of Myambutol; for prevention, two 600 mg tablets, once weekly, which may be combined with Mycobutin.

what it does: Treats and helps prevent Mycobacterium avium complex (MAC). what to know: When used with Viracept, which can increase concentrations of Zithromax, you should be monitored closely for known side effects of Zithromax, such as liver enzyme abnormalities and hearing impairment.

most serious: irregular heart activity (including fatal); liver liver problems, severe diarrhea, hearing impairment other: nausea, vomiting, mild to moderate diarrhea, abdominal pain

ZOVIRAX

Dosage varies depending on type of infection; available in capsules, tablets, oral suspension, topical cream, and as intravenous injectable.

what it does: Treats and controls herpes viral infections, like shingles, genital warts, cold sores around the lip and mouth, and chicken pox. what to know: Use with caution with Retrovir, antifungal agents, probenecid, interferon, intrathecal methotrexate, and drugs that can cause kidney toxicity. Drink plenty of fluids while taking the drug. Topical cream should not be applied to eyes, mouth, nose or genitals.

most serious: severe allergic reaction, blood and liver disorders, hepatitis, peripheral edema (blood clotting leading to swelling of the legs or arms), gastrointestinal upset, nausea, hair loss, jaundice, seizures, confusion; dullness, tiredness, weakness; hallucination other: skin redness, dryness and cracking; headache, visual impairment, tremors, rash or stinging skin

generic name: Valganciclovir maker: Genentech

generic name: Voriconazole maker: Pfizer

generic name: Azithromycin maker: Pfizer

generic name: Acyclovir maker: GlaxoSmithKline

HIVPLUSMAG.COM

LEDBUG

the 2017 hepatitis c treatment guide

JULY / AUGUST 2017

INTERFERONS

The oldest class of drug used to fight HVC does so two ways: it makes the hep C virus more visible to the immune system and it directly suppresses formation of new virus particles in the liver. medication

traditional dosage

INTRON A

drug interactions, precautions, and recommendations

side effects

See page 19 for information on this drug.

See page 19

PEGASYS

180 micrograms, once weekly, by subcutaneous injection.

Do not take if you have autoimmune hepatitis or liver problems. Do not take with Copegus or Rebetol if you are pregnant or if you or your partner plan to become pregnant. Do not take with Videx. Use with caution if taking Tyzeka, Theo-24, Elixophyllin, Uniphyl, Theolair, Azasan, Imuran, warfarin (Coumadin, Jantoven), phenytoin (Dilantin, Phenytek, Dilantin-125, Cerebyx), or methadone.

most serious: severe eye, blood, liver, nerve, intestines, eye, thyroid, or lung problems; stroke, heart attack, pancreatitis, severe infections, suppression of bone marrow function, colitis, high blood sugar or diabetes, allergic reaction, growth inhibition in pediatric patients; neuropsychiatric reactions including suicide, homicidal ideation, relapse of drug addiction, and drug overdose other: flu-like symptoms, tiredness, weakness, stomach problems, loss of appetite, skin reactions, tongue discoloration, hair thinning, insomnia

PEGINTRON

1.5 micrograms per kg of body weight, once weekly, by subcutaneous injection; other doses no longer being manufactured.

Use caution with drugs metabolized by CYP2C8/9 or CYP2D6. Monitor for toxicities when used with NRTIs. Do not take if you have Stevens-Johnson syndrome, autoimmune hepatitis, or certain other liver problems. Do not take if you are pregnant or plan to become pregnant. Use with caution if you have a history of psychiatric disorders.

most serious: severe eye, heart, blood, liver, nerve, thyroid, or lung problems; pancreatitis, colitis, high blood sugar or diabetes; or allergic reaction other: flu-like symptoms, tiredness, appetite problems, headache, nausea, myalgia, anxiety or emotional irritability, skin reactions, thinning hair

ROFERON-A

3 million IUs per square meter of body surface, subcutaneously or intramuscularly, three times a week.

