Standard Dose: Rarely used by itself (two 400 mg capsules every eight hours with no food or a low-fat snack). Almost always boosted with Norvir, both twice daily: 400 mg Crixivan + 400 mg Norvir; 800 mg + 100 mg; or 800 mg + 200 mg (all combination doses taken with food, and with plenty of water to avoid kidney sludge or stones). Take missed dose as soon as possible, but do not double up on your next dose. Also available in 100 mg, 200 mg and 333 mg capsules.

AWP: $548.12 / month for 400 mg, 180 capsules

Manufacturer contact: Merck and Co.,
www.crixivan.com, 1 (800) 850–3430

AIDSInfo:1 (800) HIV–0440 (448–0440), www.aidsinfo.nih.gov

Potential side effects include: headache, fatigue or weakness, malaise (general ill feeling), nausea, diarrhea, stomach pains, loss of appetite, yellowing of skin/eyes, changed skin color, dry mouth/sore throat, taste changes, painful urination, indigestion, joint pain, hives, and liver toxicity. Itchy/dry skin, ingrown toe nails and hair loss are unique to Crixivan. Kidney stones, which may lead to more serious problems, can also occur. If pain develops in the middle to lower stomach or the back, or if there is blood in the urine call your healthcare provider immediately. An increase in bilirubin (a test of liver function) has been reported, but it is not associated with liver problems. It may sometimes cause yellowing of the skin or eyes. As seen with other protease inhibitors, there can be increased levels of cholesterol and triglycerides (except possibly unboosted Reyataz) which may be associated with an increased risk of heart disease. But it is important to remember the risk of heart disease is determined by many other factors, such as family history of heart disease, smoking, high blood pressure, diabetes, obesity, etc. HIV therapy should not be delayed due to this risk. Other possible side effects are lipodystrophy (body fat changes, including thinning of the face, arms and legs, with or without fat accumulation in the stomach, breasts and sometimes the upper back), onset of new cases or worsening of diabetes (see your doctor promptly) and increased bleeding in hemophiliacs.

Do not take with Tambocor (flecainide), Rythmol (propafenone), Cordarone (amiodarone), Versed (midazolam), Halcion (triazolam), Rifadin (rifampin), Orap (pimozide, a psychiatric drug), ergot derivatives (such as Cafergot, Wigraine and Methergine, D.H.E. 45), garlic supplements, or the herb St. John’s wort (hypericum perforatum). Do not use Zocor (simvastatin) or Mevacor (lovastatin); lipid-lowering alternatives are Lipitor (atorvastatin), Lescol, and Pravachol (pravastatin), but they should be used with caution due to potential for liver toxicity.

Not recommended in combination with Reyataz. Reduce Crixivan to 600 mg every eight hours when taken with Rescriptor. Reduce Crixivan to 600 mg every eight hours when taken with Sporanax (itraconazole, 200 mg twice-a-day) or Nizoral (ketoconazole, 200 mg once-a-day).

The dose of rifabutin (Mycobutin) should be reduced by 50% and increase Crixivan dose to 1,000 mg every eight hours when taken together.

Protease inhibitors increase blood levels of Viagra (sidenafil citrate), Cialis (tadalafil) and Levitra (vardenafil). Use with caution. Initially the Viagra dose should be 12.5 mg (1/2 of 25 mg tablet) and increased as needed and tolerated. It’s recommended that people on PIs do not exceed 25 mg of Viagra in a 48-hour period because of potential for serious reaction such as low blood pressure, visual changes, and prolonged erection leading to permanent tissue damage. Use Cialis at reduced doses of 10 mg every 72 hours and Levitra at reduced doses of no more than 2.5 mg every 72 hours, with increased monitoring for adverse events.

Effectiveness of birth control pills may be decreased; consider the use of alternative or additional contraception. Additional monitoring may be required when taking Coumadin, immunosuppressants, or calcium channel blockers (such as Norvasc, Procardia, and others). Tegretol, Dilantin, or phenobarbital may decrease Crixivan, so alternate seizure medications should be used.

Crixivan may decrease levels of methadone but withdrawal rarely occurs and methadone doses may need to be increased. Also, increased levels of Desyrel (trazodone) can occur with Crixivan, which may lead to nausea, dizziness, low blood pressure, or loss of consciousness.

Increased levels of the inhaled and nasal sprays with fluticasone, a steroid for asthma or allergies (found in Advair, Flonase, and Flovent) can occur with Crixivan and therefore should be used with caution.

It is recommended that you drink at least 48 oz. of fluids daily, preferably water or clear liquids (soda pop doesn’t count!) to decrease the chances of a kidney stone forming. Don’t forget to drink more water in summer or with increased sweating. Large amounts of coffee or alcohol can increase risk of stones due to increased dehydration. Stones may continue after stopping Crixivan. Grapefruit juice decreases Crixivan blood levels. Should be stored in original container and kept dry.