Delavirdine

INTRODUCTION

Indications

Treatment of HIV infection in combination with other antiretrovirals.

Action

Binds to reverse transcriptase, inhibiting viral DNA synthesis. Therapeutic Effects: Decreased viral load and increased CD4 cell count. Slowed progression of HIV infection and decreased severity of its sequelae.

Adverse Reactions/Side Effects

CNS: fatigue, headache. GI: diarrhea, increased amylase, increased liver enzymes, nausea, vomiting. Derm: rash, pruritus. Misc: fat redistribution.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor excessive headache or fatigue. Some fatigue is expected, but any sudden or severe change in muscle strength or energy levels should be reported.

Interventions

• Implement resistive exercises and other therapeutic exercises as tolerated to maintain muscle strength and function and prevent muscle wasting associated with HIV infection and AIDS.

Patient/Client-Related Instruction

• Emphasize the importance of taking delavirdine as directed even if the patient is asymptomatic, and that this drug must always be used in combination with other antiretroviral drugs. Do not take more than prescribed amount and do not stop taking without consulting health care professional.

• Inform patient that delavirdine does not cure HIV or AIDS or prevent associated or opportunistic infections. Delavirdine does not reduce the risk of transmission of HIV to others through sexual contact or blood contamination. Caution patient to use a condom, and to avoid sharing needles or donating blood to prevent spreading the AIDS virus to others.

• Advise patient about possible fat redistribution, characterized by increased fat in the torso and thin arms and legs. Discuss possible effects on body image, and help patient explore coping mechanisms.

• Advise patient about the likelihood of GI reactions (nausea, vomiting, diarrhea) and skin problems (rash, itching). Instruct patient to report severe or prolonged GI or skin reactions.

Pharmacokinetics

Absorption: 85% absorbed after oral administration; increased when tablet is dispersed in water.

Distribution: Unknown.

Protein Binding: 98%.

Metabolism and Excretion: Extensively metabolized by the liver; <5% excreted unchanged in urine.

Half-life: 5.8 hr.

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Concurrent use of astemizole, benzodiazepines and antiarrhythmics, dihydropyridine, calcium channel blockers (nifedipine), ergot alkaloids, amphetamines, and sildenafil (may result in excessive sedation, vasoconstriction, or arrhythmias).

Use Cautiously in: Impaired hepatic function; Achlorhydria (requires acidic environment for absorption); Pregnancy, lactation, or children (safety not established; HIV-infected patients should not breast-feed).