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Main Medicine Class:: Anti Infectives   Sub Medicine Class ::  Anti Retrovirals (Drugs for HIV)

13N. ANTI-RETROVIRALS (DRUGS FOR HIV) in 13. ANTI-INFECTIVES
DIDANOSINE
NRTI | ANTI-VIRAL, ANTI-RETROVIRAL
PK: A: Rapid D: Child: 28 L/m2; Adults: 1.08 L/kg (Vd) E: Urine (~55% as unchanged drug)

Indications & Dose: HIV INFECT PO Adult < 60 kg: 250mg OD, >60kg: 400mg OD as delayed release capsules Child 20 kg to <25 kg: 200mg OD as delayed release capsules | Combination therapy PO Adult <60 kg: 200mg OD; >60 kg: 250mg OD with tenofovir | NON-OCCUPATIONAL EXPOSURE TO HIV INFECTION Combination therapy/Postexposure prophylaxis PO Adult < 60 kg: 125mg BID or 250mg OD, >60kg: 200mg BID or 400mg OD with 2 other antiretrovirals | OCCUPATIONAL EXPOSURE TO HIV INFECTION Combination therapy/Postexposure prophylaxis PO Adult 200mg BID or 400mg OD 4wk with 2 other antiretrovirals

Contra: Concurrent administration with allopurinol/ribavirin

Precautions: Renal impairment, history of pancreatitis, peripheral neuropathy/hyperuricemia, chronic hepatitis B/C

ADR: Serious: Peripheral neuropathy, pancreatitis, hyperuricemia, parotid gland enlargement, sialadenitis, hypersensitivity reactions, retinal & optic nerve changes, DM, hypoglycemia, raised liver enzymes, liver failure, ARF, rhabdomyolysis, blood disorders, lipodystrophy, Others: alopecia, insomnia, dizziness, dry eyes, headache, diarrhea, nausea, vomiting, dry mouth

DDI: Serious Tenofovir increases drug levels (increases risk of pancreatitis, peripheral neuropathy & treatment failure), Stavudine leads to additive toxicity, Ribavirin leads to increase in toxicity (lactic acidosis, blood dyscrasias and hepatotoxicity), Allopurinol markedly raises drug level

Diet: Empty stomach (30 min before/2h after food)

Monitor: Serum K, uric acid, SeCr, CBC with neutrophil & platelet count, CD4 cells, viral load, LFT, serum bilirubin, albumin, INR, amylase, wt gain, perform dilated retinal exam q6 months, ultrasonography (if portal HTN suspected)

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