Taking it

As with all antiretrovirals it is important to take indinavir (Crixivan) as recommended. If doses are missed, blood levels of the drug may fall and lead to the development of resistance.

The recommended dose of indinavir is 800mg three times daily. Indinavir comes in 200, 333 and 400mg capsules. Indinavir is the only anti-HIV drug that needs to be taken three times a day, limiting its appeal for many patients. In the US, dosing boosted indinavir twice a day is allowed in adults at 800mg indinavir with either 100mg or 200mg ritonavir every 12 hours.

A dose of 1000mg three times daily may be recommended if drug level testing indicates that there are low blood levels of the drug or if it is being taken in combination with a drug that reduces blood levels of indinavir. People with liver damage due to cirrhosis should take 600mg three times daily.

Research into twice-daily indinavir was halted due to poor results.1 Although some experts believe that this was due to poor adherence in the twice-daily arm, the manufacturer advises that anyone taking indinavir twice daily as their only protease inhibitor should move to the three-times-daily regimen.

A twice-daily regimen including 667mg indinavir boosted with 100mg ritonavir (Norvir) produces similar maximal blood concentrations to 800mg indinavir taken three times a day. The boosted combination also brought about a sixfold increase in the minimal blood drug concentration.2 However, there is some evidence that adding ritonavir increases the incidence of side-effects such as kidney stones, and the best doses for ritonavir and indinavir are unclear.3 4 Other dose combinations that may be effective with low rates of side-effects include 400mg indinavir boosted by 100mg ritonavir twice a day, but further studies are required.5

Indinavir is best absorbed into the body when it is taken with water on an empty stomach. Ideally, each indinavir dose should be taken at least one hour before or at least two hours after eating a meal. However, a low-fat light snack, such as toast and jam without butter or margarine, corn flakes and skimmed milk or orange juice will not interfere significantly with its absorption. Grapefruit juice delays the absorption of indinavir and should be avoided.

People taking indinavir should drink at least 1.5l of fluid a day to reduce the risk of kidney problems. The extra water should be taken with each indinavir dose and before going to bed.

Indinavir capsules are sensitive to moisture and should always be kept in the original bottle, which includes a desiccant to absorb moisture.

A lipid-associated form of indinavir is being developed. It is hoped that this form will enable the drug to reach higher levels within the lymph tissue, leading to better control of HIV. It is predicted that this form of indinavir will only need to be taken every four days.6

References

  1. Haas DW et al. Comparative studies of two-times-daily versus three-times-daily indinavir in combination with zidovudine and lamivudine. AIDS 14: 1973-1978, 2000
  2. Rhame FS et al. Pharmacokinetics of indinavir and ritonavir administered at 667 and 100 milligrams, respectively, every 12 hours compared with indinavir administered at 800 milligrams every 8 hours in human immunodeficiency virus-infected patients. Antimicrob Agents Chemother 48: 4200-4208, 2004
  3. de Jesus E et al. A randomised, controlled, open label study comparing the adherence and convenience of continuing indinavir (q8h) vs switching to Norvir / indinavir 400mg / 400mg (the NICE study). 13th International AIDS Conference, Durban, abstract WeOrB482, 2000
  4. Gatell JM et al. A randomised study comparing continued indinavir (800mg tid) vs switching to indinavir / ritonavir (800 / 100mg bid) in HIV patients having achieved viral load suppression with indinavir plus 2 nucleoside analogues: the BID Efficacy and Safety Trial (BEST). XIII International AIDS Conference, Durban, abstract WeOrB484, 2000
  5. Patel AK et al. Effectiveness of low-dose indinavir / ritonavir at 400 / 100mg twice a day with 2 nucleoside reverse transcriptase inhibitors in nonnucleoside reverse transcriptase inhibitor-experienced HIV-infected patients in India. 1-year follow-up. J Acquir Immune Defic Syndr 43: 124-126, 2006
  6. Snedecor SJ et al. Feasibility of weekly HIV drug delivery to enhance drug localization in lymphoid tissues based on pharmacokinetic models of lipid-associated indinavir. Pharm Res (online edition), 2006
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.