Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Discovery and development of neuraminidase inhibitors wikipedia , lookup
Discovery and development of non-nucleoside reverse-transcriptase inhibitors wikipedia , lookup
Adherence (medicine) wikipedia , lookup
Discovery and development of direct thrombin inhibitors wikipedia , lookup
Hormonal contraception wikipedia , lookup
Pharmacokinetics wikipedia , lookup
Dydrogesterone wikipedia , lookup
Drug Target dosing range ABC 8-10mg/kg/dose twice daily AZT 180-240mg/m2 /dose twice daily d4T 1mg/kg/dose twice daily ddI ≤3 months of age: 50mg/m2/dose; >3 months of age: 120mg/m2/dose twice daily 4mg/kg/dose twice daily 3TC NVP A BSA dose range of 150200mg/m2/dose twice daily is used to generate weight band dosing EFV By weight band (15-18.75mg/kg/dose solid formulation or 19.5mg/kg/dose suspension, once daily <6 months: <15kg – 12/3 mg/kg/dose; ≥15kg – 10/2.5 mg/kg/dose twice daily Approved dose is 230/75.5mg/m2/dose twice daily; L/r Considerations Clearance in children <3 years old is increased, but recent data on once daily dosing in children from 3 months of age suggests favourable PK profile. Twice daily dosing is acceptable and preferred Dosing at the upper end of the range is recommended for central nervous system HIV disease, dosing at the lower end may be preferred is settings where anaemia is prevalent. Needed as a priority product despite well recognised longer term toxicities (lipodystrophy), as it is initially well tolerated, is safer to use in anaemia than AZT, and has lower laboratory monitoring requirements. Avoid over-dosing wherever possible (noting recent revision to adult dosing recommendation to reduce dose) and especially for extended periods to minimise toxicity. Enteric coated formulations are preferred over the buffered form. Needs to be given 1 hour before or 2 hours after food. Once daily dosing accepted over 6 years of age. Clearance in children <3 years old is increased, and minimal observed toxicity allows for higher dosing in younger children (up to 5mg/kg/dose twice daily). Under-dosing must be avoided wherever possible due to low barrier development of HIV drug resistance. A reduced dose (150200mg/m2/dose once daily) is recommended for the first 2 weeks when initiating NVP treatment regimens. Young children require a higher NVP dose relative to the NRTI components than delivered in current adult FDCs. Dosing not established for children <3 years. Suspension is over 30% less bioavailable than solid formulations. Clearance in children <2 years old is increased. Actual exposure depends on metabolism and inter-patient variability, which is considerable. Heat-stable paediatric formulation is recently approved (awaiting registration in SA). 300/75mg/m2/dose is recommended in children <2 years of age, if taken with NNRTI, or for PI-experienced patients RTV Co-formulated with lopinavir Needed for use as a pharmacological (L:r ratio 4:1). booster with PI-based treatment and for For patients receiving children receiving rifampicin-based antirifampicin, additional RTV tuberculosis therapy dosed at 0.75 x L/r dose to achieve L:r ratio of 1:1 Table 2 ABC, abacavir; AZT, zidovudine; d4T, stavudine; ddI, didanosine; 3TC, lamivudine; NVP, nevirapine; EFV, efavirenz; L/r, lopinavir/ritonavir; RTV, ritonavir; NNRTI, non-nucleoside reverse transcriptase inhibitor; BSA, body surface area; FDC, fixed dose combination; SA, South Africa Adapted from [18]