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1 Adverse Reactions/Side Effects

CNS: fatigue, headache. GI: diarrhea,qamylase,qliver enzymes, nausea, vomiting. PDF Page #1
delavirdine (de-la-veer-deen) Derm: rash, pruritus. Misc: fat redistribution, immune reconstitution syndrome.
Rescriptor Interactions
Classification Drug-Drug: Delavirdine inhibits the hepatic drug-metabolizing enzyme
Therapeutic: antiretrovirals CYP3A4 andqblood levels of midazolam triazolam, alprazolam, pimozide,
Pharmacologic: non-nucleoside reverse transcriptase inhibitors or ergot alkaloids, a; concurrent use is contraindicated. Concurrent adminis-
Pregnancy Category C tration of clarithromycin significantlyqlevels of both agents. Concurrent adminis-
tration with didanosineplevels of both agents (separate doses by 1 hr). Concurrent
use with other NNRTIs including efavirenz, nevirapine, rilpivirine, and etravi-
Indications rine may lead topeffectiveness and should be avoided. Fluoxetine andketocona-
Treatment of HIV infection in combination with other antiretrovirals. zoleqdelavirdine levels. Antacidspabsorption (do not use within 1 hr of each
Action other). Mayqlevels of amphetamines, amiodarone, lidocaine, quinidine, fle-
Binds to reverse transcriptase, inhibiting viral DNA synthesis. Therapeutic Ef- cainide, propafenone, calcium channel blockers, sildenafil, atorvastatin,
fects: Decreased viral load and increased CD4 cell count. Slowed progression of HIV fluvastatin, cyclosporine, tacrolimus, and fluticasone. Mayqtrazodone levels
infection and decreased severity of its sequelae. (pdose of trazodone). Mayqclarithromycin levels (pdose of clarithromycin).
Mayqmethadone levels (pdose of methadone). H2 antagonists and proton
Pharmacokinetics pump inhibitorspabsorption (avoid chronic use). Levels arepby rifabutin, rif-
Absorption: 85% absorbed after oral administration, increased when tablet is dis- ampin, phenytoin, phenobarbital, dexamethasone, and carbamazepine
persed in water. (avoid concurrent use).qlevels of indinavir, lopinavir, ritonavir, nelfinavir,
Distribution: Unknown. and saquinavir (dosagepmay be necessary). Mayqmaraviroc levels (pdose of
Protein Binding: 98%. maraviroc). Mayqwarfarin levels (monitor INR closely).
Metabolism and Excretion: Extensively metabolized by the liver; ⬍5% excreted Drug-Natural Products: Use with St. John’s wort mayplevels and effective-
unchanged in urine. ness, including development of drug resistance.
Half-life: 5.8 hr. Route/Dosage
TIME/ACTION PROFILE (blood levels) PO (Adults): 400 mg 3 times daily.
ROUTE ONSET PEAK DURATION NURSING IMPLICATIONS
PO rapid 1 hr 8 hr Assessment
● Assess for change in severity of HIV symptoms and for symptoms of opportunistic
Contraindications/Precautions infections throughout therapy.
Contraindicated in: Hypersensitivity; Concurrent use of pimozide, ergot alka- ● Monitor for development of rash; usually maculopapular and self-limited. May
loids, alprazolam, midazolam, and triazolam. cause Stevens-Johnson syndrome or toxic epidermal necrolysis. Discon-
Use Cautiously in: Impaired hepatic function; Achlorhydria (requires acidic en- tinue therapy if severe or if accompanied with fever, general malaise, fa-
vironment for absorption); OB, Lactation, Pedi: Safety not established; HIV-in- tigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepati-
fected patients should not breast fed. tis and/or eosinophilia.
⫽ Canadian drug name. ⫽ Genetic Implication. CAPITALS indicate life-threatening, underlines indicate most frequent. Strikethrough ⫽ Discontinued.
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2 wasting, breast enlargement, and cushingoid appearance. The cause and long-
term effects are not known.
● Lab Test Considerations: Monitor viral load and CD4 cell counts regularly ● Advise patients taking oral contraceptives to use a nonhormonal method of birth PDF Page #2
during therapy. control during delavirdine therapy. Advise female patients to avoid breast feeding
● May causeqserum AST and ALT concentrations. during therapy with delavirdine.
● May causepin neutrophil counts. ● Emphasize the importance of regular follow-up exams and blood counts to deter-
Potential Nursing Diagnoses mine progress and monitor for side effects.
Risk for infection (Indications) Evaluation/Desired Outcomes
Noncompliance (Patient/Family Teaching) ● Delayed progression of AIDS and decreased opportunistic infections in patients
Implementation with HIV.
● PO: Administer without regard to food. Tablets should be taken whole or dis- ● Improved CD4 cell count and decrease in viral load.
persed in water. To prepare dispersion, add 4 tablets to at least 3 oz water and al-
low to stand for a few minutes. Stir mixture until a uniform dispersion occurs. Dis- Why was this drug prescribed for your patient?
persion should be consumed promptly, followed by rinsing the glass and
swallowing rinse to consume entire dose. Swallow 200 mg tablets whole; not read-
ily dispersed in water.
● Do not administer within 1 hr of antacids or didanosine.
● Patients with achlorhydria should take delavirdine with an acidic beverage such as
orange juice or cranberry juice.
Patient/Family Teaching
● Emphasize the importance of taking delavirdine as directed, at evenly spaced
times throughout day. Do not take more than prescribed amount and do not stop
taking without consulting health care professional. Take missed doses as soon as
remembered; do not double doses.
● Instruct patient that delavirdine should not be shared with others.
● Instruct patient to notify health care professional of all Rx or OTC medications, vi-
tamins, or herbal products being taken and consult health care professional be-
fore taking any new medications.
● Inform patient that delavirdine does not cure AIDS or prevent associated or op-
portunistic 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 avoid sharing needles or donating blood to prevent spreading the
AIDS virus to others. Advise patient that the long-term effects of delavirdine are un-
known at this time.
● Inform patient that redistribution and accumulation of body fat may occur, caus-
ing central obesity, dorsocervical fat enlargement (buffalo hump), peripheral
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