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Brand Name: Rescriptor
Common Name: delavirdine (DLV)
Class: non-nucleoside analog (also called non-nucleoside reverse transcriptase inhibitor, NNRTI or non-nuke)
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; no food restrictions (may be taken with or without food). Take missed dose as soon as possible, but do not double up on your next dose.
AWP: $316.35 / month for 200 mg
Manufacturer contact: Pharmacia and Upjohn Company, a Pfizer company, www.pfizer.com, 1 (212) 573–1000
AIDSInfo:1 (800) HIV–0440 (448–0440), www.aidsinfo.nih.gov
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| Potential side effects and toxicity: |
Most common side effects include headache, nausea, vomiting, diarrhea, fatigue, elevated liver enzymes, 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 eye, which if untreated may result in permanent vision loss), swelling, muscle or joint aches, fever or general malaise (general ill feeling), you may need to stop the medications so seek medical attention immediately. Body fat accumulation or redistribution may occur.
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| Potential drug interactions: |
| You cannot take Rescriptor with Versed (midazolam), Halcion (triazolam) and Xanax (alprazolam), pimozide (a psychiatric medication), ergot alkaloids, used for migraine headaches (Wigraine, Methergine, and Cafergot) in any form, or the herb St. John’s wort (hypericum perforatum). Do not use Zocor (simvastatin) or Mevacor (lovastatin) cholesterol (lipid) lowering meds; suggested alternatives are Lipitor (atorvastatin), Lescol (fluvastatin), Crestor (rosuvastatin), and Pravachol (pravastatin, the one with less incidence of problems and interactions according to study data). 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 healthcare provider if you have a history of heart or blood pressure problems. Potential toxicity when given with Biaxin (clarithromycin), dapsone, Mycobutin (rifabutin), Procardia or Adalat (nifedipine), Norvasc (amlodipine), Plendil (felodipine), Coumadin (warfarin), Propulsid (cisapride), and quinidine. Tegretol (carbamazepine, an anti-seizure medication used to treat peripheral neuropathy), phenobarbital, Dilantin (phenytoin), Mycobutin (rifabutin) and rifampin (used to treat tuberculosis) are drugs that decrease Rescriptor levels. Rescriptor increases levels of Crixivan, Lexiva, Invirase, Kaletra, Norvir, Reyataz, Viracept, immunosuppressants, birth control pills (ethinyl estradiol), and methadone, so caution is advised if using together. Cialis, Levitra, and Viagra levels are increased by Rescriptor; doses should not exceed 10 mg Cialis per 72 hours, 2.5 mg Levitra per 24 hours, or 25 mg Viagra per 48 hours. Rescriptor is not recommended with either rifampin or rifabutin, used for tuberculosis or MAC infections. Also, increased levels of Desyrel (trazodone) can occur with Rescriptor, which may lead to nausea, dizziness, low blood pressure, or loss of consciousness. A lower dose of Desyrel is recommended. Increased levels of the inhaled and nasal sprays that contain fluticasone, a steroid for asthma or alleries (found in Advair, Flonase, and Flovent) can occur with Rescriptor and therefore should be used with caution. |
| Tips: |
Research demonstrates smaller doses of Rescriptor increase blood levels of some protease inhibitors, making it unique among the NNRTIs. Antacids (like Tagamet, Zantac, Prilosec, and Tums) and gastric achlorhydria (low stomach acid) decreases absorption of Rescriptor, so take at least one hour apart from these drugs and take with acidic beverages such as orange or cranberry juice.
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| Doctor |
| Delavirdine (DLV) is used infrequently due to its dosing requirements (two pills three times a day) and the absence of updated studies documenting its effectiveness compared to other contemporary regimens. It is mainly used as a niche drug in salvage regimens due to its generally more favorable interactions with other protease inhibitors. It is generally well tolerated with rash being the most common challenging adverse reaction. I personally have had good experience with DLV in salvage regimens, but the increasing availability of new active drugs makes it likely that use of delavirdine will essentially stop altogether.—Keith Henry, MD |
| Activist |
| Do they still make this stuff? This is one drug that fell off the wagon a long time ago. In fact, I’m not sure if it ever really was in the race. High pill burden, bad side effects, minimal efficacy…need I say more?—Cathy Olufs |
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Back to 2007 Drug Guide