NOTES FROM THE UNDERGROUND; PWA Health Group - April, 1996
| Protease Inhibitors Comparision Chart | CRIXIVAN (indinavir/Merck) | NORVIR (ritonavir/Abbott) | INVIRASE (saquinavir/Roche) |
|---|---|---|---|
| What is the correct dose? | Four 200 or two 400 mg capsules every eight hours on an empty stomach (dry toast is ok, no fats) (4 or 2 pills every 8 hours). | Six 100 mg capsules every twelve hours with food. Note: this medicine contains alcohol. (6 pills every morning and night). | Roche says to take three 200 mg capsules three times a day (1800 mg), but some doctors suggest 3600 mg or even 7200 mg a day. (3-18 pills every 8 hours). |
| How to store it? | Keep it in a cool, dry place. | Keep it in your fridge. | Keep at room temperature. |
| What is the effect on disease progression? | Unknown. There is a clinical trial in progress to determine effect on disease progression. The only data so far is on viral load and T cells, not on preventing illness. | In a big trial, people with less than 100 T cells took Norvir and whatever combination of antivirals they wanted. People who took Norvir had half as many OIs and half as many people died. There is no info on people who have less advanced HIV infection. | Unknown. There is currently one trial open studying a new formulation of Invirase in 600 people with less than 500 T cells (CD4 cells). |
| What is the effect on the virus? | The amount of HIV in blood can be reduced by 100 times (eg. 100,000 to 1,000 copies). This has been seen in the lymph nodes too, in a few people studied. We are told that about 20% of the drug is absorbed into the brain. | The amount of HIV in blood is reduced by up to 100 times on average. No info on how it works in lymph nodes, and only 1% of Norvir gets into your brain. | The amount of HIV in the blood is reduced by up to 55% when the drug is taken with AZT or ddC. It is not known how combinations affect viral load in the blood, lymph, or brain. The drug is only for use in combinations. |
| How long does the antiviral effect last? | In small numbers of patients, the effect on the virus lasts 6 months to a year in 40-60% of people who take Crixivan alone. We don’t know how long or how strongly this effect lasts. | Unknown. No info on people who have taken Norvir for longer than four months. In advanced patients, the antiviral effect seems to decrease between the second week and the fourth month of therapy. | If Invirase is taken alone the effect is less than AZT taken alone and lasts for about six months. It lasts longer if Invirase is taken in combination. |
| What is the effect on CD4 counts? (T cells)? | On average, CD4 counts increase by about 100 and seem to stay up for six months to a year, in most of the few patients who have taken the drug for that long. | In most studies, CD4 counts increase between 30 and 60 cells, but the followup is very short. | On average, CD4 counts increase 40-70 within the first few weeks of treatment, but taper off between four and six months, even in combination. |
| Can it be used with other anti HIV drugs? | Yes. Combinations with AZT, AZT+3TC, and AZT+ddI, were well tolerated. In fact, early data suggests that combination therapy may delay resistance. Note: it’s recommended that ddI and Crix-ivan be taken at different times of the day, and both on an empty stomach. Hello!!! When do we eat???? | Poorly tolerated...2 out of 5 people who took Norvir and AZT dropped out of the study. 1 out of 3 who took Norvir, AZT, and ddC dropped out. In fact, because it’s so hard on your stomach , it’s recommended that you start with two weeks of Norvir alone to get used to it... it’s supposed to get better. | Yes. Some patients felt nauseous, weak, and had stomach pain when they took Invirase and AZT or ddC, but combination therapy is preferred. Resistance problems seem to be less with combo therapy. Test tube evidence suggests that a combo of Norvir and Invirase may be super strong - but we have no idea if it’s safe at all. |
