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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. 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: Agouron Pharmaceuticals, a Pfizer company, www.pfizer.com, 1 (888) 777–6637
AIDS Treatment Information Service: 1 (800) HIV–0440 (448–0440)
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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), stop taking Rescriptor and seek immediate medical attention. Body fat accumulation or redistribution may occur.
Potential drug interactions: You cannot take the following medications with Rescriptor: Versed (midazolam), Halcion (triazolam) and Xanax (alprazolam), pimozide (a psychiatric medication), ergot alkaloids (Wigraine, Methergine, and Cafergot) in any form—serious interactions are seen with dilation during gynecological exams (vasospasm, a spasm of a blood vessel; or ischemia, a poor blood supply due to obstructed circulation). 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 Agenerase, Crixivan, Fortovase, Lexiva, Invirase, Kaletra, Norvir, Reyataz, Viracept, immunosuppressants, birth control pills (ethinyl estradiol) and methadone. Cialis, Levitra, and Viagra levels are increased by Rescriptor; doses should not exceed 10 mg Cialis per 72 hours, 2.5 mg Levitra per 72 hours, or 25 mg Viagra per 48 hours. Do not take with St. John’s wort, due to decreased virologic response.
Tips: Research demonstrates smaller doses of Rescriptor increases blood levels of some protease inhibitors, making it unique among the NNRTIs. Videx (not Videx EC), 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.
Doctor
Delaviridine (DLV) is an infrequently used non-nuke. It requires dosing three times a day. Its side effects include a rash which may be life-threatening. It also has an effect on a metabolic pathway in the liver that the body normally uses to break down other medicines. Because of this, Rescriptor has the potential for many significant drug-drug interactions that the other non-nukes do not, further reducing its usefulness.—Chad J. Zawitz, MD
Activist
A non-nuke that never caught on. Its high pill burden, three times a day dosing and drug-drug interactions made it an unpopular choice for doctors. It is still used as a “booster” in some salvage combos.—Nelson Vergel
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