A diagnosis of hepatotoxicity should be considered for patients who present with nonspecific symptoms of hepatitis, even if liver function studies are normal. If clinical hepatotoxicity occurs, nevirapine should be permanently discontinued. Clinical trial data indicate that prednisone actually increases both the incidence and severity of nevirapine-related rashes when used with nevirapine and should therefore not be used. However, the agency cautions that twice daily dosing with buffered didanosine tablets is preferred because there are only limited data to support the durability of virologic suppression with the new once-daily capsules. As with the tablets, enteric coated didanosine must be taken on an empty stomach, defined as 1 hour before or 2 hours after food.
Methadone decreases absorption of didanosine, stavudine.
Researchers from the University of Washington, Seattle, monitored serum levels of didanosine and stavudine in 17 patients who were on stable methadone therapy. Levels of methadone appeared to be unaffected by either didanosine or stavudine. This study did not look at intracellular concentrations of the drugs, which is where didanosine and stavudine are active. CD4 T cell response predicts clinical benefit. The researchers followed 2236 protease inhibitor na ve patients for an average of 18 months.