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HIV drugs

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sgthuan's version from 2017-07-12 03:13

NRTI - Renal dosing CrCl < 50 (Except abacavir)/ No CYP450/ BBW lactic acidosis and severe hepatomegaly with steatosis

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abacavir ABCZiagennucleotide reverse transcriptase inhibitors NRTIs (usually 2nd line)screen for HLA-B*5701, hypersensitivity - never rechallenge, increased MI risk, tab, do NOT use with alcohol - toxicity, do NOT use if viral load > 100,000 copies/ml or CD4 < 200
* abacavir + lamivudineEpzicomNRTI + NRTI (3rd common backbone)only qd, screen for HLA-B*5701, hypersensitivity, increased MI risk
abacavir + lamivudine + dolutegravirTriumeqNRTI + NRTI + INSTIscreen for HLA-B*5701, hypersensitivity, increased MI risk, ***First Line Tx in HIV naive
abacavir + lamivudine + zidovudineTrizivirNRTI + NRTI + NRTIBID, screen for HLA-B*5701, hypersensitivity, increased MI risk
lamivudine 3TCEpivirnucleotide reverse transcriptase inhibitors NRTIsdo NOT use Epivir-HBV (lower dose), do NOT combine with emtricitabine (same structure), have HBV activity
lamivudine + zidovudineCombivirNRTI + NRTIBID, not very common
emtricitabine FTCEmtriva, Emtriva-HPVnucleotide reverse transcriptase inhibitors NRTIsdo NOT combine with lamivudine (same structure), cap, have HBV activity
tenofovir disoproxil fumarate TDFVireadnucleotide reverse transcriptase inhibitors NRTIstab, PO sln, severe exacerbation of HepB if d/c, "NEPHROTOXICITY", osteoporosis, fanconi syndrome - PO4 wasting in the urine, ** increased CPK
*** emtricitabine + tenofovir disoproxil fumarateTruvadaNRTI + NRTI (most common backbone)*** 200/300mg only qd, Original container!, pre-exposure prophylaxis - PrEP
emtricitabine + tenofovir disoproxil fumarate + rilpivirineCompleraNRTI + NRTI + NNRTIonly qd, WITH FOOD, Original container!
emtricitabine + tenofovir disoproxil fumarate + elvitegravir + cobicistatStribildNRTI + NRTI + INSTI + boosteronly qd, WITH FOOD, Original container! *** Do NOT use if CrCl < 70, ***First Line Tx in HIV naive
emtricitabine + efavirenz + tenofovir disoproxil fumarateAtriplaNRTI + NRTI + NNRTI***"NPO empty stomach", preferred at bedtime, Original container!
tenofovir alafenamide TAFVemlidy (HepB)nucleotide reverse transcriptase inhibitors NRTIsnot available as individual ONLY combo, better renal and bone toxicity, severe exacerbation of HepB if d/c
** emtricitabine + tenofovir alafenamideDescovyNRTI + NRTI (2nd most common)only qd, Original container!
emtricitabine + tenofovir alafenamide + rilpivirineOdefseyNRTI + NRTI + NNRTIonly qd, WITH FOOD, Original container!
emtricitabine + tenofovir alafenamide + elvitegravir + cobicistatGenvoyaNRTI + NRTI + INSTI + boosteronly qd, WITH FOOD, Original container! *** Do NOT use if CrCl < 30, ***First Line Tx in HIV naive
zidovudine ZDVRetrovirnucleotide reverse transcriptase inhibitors NRTIscap,tab,"sln IV", M - myopathy, Macrocytic ANEMIA (increased MCV), lipoatrophy, do NOT combine with stavudine, **** use for PERINATAL prevention as IV injecction --> ONLY ONE has IV
stavudine d4TZeritnucleotide reverse transcriptase inhibitors NRTIs (rarely used - last line)cap,sln, *** LIPOATROPHY!!!, do NOT combine with stavudine and didanosine ("pancreatitis", neuropathy, lactic acidosis), stable for 30d in refridgerator
didanosineVidexnucleotide reverse transcriptase inhibitors NRTIs"NPO Empty Stomach", stable for 30d in refridgerator, do NOT combine with stavudine (pancreatitis,neuropathy,lactic acidosis), P - pancreatitis, peripheral neuropathy, pink skin or rash
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NNRTI - No Renal dosing / Many CYP450/ RASH/ No naive HIV

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***efavirenzSustivanon-nucleoside reverse transcriptase inhibitors NNRTI"NPO Empty Stomach", CNS & serious psychiatric sx - "qHS", QT prolong, decrease hormonal contraceptive level!!! - "TERATOGENIC" AVOID in pregnancy
emtricitabine + efavirenz + tenofovir fumarate TDFAtriplaNRTI + NRTI + NNRTI"NPO Empty Stomach" or qHS, Original container
***rilpivirineEdurantNNRTI"ABSORPTION" - ContraIndication with PPI, require acidic environment, With Food - full meal, "depression & insomnia", ***Avoid in viral load > 100,000 or CD4 < 200
emtricitabine + tenofovir fumarate TDF + rilpivirineCompleraNRTI + NRTI + NNRTIqd, keep in original container, do NOT use with PPI
emtricitabine + tenofovir alafenamide + rilpivirineOdefseyNRTI + NRTI + NNRTIqd, keep in original container, do NOT use with PPI
delavirdine DLVRescriptorNNRTIacidic environment, headache, rarely used due to TID, strong 2C9,2C19,2D6 & mod 3A4 inhibitor
nevirapine NVPViramune, Viramune XR (t,sus)NNRTI14d lead-in or titrate up, hepatotoxicity, SJS/TEN
etravirineIntelenceNNRTIWITH Food, SJS/TEN, 2nd line after failing 1st ART regimen
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PIs + Boosters - major CYP inhibitor, NO renal dose, **** METABOLIC syndromes

