Nucleoside reverse transcriptase inhibitor

Nucleoside reverse transcriptase inhibitor; obstructs RNA and DNA synthesis and inhibits viral reproduction. Used in combination with other anti-HIV drugs to reduce the viral load as low as possible and decrease the chance of further viral mutation. Thought to cross the blood�brain barrier and be effective in the treatment of HIV-related dementia. There are no long-term studies on the effectiveness of this drug.

Indications

Treatment of HIV-1 infection in combination with other antiretrovirals

Contraindications and cautions

Contraindicated with life-threatening allergy or hypersensitivity to any component, moderate to severe hepatic impairment, lactation.

Use cautiously with mild hepatic impairment, lactic acidosis, pregnancy. Available forms Tablets�300 mg; oral solution�20 mg/mL
Metabolism: Hepatic; T1/2: 1�2 hr
Distribution: Crosses placenta; may enter breast milk
Excretion: Urine, feces

Adverse effects

CNS: Headache, weakness, malaise, fatigue, insomnia, dizziness, anxiety, depression

Dermatologic: Rash

GI: Diarrhea, nausea, anorexia, vomiting,dyspepsia, liver enzyme elevations, liver enlargement, risk of severe to fatal hepatomegaly

Other: Severe hypersensitivity reactions (fever, malaise, nausea, vomiting, rash), severe to fatal lactic acidosis, fat redistribution, increased lipid levels, MI

Interactions

Drug-drug

Risk of severe toxic effects if combined with alcohol

Nursing considerations

Assessment

History: Life-threatening allergy to any component, impaired hepatic or renal function, lactic acidosis, pregnancy, lactation

Physical: T; affect, reflexes, peripheral sensation; R, adventitious sounds; bowel sounds, liver evaluation; LFTs, renal function tests

Interventions

Administer with meals or a light snack if GI upset occurs.

Black box

warning Monitor patient for signs of potentially fatal hypersensitivity reaction; give patient hypersensitivity reaction warning card provided by manufacturer. Advise patient to stop drug at first sign of reaction. Do not try the drug again if patient has a hyper- sensitivity reaction.