| Can it be used with other types of drugs? | Many drugs cannot be taken;-like Mycobutin (rifabutin) for MAC, rifampin for TB, Nizoral (ketoconazole) for fungal infections, antihistamines Hismanal or Seldane, sedatives like Atavan, Valium, and Xanax, or Propulsid. CHECK WITH YOUR PHARMACIST BEFORE TAKING ANYTHING WITH ANY PROTEASE, EVEN OVER THE COUNTER STUFF. | Many, many drugs cannot be taken: Mycobutin, Demerol, Darvon, Feldene, many heart meds, Vascor, Hismanal, Seldane, Pro-pulsid, Wellbutrin, Clozaril, sed-atives like Valium and Xanax. TELL YOUR DOCTORS YOU’RE TAKING NORVIR IF THEY PRESCRIBE ANY DRUG, BECAUSE THE LIST PROVIDED BY ABBOTT IS NOT COMPLETE. HEY! ANYTHING CAN HAPPEN! | Yes, but again no Mycobutin-/rifampin, and antihistamines like Hismanal and Seldane. Check with your doctors for heart and asthma meds, antifungals, sedatives, pain killers, and antibiotics like Dapsone.. Invirase is poorly absorbed by your body and a lot of drugs make the absorption even worse, so CHECK IT OUT WITH YOUR DOCTOR!! |
| What are the side effects? | Crixivan causes low back pain due to kidney stones in 2-3% of patients. You can reduce your chances of this by drinking lots of extra water - like 8-10 glasses a day. Also nausea and diarrhea, and bilirubin levels go up in the blood, but this doesn’t seem to cause any problems. | Lots of side effects: nausea, vomiting, gas and diarrhea, which have forced people to stop taking the drug. 25% of patients taking Nor-vir alone stopped, and 38% people stopped who took it in combo. We have no data on the new formula that they claim is gentler - but people report it’s no different. Norvir makes triglyceride levels (a type of fat) go up, but we don’t know if this necessarily causes any problems. | Of course, a few people have had strange (and dangerous) reactions to Invirase, but overall it’s easier on your system than AZT. Most of the side effects have to do with the fact that you have to take so much Invirase to get any into your system. Roche is studying a new formulation that may be easier to absorb, and should reduce stomach side effects. |
| How important is it to take the drug exactly as prescribed? | VERY IMPORTANT!!!!!!!!!!!! Missing doses or taking lower doses might result in your virus becoming resistant to Crixivan and all other protease inhibitors (cross resistance). The drug, however, was well tolerated in clinical trials. More than 90% of patients took this drug, even in combination, without stopping. | VERY IMPORTANT!!!!!!!!!!! Missing doses or taking lower doses might result in your virus becoming resistant to Norvir and all other protease inhibitors (cross resistance). The drug was not well tolerated in clinical trials. 25% of patients stopped taking the drug when used alone and more than 1 of 3 people stopped Norvir in combination trials. This is a very important consideration if you decide to take Norvir because of the potential for cross resistance. | VERY IMPORTANT!!!!!!!!!!!!!! Missing doses or taking lower doses increases the chances of HIV becoming resistant to Invirase. It seems that most resistance caused by Invirase is different than HIV caused by Crixivan and Norvir. If Invirase stops working for you, the other protease inhibitors will still be an option, most likely. |
| Where is the drug available? | Through Stadtlanders, a mail order pharmacy: call 800-927-8888 MD fax #:800-682-7436 Patient assistance: 1/800-850-3430 | In most pharmacies today. Patient assistance: 1/800-293-4393 | Drugstores all over the US. Pt. Assistance: 1/800-282-7780 |
| How much is it? | Less than a ton; Merck sells it for $4,380, and Stadtlanders charges you $6,022 a year. | A ton, or about $8,000 a year. | A veritable bargain at $7600 a year. |
Copyright © 1996 - NOTES FROM THE UNDERGROUND - The PWA Health Group Newsletter. All rights reserved. No part of this publication may be copied or reproduced in any form or by any means without the written permission from the PWA Health Group. NOTE: The PWA Health Group is no longer in existence, as per notification in 2003. An organization called Visionary Health Concepts has succeded them. VHConcepts is a HIV/Hepatitis+ owned and operated health education company specializing in providing free HIV & Hepatitis treatment programs For more information please contact Email: edu@vhconcepts.com. .
This information is designed to support, not replace, the relationship that exists between you and your doctor.