Invirase (saquinavir mesylate) is a protease inhibitor antiretroviral drug indicated for the treatment of HIV infection. This medication should be used in combination with other antiretroviral medications.
Dosage and administration
Invirase can be used in adults and children age two and up. Dosage depends on whether or not the patient is treatment-naïve or switching from other antiretroviral drugs, and is also based on weight in children 16 and under. Tablets should not be crushed, but the capsule may be given in a suspension. This medication should be taken within two hours of eating.
The use of Invirase in combination with ritinovir may cause significant QT prolongation, as well as first, second, and third degree heart blocks. Torsades de Pointes has also been reported. The use of this combination is contraindicated in patients with long QT syndrome, or hyperkalemia or hypomagnesemia. This medication does not require dosage adjustments for patients with mild to moderate hepatic impairment, and is contraindicated in severe hepatic impairment. Invirase may worsen liver disease in patients with alcoholism, comorbid hepatitis B (HBV) or hepatitis C (HCV) infection, liver cirrhosis, and other liver diseases, and should be reviewed carefully in such patients. Invirase does not require dosage adjustment in renal impairment, but should be used with caution in patients with severe kidney impairment.
Patients using this medication may experience side effects, which include, but are not limited to:
- nausea, vomiting
- stomach pain
- changes in distribution of body fat
Patients should contact a medical professional if they are experiencing any of the following serious side effects:
- stabbing chest pain
- rapid heart rate
- problems breathing or swallowing
Current HIV treatment guidelines recommend testing HIV-positive patients for hepatitis C virus (HCV). If HIV/HCV co-infection is identified, consideration should be given to treating both infections concurrently.
All patients who test positive for HIV should be screened for comorbid HBV infection. If positive, co-infected patients should start an antiretroviral regimen targeting both viruses, regardless of CD4 counts or HBV viral loads. Treatment should be continued indefinitely unless advised by a physician to achieve HIV suppression and prevention of HBV activation. Co-infected patients will require vaccination against Hepatitis A and HBV, and should avoid alcohol. Current HIV treatment guidelines outline drug regimens and prescribing considerations.
Pregnancy and lactation
Pregnant women should use a highly active retroviral combination treatment, regardless of viral load and CD4 count. Clinicians should report exposure to Invirase before or during pregnancy to the Antiretroviral Pregnancy Registry to assist in data collection. There is insufficient data to determine whether Invirase causes birth defects. HIV-positive women, treated or untreated, should avoid breastfeeding to prevent vertical transmission of the virus, as it is unknown whether or not this medication is excreted in breast milk.
Information regarding potential cardiac concerns and drug interactions are detailed in the product monograph and should be reviewed by all prescribers.
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