Nelfinavir

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Nelfinavir Brand Name– Viracept

What is Nelfinavir

Nelfinavir is an antiretroviral protease inhibitor (PI) indicated for use with other antiretroviral medications to treat HIV-1 infections in patients 2 years and older.

The drug is available in tablet and oral powder formulations, both of which must be administered with meals.

The oral powder contains phenylalanine (11.2 mg per 1 gram of powder), and therefore should not be used in patients with phenylketonuria.

Like other protease inhibitors, there is a potential for significant drug interactions, as nelfinavir inhibits the hepatic isoenzyme CYP3A4.

Indications

  • human immunodeficiency virus (HIV)
  • human immunodeficiency virus (HIV) infection

Side Effects

  1. abdominal pain
  2. anemia
  3. anorexia
  4. anxiety
  5. arthralgia
  6. asthenia
  7. back pain
  8. bleeding
  9. bronchospasm
  10. Cushingoid features
  11. dehydration
  12. depression
  13. diabetes mellitus
  14. diabetic ketoacidosis
  15. diarrhea
  16. dizziness
  17. drowsiness
  18. dyspepsia
  19. dyspnea
  20. edema
  21. elevated hepatic enzymes
  22. emotional lability
  23. fever
  24. flatulence
  25. folliculitis
  26. GI bleeding
  27. gynecomastia
  28. headache
  29. hematoma
  30. hepatitis
  31. hyperamylasemia
  32. hyperbilirubinemia
  33. hypercholesterolemia
  34. hyperglycemia
  35. hyperhidrosis
  36. hyperkinesis
  37. hyperlipidemia
  38. hypertriglyceridemia
  39. hyperuricemia
  40. hypoglycemia
  41. impotence (erectile dysfunction)
  42. insomnia
  43. iritis
  44. jaundice
  45. leukopenia
  46. lipodystrophy
  47. lymphopenia
  48. maculopapular rash
  49. malaise
  50. metabolic acidosis
  51. migraine
  52. muscle cramps
  53. myalgia
  54. myasthenia
  55. myopathy
  56. nausea
  57. neutropenia
  58. oral ulceration
  59. pancreatitis
  60. paresthesias
  61. pharyngitis
  62. pruritus
  63. QT prolongation
  64. rash
  65. rhinitis
  66. seizures
  67. sinusitis
  68. suicidal ideation
  69. thrombocytopenia
  70. torsade de pointes
  71. urticaria
  72. vomiting

Adverse events reported in pediatric patients were similar to those noted with adults treated with nelfinavir.

Monitoring Parameters

  • blood glucose
  • CBC with differential
  • CD4+ T cell count
  • hepatitis B serology
  • LFTs
  • plasma hepatitis C RNA
  • plasma HIV RNA
  • pregnancy testing
  • serum bilirubin (total and direct)
  • serum cholesterol
  • serum lipid profile
  • urinalysis

Contraindications

  • antimicrobial resistance
  • autoimmune disease
  • breast-feeding
  • children
  • diabetes mellitus
  • diabetic ketoacidosis
  • Graves’ disease
  • Guillain-Barre syndrome
  • hemophilia
  • hepatic disease
  • hepatitis B and HIV coinfection
  • hepatitis C and HIV coinfection
  • hypercholesterolemia
  • hyperglycemia
  • hyperlipidemia
  • hypertriglyceridemia
  • immune reconstitution syndrome
  • infants
  • neonates
  • pancreatitis
  • phenylketonuria
  • pregnancy

Interactions

  • Abemaciclib
  • Acalabrutinib
  • Acarbose
  • Acetaminophen; Butalbital
  • Acetaminophen; Butalbital; Caffeine
  • Acetaminophen; Butalbital; Caffeine; Codeine
  • Acetaminophen; Caffeine; Dihydrocodeine
  • Acetaminophen; Codeine
  • Acetaminophen; Hydrocodone
  • Acetaminophen; Oxycodone
  • Adefovir
  • Ado-Trastuzumab emtansine
  • Afatinib
  • Alfentanil
  • Alfuzosin
  • Aliskiren; Amlodipine
  • Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
  • Almotriptan
  • Alogliptin
  • Alogliptin; Metformin
  • Alogliptin; Pioglitazone
  • Alosetron
  • Alpha-glucosidase Inhibitors
  • Alprazolam
  • Amiodarone
  • Amitriptyline; Chlordiazepoxide
  • Amlodipine
  • Amlodipine; Atorvastatin
  • Amlodipine; Benazepril
  • Amlodipine; Celecoxib
  • Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
  • Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
  • Amlodipine; Olmesartan
  • Amlodipine; Telmisartan
  • Amlodipine; Valsartan
  • Amobarbital
  • Amoxicillin; Clarithromycin; Lansoprazole
  • Amoxicillin; Clarithromycin; Omeprazole
  • Apalutamide
  • Apixaban
  • Aprepitant, Fosaprepitant
  • Aripiprazole
  • Artemether; Lumefantrine
  • Aspirin, ASA; Butalbital; Caffeine
  • Aspirin, ASA; Butalbital; Caffeine; Codeine
  • Aspirin, ASA; Caffeine; Dihydrocodeine
  • Aspirin, ASA; Carisoprodol; Codeine
  • Aspirin, ASA; Omeprazole
  • Aspirin, ASA; Oxycodone
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  • food
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