Indinavir (Crixivan): A Powerful Antiretroviral Drug for HIV Treatment

Indinavir, also known as Crixivan, is a medication that belongs to the class of antiretroviral drugs called protease inhibitors. It is used to treat human immunodeficiency virus (HIV) infection, the virus that causes acquired immunodeficiency syndrome (AIDS). Indinavir works by blocking the enzyme protease, which HIV needs to multiply and infect more cells. By reducing the amount of virus in the body, indinavir can improve the immune system and prevent or delay the development of AIDS-related complications.

Indinavir was approved by the US Food and Drug Administration (FDA) in 1996 and was one of the first protease inhibitors to be widely used in combination with other antiretroviral drugs. It has been shown to be effective and safe in reducing viral load, increasing CD4 cell count, and prolonging survival in people with HIV infection. However, indinavir also has some drawbacks, such as requiring strict dosing schedules, causing kidney stones and other side effects, and developing resistance over time.

How to Use Indinavir

Indinavir is available as capsules that contain 200 mg or 400 mg of the active ingredient. The recommended dose for adults is 800 mg every eight hours, taken on an empty stomach or with a light meal. Indinavir should be taken with plenty of water to prevent kidney stones. Indinavir should not be taken with certain foods and drinks that can interact with it, such as grapefruit juice, high-fat meals, and alcohol. Indinavir should also not be taken with certain medications that can affect its levels in the blood, such as rifampin, ketoconazole, St. John’s wort, and some herbal supplements.

Indinavir is usually prescribed as part of a combination therapy with other antiretroviral drugs, such as nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs). The choice of the best combination depends on several factors, such as the patient’s medical history, viral load, CD4 cell count, drug resistance, and potential side effects. It is important to follow the doctor’s instructions and take all the medications exactly as prescribed. Missing doses or stopping treatment can lead to viral rebound, drug resistance, and treatment failure.

Side Effects of Indinavir

Like all medications, indinavir can cause side effects in some people. The most common side effects of indinavir are nausea, diarrhea, abdominal pain, headache, fatigue, and rash. These side effects are usually mild and temporary and can be managed with symptomatic treatment or dose adjustment. However, some side effects can be serious and require medical attention. These include:

  • Kidney stones: Indinavir can crystallize in the urine and form kidney stones that can block the urinary tract and cause pain, blood in the urine, infection, and kidney damage. To prevent this complication, indinavir users should drink at least 1.5 liters of water per day and avoid dehydration.
  • Liver problems: Indinavir can increase the levels of liver enzymes in the blood, indicating liver inflammation or damage. This can be more common in people who have hepatitis B or C co-infection or who drink alcohol excessively. Symptoms of liver problems include jaundice (yellowing of the skin and eyes), dark urine, pale stools, nausea, vomiting, loss of appetite, and abdominal pain.
  • Lipodystrophy: Indinavir can cause changes in body fat distribution, such as loss of fat from the face, arms, and legs (lipoatrophy) or accumulation of fat in the abdomen, breasts, and neck (lipohypertrophy). These changes can affect the appearance and self-esteem of indinavir users and also increase the risk of cardiovascular diseases.
  • Diabetes: Indinavir can impair glucose metabolism and cause high blood sugar levels (hyperglycemia) or diabetes mellitus. Symptoms of diabetes include increased thirst, urination, hunger, weight loss, blurred vision, and infections.
  • Bleeding: Indinavir can increase the risk of bleeding in people who have hemophilia or who take blood thinners such as warfarin.

Price Comparison of Indinavir in Different Countries

Indinavir is a patented drug that is manufactured by Merck & Co., Inc., a US-based pharmaceutical company. The price of indinavir varies depending on the country, the availability of generic versions, and the access to subsidies or discounts. The following table shows the average price of indinavir 400 mg capsules in different countries as of September 2023, based on the data from the World Health Organization and other sources.

CountryPrice per CapsulePrice per Month (90 Capsules)Reference
Canada6.00540.00Canada Drugs Direct
South Africa0.5045.00MSF Access Campaign
Zimbabwe0.109.00The Lancet
Average Price per Capsule: 2.92 USD | Average Price per Month: 262.80 USD

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