Home Drug Guide Etravirine

Drug Guide

Generic Name

Etravirine

Brand Names Intelence

Classification

Therapeutic: Antiretroviral agent, HIV-1 non-nucleoside reverse transcriptase inhibitor (NNRTI)

Pharmacological: Nucleoside reverse transcriptase inhibitor

FDA Approved Indications

  • Treatment of HIV-1 infection in combination with other antiretroviral agents

Mechanism of Action

Etravirine binds directly to reverse transcriptase enzyme, causing an enzyme conformational change that inhibits its activity, thereby preventing viral replication.

Dosage and Administration

Adult: 200 mg twice daily after meals

Pediatric: Not FDA approved for pediatric use

Geriatric: Adjust dosing based on hepatic function; no specific dose adjustments established solely based on age.

Renal Impairment: Use with caution; no specific adjustment recommended.

Hepatic Impairment: Use caution, especially in moderate to severe hepatic impairment; no specific dosing adjustments established.

Pharmacokinetics

Absorption: Rapidly absorbed with food, with increased bioavailability when taken with meals.

Distribution: Widely distributed; plasma protein binding ~99.7%.

Metabolism: Primarily metabolized in the liver via CYP3A4 and CYP2C9/19.

Excretion: Excreted mainly in feces; minimal renal excretion.

Half Life: approx. 49 hours.

Contraindications

  • Co-administration with certain drugs metabolized by CYP3A4 or that have QT prolongation risk.

Precautions

  • Use with caution in patients with known hypersensitivity, hepatic impairment, or QT prolongation risk.
  • Monitor for drug interactions reducing efficacy or increasing toxicity.

Adverse Reactions - Common

  • Rash (Common)
  • Nausea (Common)
  • Diarrhea (Common)

Adverse Reactions - Serious

  • Hepatotoxicity (Less common)
  • Hypersensitivity reactions (Rare)
  • QT prolongation (Less common)

Drug-Drug Interactions

  • CYP3A4 inducers and inhibitors (e.g., rifampin, ketoconazole, ritonavir)
  • Other antiretrovirals, especially those affecting CYP enzymes

Drug-Food Interactions

  • High-fat meals increase absorption, but should be taken consistently with food.

Drug-Herb Interactions

  • St. John’s Wort and other herbal products inducing CYP3A4 could reduce efficacy.

Nursing Implications

Assessment: Monitor for signs of efficacy (viral load decreasing) and adverse effects. Assess hepatic function before and during therapy.

Diagnoses:

  • Risk for infection due to immune suppression
  • Risk for adverse drug reactions

Implementation: Administer with food; counsel patients on adherence.

Evaluation: Monitor viral load and CD4 counts; observe for adverse reactions and drug interactions.

Patient/Family Teaching

  • Take medication with food to improve absorption.
  • Do not alter dose or discontinue without healthcare provider’s advice.
  • Report signs of rash, jaundice, or cardiovascular symptoms.
  • Maintain regular follow-up appointments for LAB assessments.

Special Considerations

Black Box Warnings:

  • Potential for severe skin reactions and hypersensitivity syndromes.
  • QT prolongation and torsades de pointes.

Genetic Factors: Pharmacogenomic variations in CYP450 enzymes may alter drug levels.

Lab Test Interference: May interfere with laboratory measurement of serum laboratory parameters.

Overdose Management

Signs/Symptoms: Nausea, vomiting, dizziness, possible arrhythmias.

Treatment: Supportive care, activated charcoal if within 1 hour of ingestion, cardiac monitoring if QT prolongation is suspected.

Storage and Handling

Storage: Store at room temperature, 20°C to 25°C (68°F to 77°F).

Stability: Stable for the duration of the labeled shelf life when stored properly.

🛡️ 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.