Use caution if taking with Retrovir and similar HIV drugs, theophylline (treats breathing problems), or Tyzeka.

most serious: depression, suicidal behavior, pain, breathing and vision problems, fever, bleeding or bruising other: flu-like symptoms, sleep disturbances, headache, thyroid problems, fatigue

generic name: Peginterferon alfa-2A maker: Genentech

generic name: Peginterferon alfa-2B maker: Merck

generic name: Interferon alfa-2 maker: Roche

S3/4A PROTEASE INHIBITOR

This class of drugs fight HCV by inhibiting the NS3-4A enzyme, an essential element in hep Câ&#x20AC;&#x2122;s replication. medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

OLYSIO

150mg capsule taken once daily with food. Olysio can be given in combination with sofosbuvir (Sovaldi). Olysio has also been approved for use in combination with peginterferon alfa and ribavirin (Copegus, Rebetol, and others) and Pegasys.

Do not take Olysio in combination with ribavirin if you or your partner are pregnant or plan to become pregnant as birth defects or fetal death can result. No human data on risk of using Olysio alone in pregnancy, but fetal toxicity was observed in mice, so caution is advised. Avoid using cobicistat-containing products and HIV protease inhibitors, with or without ritonavir (Norvir). Also, do not combine with amiodarone (Cordarone, Nexterone, and Pacerone), carbamazepine, fluconazole, dexamethasone, rifampin, and herbal products such as milk thistle and St. Johnâ&#x20AC;&#x2122;s Wort. Use with caution if taking Tegretol, Mycobutin, Rifadin, Norvir, Kaletra, Biaxin, cimetidine, antifungal meds, grapefruit juice, Sovaldi; antibiotics like Priftin, Ketek, erythromycin; the corticosteroid dexamethasone (Maxidex, Ozurdex, Baycadron); generic cisapride; or some anticonvulsants.

most serious: liver failure, severe rash, seriously low heart rate (in combination with sofosbuvir and amiodarone) other: fatigue, headache, nausea, itching, rash, photosensitivity

generic name: Simeprevir maker: Janssen

HIVPLUSMAG.COM

COMBINATION DRUGS

Helping to prevent the replication of HCV, drugs in this class combine two or more medications that use different methods to attack the hepatitis C virus. medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

HARVONI

One tablet daily, containing 90 mg ledipasvir and 400 mg sofosbuvir. Treatment duration 8, 12, or 24 weeks. Doesn’t need to be taken with ribavarin (except for those with decompensated cirrhosis or recipients of liver transplant) or interferon. (Harvoni combines a NS5A inhibitor and a nucleotide NS5B polymerase inhibitor.)

Do not use with St. John’s Wort, Cordarone, Crestor, Mycobutin, Rifadin, Priftin, or Olysio; the anticonvulsant drugs Tegretol, Dilantin, Luminol or Trileptal; or the HIV drugs Aptivus, Norvir, Atripla, or Stribild. For HIV regimens that contain tenofovir disoproxil fumarate, such as Viread and Truvada, monitor for tenofovir-associated adverse events. No clinically significant interactions with tenofovir alafenamide. Leave at least four hours between Harvoni and antacid consumption. Use with caution if pregnant or breastfeeding. Do not take with other sofosbuvir products. If taken with ribavirin (Copegus, Rebetol), all ribavirin warnings and contraindications apply.

most serious: serious symptomatic bradycardia when coadministered with cordarone; hepatitis B virus reactivation; skin rashes, sometimes with swelling and blisters occurring other: fatigue, headache

TECHNIVIE

Two tablets taken orally, once daily with food; used commonly with ribavirin (Copegus, Virazole, Ribasphere). (Technivie is a combo of a NS5A Inhibitor, a NS3/4A Protease Inhibitor, and a CYP3A Inhibitor.)

