POSITIVELY AWARE MARCH/APRIL 2011
brand name: Rescriptor
common name: delavirdine
class: Non-nucleoside reverse transcriptase inhibitor
(non-nucleoside, NNRTI, or non-nuke)
manufacturer: ViiV Healthcare | www.viivhealthcare.com, (877) 844-8872
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. Take with or without food, but again, avoid grapefruit juice. Take missed dose as soon as possible, unless it is almost time for your next dose. Do not double up on your next dose.
AWP: $350.57 / month for 200 mg tablets
Potential side effects and toxicity
Most common side effects include headache, nausea, vomiting, diarrhea, fatigue, elevated liver enzymes, and itchy skin or rash. A serious side effect of the NNRTI class is rash, which can be life threatening. Most rashes occur one-three weeks after starting Rescriptor. If you experience blistering, mouth lesions, conjunctivitis (redness or inflammation of the eye, which if untreated may result in permanent vision loss), swelling, muscle or joint aches, fever, or malaise (general ill feeling), you should stop the medication, and seek medical attention right away. Body fat accumulation or redistribution may occur.
Potential drug interactions
You should not take Rescriptor with oral Versed (midazolam), Halcion (triazolam), Xanax (alprazolam), Orap (pimozide), ergot alkaloids used for migraine headaches (such as Wigraine, Methergine, and Cafergot) in any form, or the herb St. John’s wort. Do not use Zocor, Vytorin, or Mevacor cholesterol (lipid) lowering meds; suggested alternatives are Lipitor (atorva-statin) and Lescol (fluvastatin). 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 health care provider if you have a history of heart or blood pressure problems. Dose adjustment may be needed when taken with Biaxin (clarithromycin). Rescriptor should be used with caution with Procardia or Adalat (nifedipine), Norvasc (amlodipine), Plendil (felodipine), Coumadin (warfarin), and quinidine. Use caution with anti-convulsants: Tegretol (carbamazepine), phenobarbital, and Dilantin (phenytoin). Mycobutin (rifabutin) and Rifadin (rifampin), used to treat tuberculosis, are drugs that decrease Rescriptor levels. Rescriptor is not recommended with either rifampin or Mycobutin. Rescriptor increases levels of protease inhibitors Crixivan, Lexiva, Invirase, Kaletra, Norvir, and Viracept, as well as immunosuppressants, birth control pills (ethinyl estradiol), and methadone, so caution is advised if using together. Cialis, Levitra, and sildanafil (Viagra) levels are increased by Rescriptor; doses should not exceed 10 mg Cialis or 2.5 mg Levitra per 72 hours, or 25 mg Viagra per 48 hours. Also, increased levels of trazodone can occur with Rescriptor and therefore should be used with caution. Increased levels of the inhaled and nasal sprays that contain fluticasone, a steroid for asthma or allergies (found in Advair, Flonase, and Flovent) can occur with Rescriptor and therefore should be used with caution or an alternative should be considered.
More information
Very rarely used. Research demonstrates that smaller doses of Rescriptor increase blood levels of some protease inhibitors, making it unique among the NNRTIs. Some people who cannot tolerate Norvir (ritonavir) are successfully using Rescriptor instead to boost their protease inhibitor. Studies of this use, however, have not been published. Antacids (like Tagamet, Zantac, Prilosec, and Tums) and gastric achlorhydria (low stomach acid) decrease absorption of Rescriptor, so take at least one hour apart from these drugs and take with acidic beverages such as orange or cranberry juice to increase stomach acidity. See package insert for more complete information on potential side effects and interactions.
Doctor’s comments
It’s the rare patient who takes Rescriptor anymore, not that it was ever a widely used drug. It may be less potent than other NNRTIs, was never extensively studied, and has to be taken three times a day. It was sometimes used in patients with unusual NNRTI mutations that caused resistance to Viramune and Sustiva but not to Rescriptor, but most of those patients are now taking Intelence. As with any NNRTI, Rescriptor can cause rash. It has drug interactions that are different from those of other NNRTIs: It increases levels of protease inhibitors rather than decreasing them. It was once suggested as an alternative PI booster for that reason, but no one was excited about taking a booster three times a day. —Joel Gallant, MD, MPH
Activist’s comments
A heavy pill burden three times a day, combined with GI problems, fatigue, a host of drug interactions, and the typical non-nuke rash kept Rescriptor from ever being used much. However, some studies have shown that it can increase PI levels like Norvir does—making it a potentially useful drug for people who can’t tolerate Norvir but need a booster. (At least for another year, assuming Gilead’s Norvir-alternative cobicistat gets approved.) —Jeff Taylor
