Home Drug Guide Raltegravir potassium

Drug Guide

Generic Name

Raltegravir potassium

Brand Names Isentress, Isentress HD

Classification

Therapeutic: Antiretroviral agent for HIV-1 infection

Pharmacological: Integrase strand transfer inhibitor

FDA Approved Indications

  • Treatment of HIV-1 infection in adults and pediatric patients (4 weeks and older)

Mechanism of Action

Raltegravir inhibits the HIV integrase enzyme, preventing the integration of viral DNA into the host cell genome, which inhibits viral replication.

Dosage and Administration

Adult: 600 mg twice daily; for some patients, 1200 mg once daily may be used, depending on co-administered drugs and clinical judgment.

Pediatric: Dose varies by weight and age; typically 4 mg/kg twice daily for children aged 4 weeks to less than 2 years, 25 mg twice daily for children 2 to less than 12 years and weighing 11 kg or more.

Geriatric: No specific dosage adjustment; consider renal, hepatic status.

Renal Impairment: No dose adjustment required for mild to moderate impairment; data limited for severe impairment.

Hepatic Impairment: No specific adjustment suggested; caution advised.

Pharmacokinetics

Absorption: Rapid absorption with peak plasma concentrations in 1 to 2 hours.

Distribution: Extensive plasma protein binding (~83%).

Metabolism: Primarily via UGT1A1-mediated glucuronidation; minor CYP3A4 contributions.

Excretion: Mostly fecal (~53%) and renal (~31%), primarily as metabolites.

Half Life: ~9 hours.

Contraindications

  • Hypersensitivity to raltegravir or any component of the formulation.

Precautions

  • Use with caution in patients with hepatic impairment.
  • May cause hepatotoxicity; monitor liver function.
  • Potential for hypersensitivity reactions.

Adverse Reactions - Common

  • Nausea (20-30%)
  • Diarrhea (10-19%)
  • Headache (10-19%)
  • Elevated liver enzymes (<10%)

Adverse Reactions - Serious

  • Musculoskeletal symptoms (including myopathy and rhabdomyolysis) (Rare)
  • Hypersensitivity reactions including rash, eosinophilia, and systemic symptoms (Rare)
  • Hepatotoxicity leading to liver failure (Rare)

Drug-Drug Interactions

  • Potential interactions with drugs metabolized by UGT1A1 and CYP3A4; avoid concomitant use with rifampin, carbamazepine, phenobarbital, or other strong inducers.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Assessment: Monitor HIV viral load and CD4 counts; assess liver function periodically.

Diagnoses:

  • Risk for infection due to immunosuppression.
  • Risk for adverse drug reactions.

Implementation: Administer medication as prescribed; counsel patient on adherence.

Evaluation: Evaluate viral suppression and monitor for adverse effects.

Patient/Family Teaching

  • Take medication consistently at the same times each day.
  • Report any rash, allergic symptoms, or signs of liver problems.
  • Maintain regular follow-up appointments for lab tests.

Special Considerations

Black Box Warnings:

  • None explicitly assigned; however, monitor for hypersensitivity reactions.

Genetic Factors: None specifically noted.

Lab Test Interference: May cause false-positive tests for cannabinoids and other drugs of abuse.

Overdose Management

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

Treatment: Supportive care; no specific antidote; consider activated charcoal if ingestion was recent.

Storage and Handling

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

Stability: Stable under recommended conditions until expiration date.

🛡️ 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.