Treatment Review; Double Issue #26 & #27 November 1997
Nucleoside Reverse Transcriptase Inhibitors (NRTIs)
AZT (zidovudine, Retrovir): Standard dose is 300 mg taken twice
a day. This can somtimes be lowered to reduce side effects.
Side effects can include nausea, vomiting, anemia, low white
blood cells, bone marrow damage, headaches and loss of muscle
tissue. Now also available in pill form in combination with
3TC. The combo pill is called Combivir.
ddI (didanosine, Videx): Comes as chewable tablet or powder.
Dose is usually 400 mg a day, but can be adjusted based on your
weight. Side effects can include nerve damage in the hands and
feet (known as peripheral neuropathy), pancreatitis, and
diarrhea. ddI is coated in an antacid buffer that can effect
the absorption of other drugs such as dapsone and indinavir.
ddC (zalcitabine, HIVID): Dose is 2.25 mg a day, divided into
three doses. Side effects can include peripheral neuropathy,
pancreatitis, and sores in the mouth.
d4T (stavudine, Zerit): Dose is usually 40 mg taken twice a
day, but can be adjusted to as low as 20 mg twice a day based
on your weight or if you experience side effects. Side effects
can include peripheral neuropathy, stomach upset, pancreatitis
and liver damage.
3TC (lamivudine, Epivir): Dose is 150 mg taken twice a day. 3TC
has also shown activity against the hepatitis B virus. Side
effects can include headache, nausea, low white blood cells,
peripheral neuropathy and rare cases of hair loss.
indinavir (Crixivan): Dose is 800 mg every 8 hours on an empty
stomach or with non-fat food like dry toast. Side effects can
be nausea and kidney stones. Drinking at least eight large
glasses of water a day is recommended with this drug.
nelfinavir (Viracept): Dose is 750 mg taken three times a day,
preferably with food. Some doctors recommend not waiting more
than 12 hours between doses. The main side effect is diarrhea,
which can sometimes be controlled with over the counter
ritonavir (Norvir): Dose is 600 mg taken twice a day with food
(fatty if possible). Side effects can be nausea, diarrhea and
numbing around the mouth. Also effects the absorption of many
other drugs by the body due to its actions in the liver. There
is a long list of drugs that can not be taken when taking
saquinavir (Invirase): Current dose is 600 mg three times a day
with food. Side effects include stomach upset and gas. Not as
well absorbed by the body as other protease inhibitors. A
better absorbed version of saquinavir called Fortovase may be
approved in later this year.
Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
nevirapine (Viramune): Dose is 200 mg once a day for two weeks,
with 200 mg taken twice a day after that. Possible side effect
can be rash, which in some cases can be severe and require
stopping the drug.
delavirdine (Rescriptor): Dose is 400 mg taken three times a
day. Possible side effect is a rash, which in some cases can be
severe. Severe rash may occur less frequently than with
Anti-HIV drugs that are available in pediatric formulations and
approved for use in children are AZT (trade name Retrovir), 3TC
(Epivir), ddI (Videx) and d4T (Zerit), nelfinavir (Viracept)
and ritonavir (Norvir).
The NNRTI drug delavirdine (Rescriptor) can be dissolved in
water but has not yet been studied in children. The other
available NNRTI drug nevirapine (Viramune) is not yet approved
for kids, but there is a special program that can provide the
drug for children. You can call (800) 595-5494 for more
information on the nevirapine pediatric program.
The US Government has issued draft guidelines on the use of
anti-HIV drugs in children. These guidelines are on the
http://www.healthcg.com/hiv/guidelines/pediatrics or downloaded
http://www.hivatis.org. If you don't have access to the
Internet call the Network and we'll mail you a copy.
A special registry has been set up to collect information on
the use of combination anti-HIV drugs in pregnancy, the contact
information is: Antiretroviral Pregnancy Registry, PO Box
13398, Research Triangle Park, NC 27709; phone: (919) 483-9437
(can be called collect) or (800) 722-9292, ext. 39437; fax: