Important note: Information in this article was accurate in 2000. The state of the art may have changed since the publication date.
TREATMENT REVIEW 32 - 33 - Fall/Winter 2000
The first Videx pills were large, chalky tablets that were very difficult to take. Many people found them foul tasting and they often caused stomach upset. In the years since the drug was first approved there have been some improvements, and there are now smaller pills available and they are flavored to make them less unpleasant. But even these newer pills still contain antacid.
For several years, the manufacturer of Videx has been working on a new version of the drug that doesn't need to contain antacid. This new version is called Enteric-Coated (EC) Videx. EC Videx has recently been approved for prescription in the U.S. and Europe.
EC Videx is only recommended for people that can't take the standard twice-daily Videx (because of side effects or interactions with other drugs they're taking, for example). This recommendation is because EC Videx is taken once-daily and there is less information on how well once-daily EC Videx works against HIV compared to the standard twice-daily version of Videx. EC Videx must be taken on an empty stomach. Recommendations from Europe currently suggest that EC Videx be taken either two hours before or two hours after a meal.
Standard Videx: New Recommendations
The standard version of Videx is usually taken twice a day. Recently, the US Food and Drug Administration (FDA) allowed a change in Videx dosing, giving people the option to take it just once-daily. New information has now caused the FDA to change their mind.
This information is from a study comparing two HIV treatment combinations. One combination was once-daily Videx taken with Zerit (d4T) and the protease inhibitor Viracept (nelfinavir). This was compared to the combination of Retrovir (AZT), Epivir (3TC) and Viracept. After 11 months of treatment, 34% (about a third) of the people in the once-daily Videx group had viral loads less than 50 copies. In the AZT/3TC/Viracept group, 47% (nearly half) the people had viral loads less than 50 copies.
The FDA now recommends that people take Videx twice-daily if possible. However, the FDA has not banned once-daily dosing. Instead, they have changed the instructions for taking Videx to say: "Although once-daily dosing frequency is available, it should only be considered for people whose management requires once-daily dosing." This will likely mean people taking complicated drug combinations. Because Videx has to be taken on an empty stomach, it can be difficult to take it twice daily if you're also taking other drugs that have food restrictions.
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