Do not take if you have cirrhosis; nor in combination with Colchicine, Alfuzosin HCI, Carbamazepine, phenytoin, phenobarbital, Rifampin, or ergot derivatives. Discontinue medications with ethinyl estradiol (estrogen) prior to starting. If taken with ribavirin (Copegus, Rebetol), all ribavirin warnings and contraindications apply.

most serious: liver failure other: asthenia, fatigue, nausea, insomnia

VIEKIRA PAK

Two ombitasvir, paritaprevir, ritonavir 12.5/75/50 mg tablets once daily (in the morning) and one dasabuvir 250 mg tablet twice daily (morning and evening) with food, for 12 weeks. For patients with HCV genotype 1a and cirrhosis, ribivarin should be added. (Viekira Pak combines a NS5A inhibitor, a NS3/4A protease inhibitor, and a nonnucleoside NS5B polymerase inhibitor.)

Do not take with Uroxatral, Carbatrol, Epitol, Equetro, Tegretol, Sustiva, Atripla, Cafergot, Complera, Kaletra, Migergot, Ergomar, Ergostat, Edurant, Medihaler, Wigraine, Wigrettes, D.H.E. 45, Migranal, Ergotrate, Methergine, ethinyl estradiol-containing medicines, Lopid, Advicor, Altoprev, Mevacor, oral midazolam, Norvir-boosted Prezista, Sustiva, Dilantin, Phenytek, Luminal, Orap, Zocor, Vytorin, Simcor, Viagra, Cialis, St. John’s Wort, Halcion, Rifadin, Rifamate, Rifater, Rimactane, or Revatio when taken for pulmonary artery hypertension. Do not take if you have liver cirrhosis or have had a severe skin rash after taking ritonavir (Norvir). Use with caution if you have other liver problems or have had a liver transplant and take the medicines Prograf, Gengraf, Neoral, or Sandimmune. If taken with ribavirin (brand names Copegus, Rebetol), all ribavirin warnings and contraindications apply.

most serious: liver damage or liver failure, hypersensitivity other: nausea, itching, sleep problems

ZEPATIER

One tablet daily containing 50 mg elbasvir and 100 mg grazoprevir. For treatment of chronic HCV genotype 1 or 4 infection in adults, use with or without ribavirin. (Zepatier combines a NS5A inhibitor, and a NS3/4A protease inhibitor.)

Do not take with anticonvulsants (Phenytoin, Carbamazepine), antimycobacterials (Rifampin), immunosuppressants (Cyclosporine), St. John’s Wort, Efavirenz, atazanavir, darunavir, lopinavir, saquinavir, or tipranavir. Co-administration is not recommended with CYP3A inhibitors, ketoconazole, bosentan, tacrolimus, etravirine (Intelence), modafinil, and cobicistat containing drugs (Stribild, Genvoya). May increase concentrations of statins; use caution with atorvastatin, rosuvastatin, fluvastatin, lovastatin, simvastatin. You should be tested for current or prior hepatitis B infection before initiating Zepatier. HCV/HBV coinfected individuals should be monitored for HBV reactivation and hepatitis flare-up during and after treatment. Hepatic lab testing should occur prior to therapy, at treatment week 8, and as clinically indicated. Those receiving 16 week therapy, should receive additional hepatic lab testing at week 12. If ALT levels elevate, follow doctor recommendations. If administered with ribavirin, the warnings and precautions for ribavirin (Copegus, Rebetol) also apply.

most serious: elevation of liver enzymes, hepatitis B reactivation other: fatigue, headache, nausea, anemia

generic name: Ledipasvir and sofosbuvir maker: Gilead

generic names: Ombitasvir, paritaprevir, and ritonavir maker: AbbVie

generic names: Ombitasvir, paritaprevir, and ritonavir tablets packaged with dasabuvir tablets maker: AbbVie

generic names: Elbasvir and grazoprevir maker: Merck

JULY / AUGUST 2017

NUCLEOSIDE ANALOGS

Often used in combination with Pegasys or PegIntron, these drugs inhibit RNA replication of the hepatitis C virus.

medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

COPEGUS

800 to 1,200 mg daily, depending on patient’s weight, taken twice daily in 200 mg capsules, with food.

