Home Drug Guide Elvitegravir

Drug Guide

Generic Name

Elvitegravir

Brand Names Vitekta

Classification

Therapeutic: Antiretroviral Agent

Pharmacological: Integrase Strand Transfer Inhibitor

FDA Approved Indications

  • Treatment of HIV-1 infection

Mechanism of Action

Elvitegravir inhibits the HIV integrase enzyme, preventing the integration of viral DNA into the host cell genome, thereby hindering viral replication.

Dosage and Administration

Adult: Typically 85 mg once daily in combination with other antiretroviral agents. Dose adjustments may be needed based on coadministration with other drugs.

Pediatric: Not approved for pediatric use.

Geriatric: No specific dosage adjustments indicated, but caution advised due to potential comorbidities and concomitant medications.

Renal Impairment: Adjustments may be necessary; assess renal function before initiation and periodically during treatment.

Hepatic Impairment: No specific dosing recommendations; use with caution.

Pharmacokinetics

Absorption: Absorption is enhanced when taken with food.

Distribution: Widely distributed in tissues, plasma protein binding approximately 99%.

Metabolism: Metabolized primarily by CYP3A4 and UGT1A1 pathways.

Excretion: Primarily excreted in feces, minimal urinary excretion.

Half Life: Approximately 3 to 4 hours.

Contraindications

  • Hypersensitivity to elvitegravir or components.
  • Co-administration with drugs highly dependent on CYP3A4 for clearance and with a narrow therapeutic window.

Precautions

  • Use with caution in patients with pre-existing liver disease, especially hepatitis B or C. Monitor liver function tests regularly.

Adverse Reactions - Common

  • Nausea (Frequent)
  • Diarrhea (Frequent)
  • Headache (Frequent)

Adverse Reactions - Serious

  • Lactic acidosis (Rare)
  • Hepatotoxicity (Rare)
  • Allergic reactions including rash or hypersensitivity (Rare)

Drug-Drug Interactions

  • Rifampin (significantly reduces elvitegravir levels).
  • CYP3A4 inhibitors or inducers (alter elvitegravir plasma levels).
  • Other antiretrovirals, especially those with overlapping toxicities.

Drug-Food Interactions

  • No significant interactions reported, but take with food to enhance absorption.

Drug-Herb Interactions

  • St. John’s Wort (reduces effectiveness).

Nursing Implications

Assessment: Monitor HIV viral load, CD4 counts, liver function tests, and renal function periodically.

Diagnoses:

  • Risk for ineffective tissue perfusion related to HIV infection.
  • Risk for imbalanced fluid volume.

Implementation: Ensure medication adherence, monitor for side effects, educate patient on importance of compliance and reporting adverse effects.

Evaluation: Assess viral load suppression, side effect profile, and hepatic and renal function over time.

Patient/Family Teaching

  • Take medication exactly as prescribed, with food.
  • Report any signs of allergic reactions, severe rash, or hepatotoxicity.
  • Use consistent dosing schedule and do not stop abruptly.
  • Inform healthcare provider about all medications and supplements.

Special Considerations

Black Box Warnings:

  • None specifically for elvitegravir, but caution with co-administration of drugs affecting renal function and increased risk of lactic acidosis.

Genetic Factors: Consider testing for HLA-B*5701 allele in some antiretroviral therapies; no specific association with elvitegravir.

Lab Test Interference: May increase serum creatinine without affecting actual renal function.

Overdose Management

Signs/Symptoms: Unknown; may include nausea, vomiting, or other nonspecific symptoms.

Treatment: Supportive care, monitor vitals, and manage symptoms. No specific antidote.

Storage and Handling

Storage: Store at room temperature 20-25°C (68-77°F). Keep container tightly closed.

Stability: Stable under recommended storage conditions for the duration specified on the packaging.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.