What is Prezista (Darunavir) Used For?
Prezista (darunavir) is a Protease Inhibitor (PI) drug used to treat HIV infection in combination with other antiretroviral medications. Prezista binds to the active site of the HIV replication enzyme protease, arresting its participation in the production the final virion, thereby rendering it non-infectious. Resistance to PI drugs and cross-resistance among PI drugs has been observed from numerous mutations, although Prezista appears to be less susceptible to cross-resistance.
Dosing & Administration
Prezista is indicated for use in adults and children aged three and up who weigh at least 10 kg for treatment of HIV infection, and off-label for HIV post-exposure prophylaxis following occupational or non-occupational settings, including sexual assault. The drug is available in oral tablets and liquid suspension, and must be taken with food. Dosing guidelines are detailed in the product monograph.
Prezista does not require dose adjustment for mild or moderate liver dysfunction, or renal impairment. It should not be used in patients with severe liver dysfunction, and it has not been studied in patients with severe kidney dysfunction.
Prezista is contraindicated in patients with hypersensitivity to the drug, and in patients with severe liver dysfunction (Child-Pugh Class C). This medication is contraindicated for concurrent use with certain medications listed in the product monograph.
Prezista Side Effects
This medication can cause spontaneous bleeding and hyperglycemia.
Common adverse effects include:
- a rash,
- abdominal pain,
A complete list of potential adverse effects is provided in the product monograph.
Prezista is a sulfonamide drug and should be used with caution in sulfa-sensitive patients.
The drug should be only used with an agent that acts as a pharmacokinetic enhancer, such as cobicistat or low-dose ritonavir. Genotypic/phenotypic HIV testing should be used to guide the use of Prezista in individual patients.
Darunavir has been associated with potentially fatal drug-induced hepatitis and hepatic injury. Patients with pre-existing liver abnormalities may be at increased risk. Screening and monitoring recommendations are listed in the product monograph.
All patients who test positive for HIV infection should be screened for comorbid HBV and HCV infection. Co-infected patients should be started on an antiretroviral regimen targeting co-infected viruses, regardless of CD4 counts or viral loads. Current HIV treatment guidelines outline drug regimens and prescribing considerations.
Prezista is associated with a large number of drug-drug interactions and contraindications. Prescribers should familiarize themselves with the list provided in the product monograph.
Pregnancy & Lactation
Highly active retroviral combination treatment should be used in all pregnant women, regardless of viral load and CD4 count. Current guidelines should be consulted when treating women in pregnancy. It is unknown if darunavir is excreted in the breast milk. The CDC recommends that all HIV positive women, treated or untreated, avoid breastfeeding to prevent vertical transmission of the virus.
Prezista overdose should be treated with supportive care and may include activated charcoal. This drug is probably not significantly dialyzed.
Alternative Brand Names
Darunavir is also available as a combination product in Rezolsta, Prezcobix, and Symtuza.
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