Case #4: Problem Solving

• Patient started on zidovudine, 3TC, lopinavir/ritonavir 400 mg/100 mg BID

• What if the patient….

  • Requires an antidepressant
  • Requires a sleeping pill
  • Requires MAC prophylaxis?
  • Wants to use Viagra?

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• Patient started on following regimen:
  zidovudine 300 mg BID
  
  3TC 150 mg BID
  delavirdine 400 mg TID
  indinavir 600 mg q8h

• Dose adjustments already made for potential delavirdine-indinavir interaction

• At initial counselling session, no issues identified; patient motivated to be on regimen

• However, over the course of the next several months, different therapeutic issues develop

• Need to constantly reassess for potential drug interactions!

• NB: indinavir and delavirdine are substrates and inhibitors of CYP3A4