Safe and Effective: Use of Antiretroviral Treatments in Adults with Particular Reference to Resource Limited Settings: ANNEX II. DRUG CHARTS

Safe and Effective: Use of Antiretroviral Treatments in Adults with Particular Reference to Resource Limited Settings
(2001; 36 pages) [French]

Table of Contents

	ACKNOWLEDGEMENTS
	INTRODUCTION
	SECTION ONE. PRINCIPLES OF ANTIRETROVIRAL THERAPY (ART)*
		1.1. BACKGROUND
		1.2. CHARACTERISTICS OF AVAILABLE ANTIRETROVIRAL DRUGS
		1.3. INITIATION OF THERAPY
		1.4. MONITORING
		1.5. TREATMENT FAILURE
		1.6. HIV RESISTANCE TO ANTIRETROVIRAL DRUGS
		1.7. FUTURE APPROACHES TO THERAPY
	SECTION TWO. SOME EXPERIENCES WITH ART IN RESOURCE LIMITED SETTINGS
		2.1. ART COVERAGE
		2.2. CONTEXT: PUBLIC OR PRIVATE SECTOR, DONOR SUPPORTED AND RESEARCH PROJECTS
		2.3. QUALITY OF CARE AND OUTCOMES
		2.4. LABORATORY MONITORING SERVICES
		2.5. SURVEILLANCE FOR DRUG RESISTANCE
		2.6. SUPPLY AND DISTRIBUTION OF THE DRUGS
		2.7. INITIATION OF TREATMENT
		2.8. CHOICE OF THERAPEUTIC REGIMEN
	SECTION THREE. GUIDE TO ART IN RESOURCE LIMITED SETTINGS
		3.1. WHAT SHOULD BE IN PLACE BEFORE INITIATING ART PROGRAMMES*
		3.2. COUNSELLING FOR ART
		3.3. CLINICAL EVALUATION BEFORE INITIATION OF ART
		3.4. INITIATION OF THERAPY
		3.5. MONITORING ANTIRETROVIRAL THERAPY*
		3.6. CONSIDERATIONS OF DRUG INTERACTIONS
		3.7. FURTHER RESEARCH NEEDS
		3.8. INFORMATION AND TRAINING NEEDS
	ANNEX I. LIST OF PARTICIPANTS
	ANNEX II. DRUG CHARTS

ANNEX II. DRUG CHARTS

Generic name Other name	Recommended dosage	Special instructions Precautions	Adverse effects minor, frequent	Adverse effects serious, dose limiting
NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS
zidovudine ZDV; AZT	300 mg (1 tablet) bid	caution in: • liver or renal insufficiency • pre-existing anaemia	initial nausea headache fatigue muscle pains	anaemia neutropenia lactic acidosis
didanosine* ddl	200 mg (2 tablets) bid weight below 60 kg: 100 mg bid	• to increase oral bioavailabity take 1 hour before or after food • contains antacid, affects absorption of other drugs	neuropathy nausea diarrhea	pancreatitis lactic acidosis
zalcitabine* ddC	0.75 mg (1 tablet) tid weight below 40 kg: 0.375 mg tid		neuropathy oral ulcers	pancreatitis lactic acidosis
stavudine* d4T	40 mg (1 capsule) bid weight below 60 kg.: 30 mg bid	caution in liver insufficiency	neuropathy	lactic acidosis
lamivudine 3TC	150 mg (tablet) bid		generally well tolerated	lactic acidosis
lamivudine + zidovudine	1 tablet bid	caution in: • liver or renal insufficiency • pre-existing anaemia	initial nausea headache fatigue muscle pains	anaemia neutropenia lactic acidosis
abacavir	300 mg (1 tablet) bid	caution in: • liver or renal insufficiency discontinue use if symptoms of hypersensitivity occur	nausea poor appetite vomiting fatigue sleep disturbance	hypersensitivity reaction lactic acidosis
NON NUCLEOSIDE REVERSE TRANSCRIPTASE INHIBITORS
nevirapine	200 mg (1 tablet) once a day, for 14 days; followed by 200 mg bid	caution in liver disease	skin rash abnormal liver function tests	hepatitis
delavirdine	400 mg (4 tablets) tid	caution in liver disease	skin rash headaches abnormal liver function tests	hepatitis
efavirenz	600 mg (3 capsules), once a day	caution in liver disease	skin rash neuropsychiatric disturbances abnormal liver function tests	hepatitis
PROTEASE INHIBITORS
saquinavir** hard gel capsule	600 mg (3 capsules) tid	• take with high fat meal to aid absorption • caution in liver disease	diarrhoea nausea abnormal liver function tests	hyperglycaemia lypodystrophy abnormal bleeding
saquinavir** hard gel capsule	1600 mg (8 capsules) bid or 1200 mg (6 capsules) tid	• take with high fat meal • refrigeration for long term storage • caution in liver disease	diarrhoea nausea abnormal liver function tests	hyperglycaemia lypodystrophy abnormal bleeding
ritonavir	600 mg (6 capsules) bid (begin with 300 mg bid and escalate over 10 days)	• capsules require refrigeration • easier tolerated if taken with food	nausea diarrhoea weakness skin sensitivity perioral tingling and numbness change in taste	hyperglycaemia lypodystrophy abnormal bleeding
indinavir	800 mg (2 capsules) tid	• take on an empty stomach • drink 1.5 litres of liquid per day. to avoid kidney problems • report any loin pain or blood in urine	nausea pain in belly headache	kidney stones hyperglycaemia lypodystrophy abnormal bleeding
nelfinavir	750 mg (3 tablets) tid or 1250 mg (5 tablets) bid	• to be taken with food	diarrhoea nausea flatulence skin rash	hyperglycaemia lypodystrophy abnormal bleeding
amprenavir	1200 mg (8 capsules) bid	• decreased absorption if taken with fatty meal • caution in patients allergic to sulphur drugs	nausea vomiting diarrhoea perioral numbness altered taste mood disorders	hypersensitivity rash hyperglycaemia lypodystrophy
lopinavir/ ritonavir	400/100 mg (3 capsules) bid	• caution in liver insufficiency • may be taken with food	abdominal pain abnormal stools diarrhoea fatigue headache nausea and vomiting	hyperglycaemia hyperlipidimea pancreatitis abnormal bleeding

* Dosage adjustments necessary for patients with reduced body weight (bwt)

** Saquinavir is available in two formulations, a hard-gel capsule (Invirase) and a soft-gel capsule (Fortovase). Saquinavir as the hard-gel capsule is poorly absorbed and is generally recommended for use in combination with ritonavir that enhances its bioavailability through a drug-drug interaction. Saquinavir as the soft-gel capsule is better absorbed and may be used with or without ritonavir.