Indinavir is commonly known by its trade name, Crixivan. Crixivan is a protease inhibitor. Protease inhibitors block the part of HIV called protease. When protease is blocked, or inhibited, HIV makes copies of itself that can't infect new cells. Protease inhibitors are almost always used in combination with at least two other anti-HIV drugs.

Taking the drug: The dose of Crixivan is 800 mg every 8 hours. Take Crixivan with water either 1 hour before or 2 hours after eating. Crixivan is best taken when your stomach is empty. Alternatively there are guidelines on food you can eat with Crixivan: any food you eat should contain less than 65 grams of carbohydrate, 5.7 grams of protein, 2 grams fat and 301 calories. You can check food nutrition labels for this information, but make sure the food item meets ALL of the above guidelines. Examples are dry toast with jelly or cornflakes with skim milk. You can take Crixivan with a drink of skim milk, coffee, tea or any juice apart from grapefruit juice. Grapefruit juice stops your body absorbing Crixivan.

An example of a Crixivan dosing schedule is: 7:00 in the morning, 3:00 in the afternoon, and 11:00 at night. Drink lots of water when taking Crixivan to avoid kidney stones - at least 8 glasses of water every day. Don't skip doses. Skipping doses gives the HIV in your body a chance to get resistant which means the Crixivan won't work. If you miss a dose, don't take twice as much with the next dose. Stick as close to the schedule as you can. Sticking to the schedule keeps the right amount of Crixivan in your body, and makes it harder for the HIV in your body to become resistant.

Twice-daily dosing of Crixivan has been investigated, but it did not work as well as the standard dosing. New studies have found that a twice daily dose of 800mg of Crixivan combined with 100mg of ritonavir (Norvir) may work very well, because ritonavir greatly boosts Crixivan levels in the body. The combination of Crixivan + ritonavir can also be taken with or without food. Although this combination is still officially experimental, some doctors have begun using it as a way to make Crixivan easier to take.

Drug interactions: You can't take some drugs, even some over-the-counter drugs, with Crixivan. Don't take terfenadine (Seldane), astemizole (Hismanal), cisapride (Propulsid), triazolam (Halcion), midazolam (Versed) or drugs called ergot derivatives with Crixivan. Any of these drugs can cause life-threatening side effects when mixed with Crixivan. If you're taking rifabutin (Mycobutin), Crixivan can cause more rifabutin to stay in your body than you need. Talk to your doctor about only taking half your dose of rifabutin. If you're taking ketoconazole (Nizoral), the ketoconazole can cause more Crixivan to stay in your body than you need. Talk to your doctor about taking 600 mg of Crixivan every 8 hours instead of 800 mg.

Cautions: A few people taking Crixivan have had a side effect called hemolytic anemia. Hemolytic anemia means you don't have enough red blood cells. If you are too tired or have yellow skin or your urine is reddish brown, tell your doctor right away. Hemolytic anemia is very rare, but can get dangerous very quickly. If you have hepatitis B and/or C, protease inhibitors like Crixivan may cause a flare-up and liver damage. Your doctor should check whether you have hepatitis before starting any protease inhibitor. If you're taking Crixivan, regular blood tests should check for both anemia and liver problems. If you have a type of liver damage known as cirrhosis, talk to your doctor about taking 600 mg of Crixivan every 8 hours instead of 800 mg.

Side effects: The most common side effect of Crixivan is kidney stones. These stones are caused by the Crixivan forming a sludge in the kidneys. A warning sign is pain in your side and/or back. Tell your doctor if you have these symptoms. Left unchecked, kidney damage can lead to kidney failure. Recent reports show that kidney stones may happen more often in women than men. Sometimes Crixivan also causes an increase in the levels of bilirubin, a colored substance produced by the liver from broken down red blood cells. Bilirubin levels usually go back to normal on their own after a few months. Other reported side effects of Crixivan include hair loss, dry skin and ingrowing toenails.

Warnings: A government warning says protease inhibitors can cause high blood sugar and diabetes. Symptoms to watch out for are being too thirsty and hungry, losing too much weight, having to pee a lot, being very tired, and having dry, itchy skin. At least 83 people have had symptoms like these so far. The symptoms show up 10-11 weeks after starting to take a protease inhibitor. One person had symptoms just four days after starting a protease inhibitor.

Some people taking combination anti-HIV drugs are experiencing swollen bellies, and losing fat from their face, arms and legs. These side effects have been given the name lipodystrophy. One of the most serious lipodystrophy-related problems is high levels of fats (cholesterol and triglycerides) in the blood. High levels of fats in the blood can increase the risk of heart attacks. Because of these risks it's important to have your cholesterol and triglyceride levels checked regularly if you're taking Crixivan.

Merck Pharmaceuticals, the company that makes Crixivan, has a patient assistance program. Call (800) 850-3430 for more information.

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