Home Drug Guide Indinavir sulfate

Drug Guide

Generic Name

Indinavir sulfate

Brand Names Crixivan

Classification

Therapeutic: Antiretroviral, protease inhibitor

Pharmacological: Protease inhibitor

FDA Approved Indications

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

Mechanism of Action

Indinavir inhibits the HIV-1 protease enzyme, preventing the cleavage of viral polyprotein precursors into mature, infectious viral particles, thereby inhibiting viral replication.

Dosage and Administration

Adult: Typically 800 mg every 8 hours, with or without food, as part of combination antiretroviral therapy.

Pediatric: Dosage determined by body weight, under specialist supervision.

Geriatric: Adjustments based on renal function and tolerability.

Renal Impairment: Use with caution; dosage adjustment may be necessary.

Hepatic Impairment: No specific adjustment; use with caution.

Pharmacokinetics

Absorption: Well absorbed orally; food may delay absorption but does not reduce overall absorption.

Distribution: Widely distributed; highly protein-bound (~60-65%).

Metabolism: Primarily hepatic via CYP3A4.

Excretion: Feces (main route), small amount in urine.

Half Life: Approximately 2-4 hours.

Contraindications

  • Known hypersensitivity to indinavir or component ingredients.

Precautions

  • Use with caution in patients with renal impairment, hepatic impairment, or kidney stones.

Adverse Reactions - Common

  • Nephrolithiasis (kidney stones) (Less frequent; monitor renal function)
  • Hyperbilirubinemia (Common)
  • Rash (Common)
  • Lipodystrophy, hyperlipidemia, elevated liver enzymes, nausea, diarrhea. (Variable)

Adverse Reactions - Serious

  • Immune reconstitution syndrome (Rare)
  • Stevens-Johnson syndrome and toxic epidermal necrolysis (Very rare)
  • Hepatotoxicity (Rare)
  • Acute renal failure (due to nephrolithiasis) (Less frequent)

Drug-Drug Interactions

  • Ritonavir (potentiates indinavir levels), other CYP3A4 inhibitors or inducers, drugs affecting renal function.

Drug-Food Interactions

  • High-fat meals may delay absorption; take consistently with or without food as advised.

Drug-Herb Interactions

  • St. John’s Wort (may decrease efficacy).

Nursing Implications

Assessment: Monitor renal function, liver function, lipid profile, and presence of renal stones.

Diagnoses:

  • Risk for renal stones, altered renal function, hyperlipidemia.

Implementation: Administer as prescribed; ensure adequate hydration to prevent kidney stones; monitor for adverse effects.

Evaluation: Assess renal function, adherence, and effectiveness of viral suppression.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Maintain adequate hydration (at least 48 ounces of water daily).
  • Report signs of kidney stones (flank pain, blood in urine).
  • Adhere to regular monitoring appointments.
  • Be aware of potential side effects and drug interactions.

Special Considerations

Black Box Warnings:

  • Risk of nephrolithiasis; recommend hydration and monitoring of renal function.

Genetic Factors: None specified.

Lab Test Interference: May slightly increase bilirubin levels without jaundice.

Overdose Management

Signs/Symptoms: Nausea, vomiting, dizziness, hypotension.

Treatment: Supportive care; no specific antidote; monitor renal function; provide hydration and symptomatic treatment.

Storage and Handling

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

Stability: Stable under recommended conditions for shelf life indicated in 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.