HIV infections

Dosage:

Recommende dosage in combination with a ne\ucleoside analog is three 200mg capsules 3 times daily within 2 hours after a full meal.

Overdosage- Symptoms No acute toxicities were noted in one patient who ingested 8g saquinavir as a single dose.

Treatment

1. Patient was treated with induction of emesis within 2 to 4 hours after ingestion

Missed dose-

1. If you miss a dose of this medicine, take it as soon as possible.

2. However, if it is almost time for next dose, skip the missed dose and go back to your regular dosing schedule.

3. Do not double doses.

EVIDENCE BASED MEDICINE (MIMS April 2003)

Post-herpetic Neuralgia

Comparitive effectiveness of various interventions

Prevention of post-herpetic neuralgia

Beneficial

1. Oral antiviral agents such as acyclovir, famciclovir, valaciclovir, netivudine

2. Tricyclic antidepressants (amitriptyline)

Unknown effectiveness

1. Levodopa 2. Amantadine 3. Isoprinosine 4. Adenosine monophosphate

Unlikely to be beneficial

1. Topical antiviral agents (idoxurine) for relief of acute oain only

2. Cimetidine Ineffective or harmful 1. Corticosteroids Relieving established post-herpetic neuralgia

Beneficial

1. Tricyclic antidepressants (amitriptyline)

2. Oxycodone (opiod)

3. Gabapentin (anticonvulasant)

Unknown effectiveness

1. Capsaicin (topical counterirritant)

2. Topical lignocaine

Ineffective or harmful

1. Epidural morphine

2. Dextromethorphan

KEY POINTS

1. Daily acyclovir reduced the relative risk of of post-herpetic pain at six months by about 50 % compared with placebo

2. Famciclovir significantly reduced pain duration after acute herpes zoster.

3. Idoxuridine was associated with short term pain relief in acute herpes zoster but did not prevent post-herpetic neuralgia

4. Conflicting evidence on whether corticosteroids alone prevent post-herpetic neuralgia. Limited evidence that high dose steroids and antiviral agents combined may speed healing of acute zoster. No evidence that it reduces post-herpetic neuralgia

5. Amitriptyline started during the acute episode reduced prevalence of post-herpetic neuralgia at six months.

6. Insufficient evidence on the effect of other drug tretment.

1. Inform patients that Saquinavir is not a cure for HIV infection and that they may acquire illness associated with advanced HIV infection

2. Tell patients that long term patients of saquinavir are not known

3.Advise patients that saquinavir should be taken within 2 hours after a full meal.

Pharmacology:

Saquinavir is an inhibitor of the human immunodefiency virus(HIV) protease. HIV prorease cleaves viral polyprotein precursors to generate functional proteins in HIV infected cells.

Pharmacokinetics:

Following multiple dosing (600mg 3 times daily) in HIV infevted patients, the staedy-state area under the plasma conc curve (AUC) was 2.5 times higher than observed after a single dose.

To be taken within 2 hours after a meal.

Pregnancy:

Use during pregnancy, taking into account the importance of the drug to the mother

Lactation:

Use with caution and decide whether to discontinue the drug or the discontinue nursing taking into account the importance of the drug to the mother.

Children-

Safety and efficacy in HIV treated children or adolescents < 16 years of age have not been established.