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Indinavir Disease Interactions

There are 3 disease interactions with indinavir.

Major

Indinavir (applies to indinavir) nephrolithiasis

Major Potential Hazard, High plausibility. Applicable conditions: Dehydration, History - Nephrolithiasis

Crystalluria and nephrolithiasis may occur during treatment with indinavir. The cumulative frequency of nephrolithiasis is substantially higher in pediatric patients (29%) than in adult patients (12.4%; range 4.7% to 34.4% across individual trials) and increases with duration of exposure to indinavir; however, the risk over time remains relatively constant. The incidence is also higher when indinavir is used in combination with ritonavir than when used alone at 800 mg three times a day. In some cases, nephrolithiasis/urolithiasis has been associated with renal insufficiency or acute renal failure and pyelonephritis with or without bacteremia. Therapy with indinavir should be administered cautiously in patients with a current or past history of nephrolithiasis. It is crucial that patients receive adequate hydration. Generally, at least 1.5 L (approximately 48 oz) of fluid per day is recommended for adults during indinavir therapy. Those who are dehydrated may be at increased risk and should be encouraged to consume additional amounts of liquid or given intravenous fluid if necessary. All patients receiving indinavir should be instructed to seek medical attention if they experience potential signs and symptoms of nephrolithiasis/urolithiasis such as flank pain, hematuria, dysuria, anuria, and urinary urgency. A brief interruption (e.g., 1 to 3 days) or discontinuation of therapy may be required.

References

  1. (2001) "Product Information. Crixivan (indinavir)." Merck & Co., Inc
  2. Tashima KT, Horowitz JD, Rosen S (1997) "Indinavir nephropathy." N Engl J Med, 336, p. 138-40
  3. Daudon M, Estepa L, Viard JP, Joly D, Jungers P (1997) "Urinary stones in HIV-1-positive patients treated with indinavir." Lancet, 349, p. 129-45
  4. Bach MC, Godofsky EW (1997) "Indinavir nephrolithiasis in warm climates." J Acquir Immune Defic Syndr Hum Retrovirol, 14, p. 296-7
  5. Kopp JB, Miller KD, Mican JA, et al. (1997) "Crystalluria and urinary tract abnormalities associated with indinavir." Ann Intern Med, 127, p. 119-25
  6. Berns JS, Cohen RM, Silverman M, Turner J (1997) "Acute renal failure due to indinavir crystalluria and nephrolithiasis: report of two cases." Am J Kidney Dis, 30, p. 558-60
  7. Gagnon RF, Tsoukas CM, Watters AK (1998) "Light microscopy of indinavir urinary crystals." Ann Intern Med, 128, p. 321
  8. Sarcletti M, Petter A, Zangerle R (1998) "Indinavir and interstitial nephritis." Ann Intern Med, 128, p. 320-1
  9. Rich JD, Ramratnam B, Chiang M, Tashima KT (1997) "Management of indinavir associated nephrolithiasis." J Urol, 158, p. 2228
  10. Sutherland SE, Reigle MD, Seftel AD, Resnick MI (1997) "Protease inhibitors and urolithiasis." J Urol, 158, p. 31-3
  11. Ascher DP, Lucy MD (1997) "Indinavir sulfate renal toxicity in a pediatric hemophiliac with HIV infection." Ann Pharmacother, 31, p. 1146-9
  12. Grunke M, Valerius T, Manger B, Kalden JR, Harrer T (1997) "Renal dysfunction in a human immunodeficiency virus-infected patient who was treated with indinavir." Clin Infect Dis, 25, p. 1270-1
  13. Bruce RG, Munch LC, Hoven AD, Jerauld RS, Greenburg R, Porter WH, Rutter PW (1997) "Urolithiasis associated with the protease inhibitor indinavir." Urology, 50, p. 513-8
  14. Gentle DL, Stoller ML, Jarrett TW, Ward JF, Geib KS, Wood AF (1997) "Protease inhibitor-induced urolithiasis." Urology, 50, p. 508-11
  15. Lerner LB, Cendron M, Rous SN (1998) "Nephrolithiasis from indinavir, a new human immunodeficiency virus drug." J Urol, 159, p. 2074-5
  16. Vigano A, Rombola G, diBelgioioso GB, Sala N, Principi N (1998) "Subtle occurrence of indinavir-induced acute renal insufficiency." AIDS, 12, p. 954-5
  17. Marroni M, Gaburri M, Mecozzi F, Baldelli F (1998) "Acute interstitial nephritis secondary to the administration of indinavir." Ann Pharmacother, 32, p. 843-4
  18. Perazella MA, Kashgarian M, Cooney E (1998) "Indinavir nephropathy in an AIDS patient with renal insufficiency and pyuria." Clin Nephrol, 50, p. 194-6
  19. Noble CB, Klein LT, Staiman VR, Neu N, Hensle TW, Berdon WE (1998) "Ureteral obstruction secondary to indinavir in the pediatric HIV population." Pediatr Radiol, 28, p. 627-9
  20. Antony SJ (1998) "Rapid development of indinavir-induced asymptomatic crystalluria in a human immunodeficiency virus-negative patient." Clin Infect Dis, 27, p. 911-2
  21. Polhemus ME, Aronson NE (1998) "Persistent nephrolithiasis after discontinuation of indinavir therapy." Clin Infect Dis, 27, p. 1536-7
  22. Boubaker K, Sudre P, Bally F, Vogel G, Meuwly JY, Glauser MP, Telenti A (1998) "Changes in renal function associated with indinavir." AIDS, 12, f249-54
  23. Brodie SB, Keller MJ, Ewenstein BM, Sax PE (1998) "Variation in incidence of indinavir-associated nephrolithiasis among HIV-positive patients." AIDS, 12, p. 2433-7
  24. Reiter WJ, SchonPernerstorfer H, Dorfinger K, Hofbauer J, Marberger M (1999) "Frequency of urolithiasis in individuals seropositive for human immunodeficiency virus treated with indinavir is higher than previously assumed." J Urol, 161, p. 1082-4
  25. Dieleman JP, Gyssens IC, vanderEnde ME, deMarie S, Burger DM (1999) "Urological complaints in relation to indinavir plasma concentrations in HIV-infected patients." AIDS, 13, p. 473-8
  26. Grabe DW, Eisele G, Miller C, Singh J, Stein D (1999) "Indinavir-induced nephropathy." Clin Nephrol, 51, p. 181-3
  27. Tsao JW, Kogan SC (1999) "Indinavir crystalluria." N Engl J Med, 340, p. 1329
  28. Kohan AD, Armenakas NA, Fracchia JA (1999) "Indinavir urolithiasis: An emerging cause of renal colic in patients with human immunodeficiency virus." J Urol, 161, p. 1765-8
  29. Guery B, Tubiana R, Martinez F, Jacquiaud C, Bochet M, Katlama C, Deray G (1999) "Renal tolerance of indinavir in HIV-positive patients." Nephron, 82, p. 72
  30. Martinez E, Leguizamon M, Mallolas J, Miro JM, Gatell JM (1999) "Influence of environmental temperature on incidence of indinavir-related nephrolithiasis." Clin Infect Dis, 29, p. 422-5
  31. Padberg J, Fritsche L, Bergmann F, Schurmann D, Suttorp N (1999) "Nephropathy and renal colic in patients treated with indinavir, ritonavir plus indinavir or ritonavir plus saquinavir." AIDS, 13, p. 2173-4
  32. Jaradat M, Phillips C, Yum MN, Cushing H, Moe S (2000) "Acute tubulointerstitial nephritis attributable to indinavir therapy." Am J Kidney Dis, 35, e161-5
  33. Famularo G, Di Toro S, Moretti S, De Simone C (2000) "Symptomatic crystalluria associated with indinavir." Ann Pharmacother, 34, p. 1414-8
  34. Salahuddin S, Hsu YS, Buchholz NP, Dieleman JP, Gyssens IC, Kok DJ (2001) "Is indinavir crystalluria an indicator for indinavir stone formation?." Aids, 15, p. 1079-80
View all 34 references
Moderate

