Home Drug Guide Nelfinavir Mesylate

Drug Guide

Generic Name

Nelfinavir Mesylate

Brand Names Viracept

Classification

Therapeutic: Antiretroviral (HIV protease inhibitor)

Pharmacological: Protease inhibitor

FDA Approved Indications

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

Mechanism of Action

Nelfinavir inhibits the HIV-1 protease enzyme, preventing the cleavage of the Gag-Pol polyprotein, resulting in the production of immature, non-infectious viral particles.

Dosage and Administration

Adult: Delivered orally, typically 750 mg twice daily with meals.

Pediatric: Dosed based on weight or age, detailed dosing should be guided by a pediatric HIV specialist.

Geriatric: No specific dosage adjustment; assess renal and hepatic function.

Renal Impairment: Use with caution; no specific dosing adjustments recommended, but limited data available.

Hepatic Impairment: Use with caution; hepatic impairment may increase drug levels.

Pharmacokinetics

Absorption: Well absorbed with food.

Distribution: Widely distributed; protein binding approximately 98%.

Metabolism: Primarily metabolized in the liver via CYP3A4 enzyme.

Excretion: Excreted mainly in feces; minimal renal excretion.

Half Life: Approximately 3–5 hours.

Contraindications

  • Hypersensitivity to nelfinavir or any component.
  • Concomitant use with certain drugs due to significant drug interactions.

Precautions

  • Use with caution in patients with hepatic impairment; monitor liver function.

Adverse Reactions - Common

  • Diarrhea (Common)
  • Nausea (Common)
  • Flattening of the T waves on ECG (rare) (Rare)

Adverse Reactions - Serious

  • Hepatotoxicity (Uncommon)
  • Drug hypersensitivity reactions (Rare)
  • Lipodystrophy, hyperlipidemia (Uncommon)

Drug-Drug Interactions

  • Many due to CYP3A4 metabolism; includes statins, sedatives, antihistamines, and others.

Drug-Food Interactions

  • High-fat meals increase absorption, but concurrent use with liver-inhibiting drugs may increase adverse effects.

Drug-Herb Interactions

  • Potential interactions with herbal supplements affecting CYP3A4 activity.

Nursing Implications

Assessment: Monitor for signs of adverse reactions, adherence, and signs of opportunistic infections.

Diagnoses:

  • Impaired skin integrity related to lipodystrophy or rash.
  • Risk for infection due to immune suppression.

Implementation: Ensure proper dosing with food, monitor liver function tests, and assess for drug interactions.

Evaluation: Evaluate viral load response, adverse reactions, and adherence.

Patient/Family Teaching

  • Take medication with food to enhance absorption.
  • Report any signs of liver problems, severe diarrhea, or rash.
  • Maintain regular follow-up appointments for blood tests.

Special Considerations

Black Box Warnings:

  • No black box warnings for nelfinavir.

Genetic Factors: None specific.

Lab Test Interference: Can cause elevations in liver enzymes; may interfere with certain lab assays.

Overdose Management

Signs/Symptoms: Nausea, vomiting, diarrhea, dizziness, sedation.

Treatment: Supportive care, monitor vital signs, and symptomatic treatment. No specific antidote.

Storage and Handling

Storage: Store at room temperature, away from moisture and light.

Stability: Stable under proper storage conditions.

🛡️ 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.