DOCSLIB.ORG

Antiretroviral Therapy and Medical Management of Pediatric HIV Infection

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Antiretroviral Therapy and Medical Management of Pediatric HIV Infection Antiretroviral Therapy and Medical Management of Pediatric HIV Infection ABBREVIATIONS. NPHRC, National Pediatric and Family HIV South Carolina, Charleston, SC), Rosemary Johnson (Family Rep- Resource Center; ZDV, zidovudine; PI, protease inhibitor; resentative), Michael Kaiser (HRSA, Rockville, MD), Aaron PACTG, Pediatric AIDS Clinical Trials Group; NIH, National In- Kaplan (Tulane Medical School, New Orleans, LA), Mark Kline (Baylor College of Medicine, Houston, TX), Andrea Kovacs stitutes of Health; DHHS, Department of Health and Human 1 Services; HRSA, Health and Human Resources Administration; (LAC USC Medical Center, Los Angeles, CA), Keith Krasinski USPHS, US Public Health Service; IDSA, Infectious Diseases So- (New York University Medical Center, New York, NY), Kathleen ciety of America; FDA, Food and Drug Administration; OI, op- McGann (Washington University Medical Center, St Louis, MO), portunistic infection; PCP, Pneumocystis carinii pneumonia; PCR, Kenneth McIntosh (Children’s Hospital, Boston, MA), Ross McK- polymerase chain reaction; CI, confidence interval; NRTI, nucleo- inney (Duke University Medical Center, Durham, NC), George side analogue reverse transcriptase inhibitor; NNRTI, nonnucleo- McSherry (UMDNJ-New Jersey Medical School, Newark, NJ), side analogue reverse transcriptase inhibitor; 3TC, lamivudine; Mark Mintz (Children’s Hospital of Philadelphia, Philadelphia, ddI, didanosine; d4T, stavudine; ddC, zalcitabine; IDV, indinavir; PA), Charles Mitchell (University of Miami, Miami, FL), Lynne M SQV, saquinavir; RTV, ritonavir; NFV, nelfinavir; CNS, central Mofenson (NIH, Rockville, MD), John Moye, Jr (NIH, Rockville, nervous system; CSF, cerebrospinal fluid; NVP, nevirapine; DLV, MD), Brigitta Mueller (Children’s Hospital, Boston, MA), Sharon delavirdine; MAC, Mycobacterium avium complex; VZV, varicella- Murphy (Children’s Memorial Hospital, Chicago, IL), Sharon zoster virus; CMV, cytomegalovirus; EBV, Epstein–Barr virus; Nachman (State University of New York Health Science Center at BAL, bronchoalveolar lavage; G-CSF, granulocyte colony stimu- Stony Brook, Stony Brook, NY), Mary Jo O’Hara (NPHRC, New- lating factor; IVIG, intravenous immunoglobulin; LIP, lymphoid ark, NJ), James Oleske (UMDNJ-New Jersey Medical School, New- interstitial pneumonia; TMP/SMX, trimethoprim/sulfamethox- ark, NJ), Savita Pahwa (North Shore University Hospital, Manhas- azole; TB, tuberculosis; MMR, measles-mumps-rubella; STD, sex- set, NY), Paul Palumbo (UMDNJ-New Jersey Medical School, ually transmitted disease; HPV, human papilloma virus; RDA, Newark, NJ), Ligia Peralta (University of Maryland, Baltimore, Recommended Daily Allowance; DEXA, dual x-ray absorptiom- MD), Jane Pitt (Columbia University Medical Center, New York City, NY), Philip Pizzo (Harvard Medical School/Children’s Hos- etry; TPN, total parenteral nutrition; PE, progressive encephalop- pital, Boston, MA), Tamara Rakusan (Children’s Hospital, Wash- athy; ADC, AIDS dementia complex; SE, static encephalopathy; ington, DC), Merlin Robb (Walter Reed Army Institute of Re- CT, computed tomography; MRI, magnetic resonance imaging; search, Rockville, MD), John Rodman (St Jude Children’s Research EPS, extrapyramidal syndrome; ADHD, attention deficit/hyper- Hospital, Memphis, TN), Arye Rubinstein (Albert Einstein College activity disorder; PNS, peripheral nervous system; NMDA, N- of Medicine, Bronx, NY), Mary Sawyer (Emory University, At- methyl-d-aspartate; EMLA, eutectic mixture of local