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*** darunavir DRVPrezistaProtease inhibitor (1st line in guideline)should NOT given alone (+ ritonavir or cobicistat), With Food, hepatitis, SJS/TEN, Sulfa Allergy, less likely to cause lipodystrophy
darunavir + cobicistatPrezcobixPI + boosterqd ONLY for naive, With Food
*** atazanavir ATVReyatazProtease inhibitorindirect hyperbilirubinemia, hepatotoxicity, Nephrolithiasis, cholelithiasis, requires ACIDIC environment - low dose PPI ok
atazanavir + cobicistatEvotazPI + boosterqd Only, With Food, acidic environment
ritonavirNorvirProtease inhibitorused as booster, strong 3A4 inhibitor, With FOOD, AVOID - alfuzosin, amiodarone, dronedarone, simvastatin, lovastatin, rifampin, st. John's wort, phenobarbital, phenytoin, "GI distress" - N/V/D
emtricitabine/TDF + darunavir + ritonavirTruvada + Prezista + NovirNRTI+ NRTI + PI + Booster***First Line Tx for HIV naive (only ONE in PI group), *** also for NON-Occupational Postexposure prophylaxis (nPEP) within 3 days for 28 DAYS
cobicistatTybostBoosterstrong 3A4 inhibitor, With Food, combo (Genvoya, Stribild, Prezcobix, Evotaz), AVOID - alfuzosin, amiodarone, dronedarone, simvastatin, lovastatin, rifampin, st. John's wort, phenobarbital, phenytoin
emtricitabine + tenofovir fumarate + elvitegravir + cobicistatStribildNRTI + NRTI + INSTI + booster*** do NOT use if CrCl < 70
emtricitabine + tenofovir alafenamide + elvitegravir + cobicistatGenvoyaNRTI + NRTI + INSTI + booster*** do NOT use if CrCl < 30
fosamprenavirLexivaProtease inhibitorWith Food, *** Sulfa Allergy
indinavirCrixivanProtease inhibitornephrolithiasis, urolithiasis, Original container
lopinavir + ritonavirKaletra (t,sus)PI + boostersln - With Food, sln has 42% alcohol, N/V/D and hyperlipidemia (TG)
nelfinavirViraceptProtease inhibitorWith Food, diarrhea, ***"NO Boosting!!!", do not use with PPI
saquinavirInviraseProtease inhibitorWith Food, Must be Given with Ritonavir
tipranavirAptivusProtease inhibitor (last line - similar structure with warfarin)With Food, Must be Given with Ritonavir, hepatitis, "Intracranial Hemorrhage", sulfa allergy
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Integrase Strand Transfer Inhibitors INSTI - NO Renal dose, 1st line in guidelinefor

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dolutegravirTivicayINSTI (newest, most preferred)50mg qd or BID with tx experienced, pts > 40kg only, increased Scr w/o affecting GFR, "INSOMNIA"
dolutegravir + emtricitabine/TDFTivicay + TruvadaNRTI + NRTI + INSTI***First Line Tx in HIV naive
abacavir + lamivudine + dolutegravirTriumeqNRTI + NRTI + INSTIincreased Scr w/o affecting GFR, CI with dofetilide, ***First Line Tx in HIV naive, *** For nPEP within 3 days for 28 DAYS
elvitegravirVitektaINSTIlactic acidosis with severe hepatomegaly, exacerbation of HBV if d/c, Must be Boosted with cobicistat
emtricitabine + tenofovir fumarate + elvitegravir + cobicistatStribildNRTI + NRTI + INSTI + boosterqd, original container, ***Do NOT use if CrCl < 70, ***First Line Tx in HIV naive
emtricitabine + tenofovir alafenamide + elvitegravir + cobicistatGenvoyaNRTI + NRTI + INSTI + boosterqd, original container, *** Do NOT use if CrCl < 30, ***First Line Tx in HIV naive
raltegravirIsentressINSTI (oldest)*** 400 BID, original container, **** increased CPK - monitor, myopathy, rhabdomyopathy
raltegravir + emtricitabine/TDFIsentress + TruvadaNRTI + NRTI + INSTI***First Line Tx in HIV naive, *** for nPEP within 3 days for 28 DAYS, *** Preferred for PEP also for 28 DAYS
maravirocSelzentryCCR5Requires Tropism testing, ONLY work with CCR5-tropic disease, hepatotoxicity
enfuvirtideFuzeonFusion inhibitor90mg SQ BID, local injection site rxn
megestrolMegaceunknownfor anorexia or cachexia associated with HIV
dronabinolMarinolcannabinoidfor anorexia associated with HIV
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