|                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            | Pharmacy Update
May/June 1997         
|--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- | --------------------------------------
|In This IssueNelfinavir (Viracept®):
A Brief ReviewFormulary UpdatePharmacy
Update Archives 
Drug Information Service
Pharmacy Department
Warren G. Magnuson Clinical Center
National Institutes of Health
Bethesda, Maryland 20892-1196

Charles E. Daniels, Ph.D.
Chief, Pharmacy Department

Editor-in-ChiefKarim Anton Calis, Pharm.D., M.P.H.
Coordinator, Drug Information Service, and Endocrinology Clinical Pharmacy
Specialist[email protected]

Associate EditorAmy M. Heck, Pharm.D.
Specialized Resident in Drug Information Practice and Pharmacotherapy[email protected] |                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                            | Nelfinavir (Viracept®):
A Brief Review
|                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        | Nelfinavir (Viracept®):
A Brief Review                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    
|                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        | Formulary Update                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          
|                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        | 3TC
+ ZDV
+ NFV 750                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        | 3TC
+ ZDV
+ NFV 500                   
|% HIV RNA Decrease                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                      | 88%                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        | 75%                                   
|Mean CD4 Count
Increase (cells/mm3)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     | 146                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        | 138                                   
|                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                        | Wk
2 (n=22)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                | Wk
4 (n=17)                           
|Median CD4 change
(cells/mm3)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           | + 75                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       | + 103                                 
|Median HIV RNA change                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   | -1.4 log                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   | -1.7 log                              
|Drug                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    | Daily
Adult Dose                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           | Cost
Per Month                        
|Nelfinavir (Viracept®)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  | 750 mg q8h                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 | $ 470.44                              
|Indinavir (Crixivan®)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   | 800 mg q8h                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 | $ 268.99                              
|Ritonavir (Norvir®)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     | 600 mg q12h                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                | $ 748.64                              
|Saquinavir (Invirase®)                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  | 600 mg q8h                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                 | $ 358.45                              
|Up to Top                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               | Formulary Update

The Pharmacy
and Therapeutics Committee recently approved the following formulary actions:

Additions



*

Nelfinavir (Viracept®), a protease inhibitor approved for the treatment
of HIV infection*

Donepezil (Aricept®), a centrally acting cholinesterase inhibitor
approved for use in the treatment of mild to moderate AlzheimerÍs
disease*

Tizanidine (Zanaflex®), a centrally acting alpha-2 adrenoreceptor
agonist indicated for the acute and intermittent management of increased
muscle tone associated with spasticity*

Ivermectin (Stromectol®), a broad-spectrum antihelmintic*

Atorvastatin (Lipitor®), a lipid-lowering HMG-CoA reductase inhibitorDeletions

None

Editor's Note

We wish to thank Michael Polis, M.D., M.P.H. for reviewing the article
on nelfinavir and acknowledge Alice Pau, Pharm.D. for her contribution
to this issue of Pharmacy Update. | *                                     
|*                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       | Nelfinavir (Viracept®), a protease inhibitor approved for the treatment
of HIV infection                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
|*                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       | Donepezil (Aricept®), a centrally acting cholinesterase inhibitor
approved for use in the treatment of mild to moderate AlzheimerÍs
disease                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                               
|*                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       | Tizanidine (Zanaflex®), a centrally acting alpha-2 adrenoreceptor
agonist indicated for the acute and intermittent management of increased
muscle tone associated with spasticity                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         
|*                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       | Ivermectin (Stromectol®), a broad-spectrum antihelmintic                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
|*                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       | Atorvastatin (Lipitor®), a lipid-lowering HMG-CoA reductase inhibitor                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                     



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Drug Information
Service

*Patient-specific medication information and pharmocotherapy consultations

*
Nutritional and metabolic support consultations

*
Comprehensive information about medications, biologics, nutrients, and
drug therapy

*
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*
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and critical literature evaluation

301-496-2407Pager 104-2619-7
Building 10, Room 1N257



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