Rescriptor
Common Name: delavirdine
Brand Name: Rescriptor
Class: non-nucleoside analogs (also called non-nucleoside reverse transcriptase inhibitors, NNRTIs, or non-nukes)
Standard dose: Two 200 mg tablets or four 100 mg tablets three times a day (every 8 hours). Only the 100 mg tablets can be dissolved in liquid; however, avoid grapefruit juice. Can be taken with or without food, with no food restrictions. Take missed dose as soon as possible, unless it is almost time for your next dose. Do not double up on your next dose.
AWP: $331.03 / month for 200 mg tablets
Manufacturer contact: ViiV Healthcare, 1 (877) 844-8872
Potential side effects and toxicity: Most common side effects include headache, nausea, vomiting, diarrhea, fatigue, elevated liver enzymes, and itchy skin or rash. A serious side effect of the NNRTI class is rash, which can be life-threatening. Most rashes occur within the first 1–3 weeks after starting Rescriptor. If you experience blistering, mouth lesions, conjunctivitis (redness or inflammation of the eye, which if untreated may result in permanent vision loss), swelling, muscle or joint aches, fever or malaise (general ill feeling), you should stop the medication, and seek medical attention right away. Body fat accumulation or redistribution may occur.
Potential drug interactions: You should not take Rescriptor with Versed (midazolam), Halcion (triazolam), Xanax (alprazolam), Orap (pimozide), ergot alkaloids used for migraine headaches (such as Wigraine, Methergine, and Cafergot) in any form, or the herb St. John’s wort. Do not use Zocor (simvastatin), Vytorin, or Mevacor (lovastatin) cholesterol (lipid) lowering meds; suggested alternatives are Lipitor (atorvastatin) and Lescol (fluvastatin). Liver enzymes should be checked regularly if you are on these cholesterol meds, as they can increase risk for liver toxicity with Rescriptor. Certain amphetamines and antiarrhythmic drugs should not be used with Rescriptor, therefore, inform your health care provider if you have a history of heart or blood pressure problems. Dose adjustment may be needed when taken with Biaxin (clarithromycin). Rescriptor should be used with caution with Procardia or Adalat (nifedipine), Norvasc (amlodipine), Plendil (felodipine), Coumadin (warfarin), and quinidine. Use caution with anti-convulsants: Tegretol (carbamazepine), phenobarbital, and Dilantin (phenytoin). Mycobutin (rifabutin) and Rifadin (rifampin), used to treat tuberculosis, are drugs that decrease Rescriptor levels. Rescriptor is not recommended with either rifampin or Mycobutin. Rescriptor increases levels of protease inhibitors Crixivan, Lexiva, Invirase, Kaletra, Norvir, and Viracept, as well as immunosuppressants, birth control pills (ethinyl estradiol), and methadone, so caution is advised if using together. Cialis, Levitra, and sildanafil (Viagra) levels are increased by Rescriptor; doses should not exceed 10 mg Cialis or 2.5 mg Levitra per 72 hours, or 25 mg Viagra per 48 hours. Also, increased levels of trazodone can occur with Rescriptor and therefore should be used with caution. Increased levels of the inhaled and nasal sprays that contain fluticasone, a steroid for asthma or allergies (found in Advair, Flonase, and Flovent) can occur with Rescriptor and therefore should be used with caution or an alternative should be considered.
Tips: Research demonstrates that smaller doses of Rescriptor increase blood levels of some protease inhibitors, making it unique among the NNRTIs. Some people who cannot tolerate Norvir (ritonavir) are successfully using Rescriptor instead to boost their protease inhibitor. Studies of this use, however, have not been published. Antacids (like Tagamet, Zantac, Prilosec, and Tums) and gastric achlorhydria (low stomach acid) decrease absorption of Rescriptor, so take at least one hour apart from these drugs and take with acidic beverages such as orange or cranberry juice to increase stomach acidity. Please see package insert for more complete potential side effects and interactions.
Doctor
Rescriptor (delavirdine) was approved for the treatment of HIV infection in 1997. The dosing regimen of this antiretroviral is a good example of the large number of pills that had to be taken multiple times per day in the past. The original dosing schedule was 4 tablets three times daily (thankfully, no dietary restrictions). When the pill size changed, it came down to 2 pills three times per day. In general, this antiretroviral is not used to any great extent in current HAART therapy as there are better choices in almost all cases where this drug is being considered. Data are available suggesting delavirdine could be used (like Norvir) to boost levels of protease inhibitors (such as saquinavir), but the booster effect was not as strong as the Norvir effect and few studies were done to validate this approach. In fact, there have been virtually no studies using this drug in the past decade, one indication of its fall out of favor. —Cal Cohen, MD
Activist
With its heavy pill burden and thrice-daily dosing, Rescriptor has largely been replaced by Sustiva and Viramune. Like others in its class, it can cause rash, and takes just one mutation to develop resistance. It does, however, have the intriguing capability to boost some protease inhibitors just like Norvir can—giving patients who can’t tolerate Norvir another option. —Jeff Taylor
