BNF for Children 2011-2012

316 5.3.1 HIV infection BNFC 2011–20125 InfectionsIndication and doseHIV infection in combination with other antiretroviraldrugs. By mouthWith low-dose ritonavirChild 6–18 yearsBody-weight 15–20 kg 150 mg once dailyBody-weight 20–40 kg 200 mg once dailyBody-weight over 40 kg 300 mg once dailyReyataz c (Bristol-Myers Squibb) TACapsules, atazanavir (as sulphate) 150 mg (dark blue/light blue), net price 60-cap pack = £303.38; 200 mg(dark blue), 60-cap pack = £303.38; 300 mg (red/blue), 30-cap pack = £303.38. Label: 5, 21DARUNAVIRCautions see notes above; also sulfonamide sensitivity;monitor liver function before and during treatment;interactions: Appendix 1 (daruanvir)Rash Mild to moderate rash occurs commonly, usuallywithin the first 4 weeks of therapy and resolves withoutstopping treatment. Severe skin rash (including Stevens-Johnson syndrome and toxic epidermal necrolysis) occursless frequently and may be accompanied by fever, malaise,arthralgia, myalgia, oral lesions, conjunctivitis, hepatitis, oreosinophilia; treatment should be stopped if severe rashdevelopsContra-indications see notes aboveHepatic impairment see notes above; also manufactureradvises caution in mild to moderate impairment;avoid in severe impairment—no information availablePregnancy manufacturer advises use only if potentialbenefit outweighs risk—no information availableBreast-feeding see p. 310Side-effects see notes above; also haematemesis,myocardial infarction, chest pain, QT interval prolongation,syncope, bradycardia, tachycardia, palpitation,hypertension, flushing, peripheral oedema,dyspnoea, cough, peripheral neuropathy, anxiety,confusion, memory impairment, depression, abnormaldreams, convulsions, increased appetite, weightchanges, pyrexia, hypothyroidism, osteoporosis,gynaecomastia, erectile dysfunction, reduced libido,dysuria, polyuria, nephrolithiasis, renal failure, arthralgia,visual disturbances, dry eyes, conjunctivalhyperaemia, rhinorrhoea, throat irritation, dry mouth,stomatitis, nail discoloration, acne, seborrhoeicdermatitis, eczema, increased sweating, and alopeciaIndication and doseIn combination with other antiretroviral drugs,for HIV infection resistant to other proteaseinhibitors in children previously treated withantiretrovirals. By mouthWith low-dose ritonavirChild 6–18 yearsBody-weight 20–30 kg 375 mg twice dailyBody-weight 30–40 kg 450 mg twice dailyBody-weight over 40 kg 600 mg twice dailyPrezista c (Janssen) TATablets, f/c, darunavir (as ethanolate) 75 mg (white),net price 480-tab pack = £446.70; 150 mg (white),240-tab pack = £446.70; 400 mg (light orange), 60-tabpack = £297.80; 600 mg (orange), 60-tab pack =£446.70. Label: 21FOSAMPRENAVIRNote Fosamprenavir is a pro-drug of amprenavirCautions see notes above; interactions: Appendix 1(fosamprenavir)Rash Rash may occur, usually in the second week of therapy;discontinue permanently if severe rash with systemic orallergic symptoms or, mucosal involvement; if rash mild ormoderate, may continue without interruption—usuallyresolves within 2 weeks and may respond to antihistaminesContra-indications see notes aboveHepatic impairment see notes above; also manufactureradvises caution in mild impairment; reduce dosein moderate to severe impairmentPregnancy toxicity in animal studies; manufactureradvises use only if potential benefit outweighs riskBreast-feeding see p. 310Side-effects see notes above; also reported, rashincluding rarely Stevens-Johnson syndrome (see alsoRash above)Indication and doseHIV infection in combination with other antiretroviraldrugs. By mouthWith low-dose ritonavirChild 6–18 yearsBody-weight 25–39 kg 18 mg/kg (max. 700 mg)twice dailyBody-weight over 39 kg 700 mg twice dailyNote 700 mg fosamprenavir is equivalent to approx. 600 mgamprenavirTelzir c (ViiV) ATablets, f/c, pink, fosamprenavir (as calcium) 700 mg,net price 60-tab pack = £258.97Oral suspension, fosamprenavir (as calcium) 50 mg/mL, net price 225-mL pack (grape-bubblegum-andpeppermint-flavoured) (with 10-mL oral syringe) =£69.06. Counselling, administrationExcipients include propylene glycolAdministration In children, oral suspension should be taken withfoodLOPINAVIR WITH RITONAVIRCautions see notes above; concomitant use with drugsthat prolong QT or PR interval; cardiac conductiondisorders, structural heart disease; pancreatitis (seebelow); interactions: Appendix 1 (lopinavir, ritonavir)Pancreatitis Signs and symptoms suggestive of pancreatitis(including raised serum lipase) should be evaluated—discontinueif pancreatitis diagnosedContra-indications see notes aboveHepatic impairment see notes above; also avoid oralsolution—high propylene glycol content; manufactureradvises avoid tablets in severe impairmentRenal impairment avoid oral solution due to highpropylene glycol contentPregnancy avoid oral solution due to high propyleneglycol content; manufacturer advises use tablets onlyif potential benefit outweighs risk (toxicity in animalstudies)Breast-feeding see p. 310