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Antiretroviral drugs

Dalal, Kavitha S. PharmD; Bridgeman, Mary Barna PharmD, BCPS

doi: 10.1097/01.NURSE.0000510749.62713.a3
Department: DRUG CHALLENGE
Free

Kavitha S. Dalal is a critical care pharmacist at Virtua in Marlton, N.J. Mary Barna Bridgeman is a clinical associate professor at Rutgers University Ernest Mario School of Pharmacy in Piscataway, N.J.

Unless otherwise specified, the information in the preceding summaries applies to adults, not children. Consult the package insert for information about each drug's safety during pregnancy and breastfeeding. Also consult a pharmacist, the package insert, or a comprehensive drug reference for more details on precautions, drug interactions, and adverse reactions.

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.

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Section I

_____ 1. Rilpivirine (Edurant), Janssen Therapeutics

_____ 2. Efavirenz (Sustiva), Bristol Meyers Squibb

_____ 3. Raltegravir (Isentress), Merck & Co., Inc.

_____ 4. Nelfinavir (Viracept), Agouron Pharmaceuticals, Inc.

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Section II

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

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