Do not use if you have cirrhosis or will be having a liver transplant; or if you take Videx or Videx EC. Use caution when taking with NRTIs (Combivir, Epivir, Epzicom, Retrovir, Trizivir), as drug interactions could lead to toxicity. Do not take if you have certain blood disorders, such as thalassemia major or sickle-cell anemia; or certain types of hepatitis. Do not take if you are pregnant or if you or your partner plan to become pregnant.

most serious: stunted growth among patients under 17; severe eye, blood, lung, or liver problems; pancreatitis; skin reactions (some fatal); depression or suicidal thoughts; high blood sugar or diabetes; fetal death or birth defects other: flu-like symptoms, tiredness and weakness, nausea and vomiting, loss of appetite, anemia, hair thinning, trouble sleeping

REBETOL

800 to 1,400 mg daily, based on patient’s weight, by oral solution, taken with food. Capsule version no longer manufactured. Usually prescribed in combination with PegIntron.

most serious: severe eye, lung, or blood problems; pancreatitis; severe depression, anorexia, homicidal or suicidal thoughts; fetal death, birth defects, or pediatric growth inhibition; skin problems (some fatal); anemia other: dental problems caused by dry mouth, mood changes, flulike symptoms, headache, fever, stiffness, injection site reaction, neutropenia

generic names: Ribivarin maker: Roche

generic name: Ribivarin maker: Schering, Merck

NUCLEOTIDE NS5B POLYMERASE INHIBITORS

This class of drugs mimics the NS5B enzyme; incorporated into viral replication they cause RNA chain termination. medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

SOVALDI

One 400 mg tablet, once daily, in combination with ribivarin (Copegus, Rebetol, and others); with some types of hep C virus, peginterferon alfa (Pegasys) and ribavirin should both be used.

Do not take with Cordarone, Aptivus, Olysio, Tegretol, Dilantin, Tileptal, Mycobutin, Rifadin, Priftin, St. John’s Wort, or drugs containing phenobarbital. Warnings and precautions of other direct acting hep C antivirals also apply in Sovaldi combination treatment; avoid other sofosbuvir-containing medications like Harvoni. When taken along with ribavirin or peginterferon, all of their associated warnings and contraindications apply. Do not take if you or partner are pregnant or plan to be, as birth defects or fetal death can result (when taken with ribavirin).

most serious: serious symptomatic bradycardia when coadministered with cordarone, risk of HBV reactivation, fetal damage (when taken with ribavirin) other: fatigue, headache, nausea, insomnia, anemia

generic name: Sofosbuvir maker: Gilead

NONSTRUCTURAL PROTEIN 5A (NS5A) REPLICATION COMPLEX INHIBITORS

Inhibitors of NS5A block a protein essential for HCV to reproduce, thus stopping viral production at an early stage. medication

traditional dosage

drug interactions, precautions, and recommendations

side effects

DAKLINZA

One 60 mg tablet taken orally, once daily in combination with sofosbuvir (Sovaldi) with or without ribavirin (Rebetol, Copegus, Virazole, Ribasphere). Also available in 30 mg and 90 mg doses.

Do not take with amiodarone, anticonvulsants (phenytoin, carbamazepine), antimycobacterials (rifampin), and St. John’s wort. Use caution with atorvastatin, fluvastatin, pitavastatin, pravastatin, rosuvastatin, and simvastatin. Dosage adjustments may been necessary when taken with protease inhibitors (atazanavir, ritonavirb, indinavir, nelfinavir, saquinavir), cobicistat-containing antiretroviral regimens, NNRTIs (efavirenzb, etravirine, nevirapine), clarithromycin, itraconazole, ketoconazole, nefazodone, posaconazole, telithromycin, voriconazole, bosentan, dexamethasone, modafinil, nafcillin, rifapentine, and digoxin.

most serious: symptomatic bradycardia (in patients taking Solvaldi, Harvoni, or amiodarone: Cordarone, Nexterone, Pacerone) other: headache, fatigue

generic name: Daclatasvir maker: Bristol-Myers Squibb

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