Taking it

T-20 (enfuvirtide, Fuzeon) needs to be injected subcutaneously, as in oral form it is destroyed by stomach acids. The recommended adult dosage is 90mg injected twice daily. The injections must be prepared daily, but both daily doses can be constituted at the same time. This takes about 50 minutes. Patients are provided with a carton containing vials of T-20 powder, water to dissolve the powder, as well as syringes and alcohol swabs. Detailed, step-by-step instructions on how to inject T-20 are included in the carton.

 The drug has to be reconstituted from a powder, in a five-step process:

1. Users must use a disposable syringe to draw up sterile water from the vial.
2. The sterile water is then injected slowly into another vial containing the freeze-dried powder.
3. The vial is rocked slowly from side to side in order to dissolve the powder and then left for up to 45 minutes.
4. When the powder has dissolved, the vial’s lid must be pierced with a second sterile needle and the liquid drawn up into the syringe.
5. The liquid is then injected beneath the skin of the abdomen, arm, or leg.

A vial of dissolved powder can be prepared at the beginning of the day for use in the evening or in the evening for use the following morning. Once constituted, the medication should be kept in the refrigerator until it is used. Although the drug should be taken every twelve hours, pharmacokinetic studies suggest that a delay of up to four hours is unlikely to be too serious.

Roche developed the Biojector, a needle-free device that had the potential to lessen injection site reactions, but which could also cause nerve pain in some persons lasting up to six months.¹ In October 2007, Roche withdrew its marketing application to the US FDA for approval, citing the amount of time it would have taken to generate additional safety data. Patients in the US who are currently using the B2000 to administer T-20 will be allowed to continue to use the B2000 to take the drug. The company will continue to explore other options for administering T-20.