Department: DRUG CHALLENGE
Many antiretroviral drugs indicated to treat HIV infection have dietary restrictions and/or other special considerations. Are you prepared to educate patients about taking them correctly? To find out, match each drug in Section I with the appropriate dietary restriction described in Section II.
_____ 1. Rilpivirine (Edurant), Janssen Therapeutics
_____ 2. Efavirenz (Sustiva), Bristol Meyers Squibb
_____ 3. Raltegravir (Isentress), Merck & Co., Inc.
_____ 4. Nelfinavir (Viracept), Agouron Pharmaceuticals, Inc.
a. Take with or without food. This HIV integrase strand transfer inhibitor is indicated to treat HIV-1 infection in patients age 4 weeks or older. It's available as film-coated tablets, chewable tablets, and an oral suspension. All formulations can be taken without regard to meals.
b. Take with a meal containing fat. Given in combination with other antiretroviral medications, this nonnucleoside reverse transcriptase inhibitor (NNRTI) is indicated for treatment-naive patients with an HIV-1 RNA viral load of ≤100,000 copies/mL. In studies, it was 40% less effective when taken in a fasting state compared with a normal caloric diet (533 kcal) or high-fat, high-caloric diet (928 kcal).
c. Take with a meal. Patients who can't swallow tablets can dissolve them in a small amount of water, mix well, and consume immediately. This protease inhibitor is indicated to treat HIV in combination with other antiretroviral medications. Increasing either the calorie or fat content of a meal increases drug exposure.
d. Take on an empty stomach, preferably at bedtime to minimize central nervous system signs and symptoms such as dizziness, insomnia, and impaired concentration. This NNRTI is indicated to treat HIV-1 infection in patients age 3 months or older who weigh at least 3.5 kg.
ANSWERS: 1b, 2d, 3a, 4c