Delavirdine Dosage

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Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for HIV Infection

400 mg orally 3 times a day

The US Department of Health and Human Services does not recommend delavirdine as part of an initial regimen due to its inferior antiviral efficacy. Efavirenz is currently the NNRTI of choice.

Usual Pediatric Dose for HIV Infection

16 years or older: 400 mg orally 3 times a day

The US Department of Health and Human Services does not recommend delavirdine as part of an initial regimen due to its inferior antiviral efficacy. Efavirenz is currently the NNRTI of choice.

Renal Dose Adjustments

No adjustment recommended.

Liver Dose Adjustments

The manufacturer recommends caution when administering this drug to patients with impaired hepatic function.

Precautions

The concomitant administration of delavirdine is contraindicated with drugs that are highly dependent on CYP450 3A for clearance and that may cause serious and/or life threatening adverse effects when their plasma concentrations are elevated. These contraindicated drugs include dihydroergotamine, ergonovine, ergotamine, methylergonovine, cisapride, pimozide, alprazolam, midazolam, and triazolam. Significant decreases in delavirdine plasma levels may occur due to drugs that induce CYP450 3A (including phenytoin, phenobarbital, carbamazepine, rifabutin, rifampin, and St. John's wort) which may result in loss of virologic response and possible resistance to delavirdine or to other nonnucleoside reverse transcriptase inhibitors (NNRTIs); such drugs should not be coadministered with delavirdine. Concomitant administration of delavirdine with lovastatin or simvastatin is also not recommended due to increased risk of myopathy, including rhabdomyolysis. Delavirdine interacts with several antiretroviral agents and appropriate dosage adjustments should be made when these drugs are used together. Patients should be advised to report all concurrent medications and supplements they are taking.

Rashes may occur within the first 1 to 3 weeks of delavirdine therapy. Most resolve within 3 days to 2 weeks. Severe rashes have been rarely associated with delavirdine use, including erythema multiforme and Stevens-Johnson syndrome. A severe rash or rash with symptoms such as fever, blistering, oral lesions, conjunctivitis, swelling, or muscle or joint aches necessitates discontinuation of delavirdine and close follow-up. Patients should be advised to notify their physician immediately if a rash occurs.

Caution is recommended in elderly patients who may have reduced hepatic, renal, or cardiac function and other concomitant diseases or medications.

Immune reconstitution syndrome has occurred during combination antiretroviral therapy. Patients responding to therapy may develop an inflammatory response to indolent or residual opportunistic infections and require evaluation and treatment.

Delavirdine should always be used in combination with other antiretroviral agents. Delavirdine should generally not be added as a single agent when antiretroviral regimens are changed due to the development of drug resistance and loss of virological response.

The potential for HIV-1 cross-resistance among NNRTIs exists. It is unknown what effect delavirdine therapy will have on the activity of subsequently administered NNRTIs for individual patients. Selection of antiretroviral agents for a patient's medication regimen should be done carefully.

Safety and effectiveness have not been established in pediatric patients less than 16 years of age.

Dialysis

Data not available

Since delavirdine is extensively metabolized by the liver and is highly protein-bound, it is not expected to be significantly removed by dialysis.

Other Comments

Although not approved by the FDA, delavirdine may be administered in a dosage of 600 mg orally every 12 hours. This dosing regimen appears to be as effective as the three-times-daily regimen and may improve medication adherence.

Delavirdine may be taken with or without food. Antacids should be taken at least 1 hour apart from delavirdine.

Patients with achlorhydria should take delavirdine with an acidic beverage such as orange or cranberry juice to improve absorption. Although the effects of acidic beverages on delavirdine absorption have not been studied, delavirdine is known to be poorly soluble when pH is greater than 3.

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