Indinavir (applies to indinavir) liver disease

Moderate Potential Hazard, High plausibility.

Indinavir is primarily metabolized by the liver. Patients with liver disease may be at greater risk for adverse effects from indinavir due to decreased drug clearance. Therapy with indinavir should be administered cautiously in patients with liver disease. A dosage reduction to 600 mg three times a day is recommended for patients with mild to moderate hepatic insufficiency due to cirrhosis.

References

  1. (2001) "Product Information. Crixivan (indinavir)." Merck & Co., Inc
  2. Balani SK, Woolf EJ, Hoagland VL, Sturgill MG, Deutsch PJ, Yeh KC, Lin JH (1996) "Disposition of indinavir, a potent HIV-1 protease inhibitor, after an oral dose in humans." Drug Metab Dispos, 24, p. 1389-94
  3. Chiba M, Hensleigh M, Nishime JA, Balani SK, Lin JH (1996) "Role of cytochrome P450 3A4 in human metabolism of MK-639, a potent human immunodeficiency virus protease inhibitor." Drug Metab Dispos, 24, p. 307-14
  4. Sommadossi JP (1999) "HIV protease inhibitors: pharmacologic and metabolic distinctions." AIDS, 13, s29-40
View all 4 references
Moderate

PIs (applies to indinavir) hyperglycemia

Moderate Potential Hazard, Moderate plausibility. Applicable conditions: Abnormal Glucose Tolerance, Diabetes Mellitus

New onset diabetes mellitus, exacerbation of preexisting diabetes mellitus, hyperglycemia, and some cases of diabetic ketoacidosis have been reported during postmarketing surveillance in HIV-infected patients treated with protease inhibitors. Some patients required either initiation or dosage adjustments of insulin or oral hypoglycemic agents for treatment of these events. In some cases, hyperglycemia persisted despite discontinuation of protease inhibitor therapy. A causal relationship has not been established between protease inhibitor therapy and these events. Monitoring patients for hyperglycemia, new onset diabetes mellitus, or exacerbation of diabetes mellitus should be considered during protease inhibitor therapy.

References

  1. (2022) "Product Information. Norvir (ritonavir)." AbbVie US LLC, SUPPL-25
  2. (2020) "Product Information. Reyataz (atazanavir)." Bristol-Myers Squibb, SUPPL-44
  3. (2023) "Product Information. Prezista (darunavir)." Janssen Pharmaceuticals, SUPPL-68
  4. (2019) "Product Information. Lexiva (fosamprenavir)." ViiV Healthcare, SUPPL-41
  5. (2020) "Product Information. Kaletra (lopinavir-ritonavir)." AbbVie US LLC, SUPPL-54
  6. (2021) "Product Information. Viracept (nelfinavir)." Agouron Pharma Inc, SUPPL-25
  7. (2020) "Product Information. Invirase (saquinavir)." Roche Laboratories, SUPPL-25
  8. (2020) "Product Information. Aptivus (tipranavir)." Boehringer Ingelheim, SUPPL-21
View all 8 references

Indinavir drug interactions

There are 511 drug interactions with indinavir.

Indinavir alcohol/food interactions

There is 1 alcohol/food interaction with indinavir.

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.
Unknown No interaction information available.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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