anesthetics. lanta, GA), Gwendolyn B. Scott (University of Miami, Miami, FL), John Sever (Children’s National Medical Center, Washington, These guidelines were developed by the Working Group on DC), Minora Sharpe (Family Representative), William Shearer Antiretroviral Therapy and Medical Management of Infants, Chil- (Baylor College of Medicine, Houston, TX), R. J. Simonds (Centers dren and Adolescents with HIV Infection convened by the Na- for Disease Control and Prevention, Atlanta, GA), Peter Smith tional Pediatric and Family HIV Resource Center (NPHRC), the (Hasbro Children’s Hospital, Providence, RI), Stephen Spector Health Resources and Services Administration (HRSA), and the (University of California at San Diego, La Jolla, CA), Deborah National Institutes of Health (NIH). The Co-Chairs of the Working Storm (UMDNJ-New Jersey Medical School, Newark, NJ), Russell Group were James Oleske, MD, MPH, University of Medicine and Van Dyke (Tulane University School of Medicine, New Orleans, Dentistry of New Jersey (UMDNJ)-New Jersey Medical School, LA), Diane Wara (University of California at San Francisco School Newark, NJ and Gwendolyn B. Scott, MD, University of Miami of Medicine, San Francisco, CA), Catherine Wilfert (Duke Univer- School of Medicine, Miami, FL. sity Medical Center, Durham, NC; The Pediatric AIDS Founda- Members of the Working Group who participated in the devel- tion, Santa Monica, CA), Harland Winter (Boston Medical Center, opment of this document include: Elaine Abrams (Harlem Hospi- Boston, MA), Andrew Wiznia (Bronx Lebanon Hospital Center, tal Center, New York City, NY), Arthur Ammann (AmFAR, New Bronx, NY), Ram Yogev (Children’s Memorial Hospital, Chicago, York City, NY), Martin Anderson (University of California at Los IL). Angeles, Los Angeles, CA), Carol Baker (Baylor College of Med- icine, Houston, TX), Lawrence Bernstein (Albert Einstein College INTRODUCTION of Medicine, Bronx, NY), Michael Brady (Columbus Children’s n 1993, the Working Group on Antiretroviral Hospital, Columbus, OH), Kathleen Brooke (Family Representa- Therapy and Medical Management of HIV-in- tive), Sandra Burchett (Children’s Hospital, Boston, MA), Carolyn fected Children, composed of specialists in the Burr (NPHRC, Newark, NJ), Joseph Cervia (Cornell Medical Cen- I ter, New York City, NY), Diana Clarke (Boston Medical Center, care of infants, children, and adolescents with HIV Boston, MA), Daniel Collado (Family Representative), Ellen Coo- infection, was convened by the National Pediatric per (Boston University School of Medicine, Boston, MA), Marilyn and Family HIV Resource Center (NPHRC). On the Crain (University of Alabama at Birmingham, Birmingham, AL), basis of available data and a consensus reflecting Barry Dashefsky (NPHRC and UMDNJ-New Jersey Medical School, Newark, NJ), Carol DiPaolo (Family Representative), Di- clinical experience, the Working Group concluded ane Donovan (Family Representative), Janet A. Englund (Baylor that antiretroviral therapy was indicated for any College of Medicine, Houston, TX), Mary Glenn Fowler (NIH, child with a definitive diagnosis of HIV infection Rockville, MD), Lisa M Frenkel (University of Washington, Seat- who had evidence of substantial immunodeficiency tle, WA), Donna Futterman (Montefiore Medical Center, New York City, NY), Anne Gershon (Columbia University, New York City, NY), Samuel Grubman (St Vincent’s Hospital and Medical Received for publication Mar 24, 1998; accepted Apr 24, 1998. Center of New York, New York City, NY), Peter Havens (Chil- Address correspondence to Dr James Oleske, Division of Allergy, Immu- dren’s Hospital of Wisconsin, Milwaukee, WI), Karen Hench nology, and Infectious Diseases, New Jersey Medical School, 185 S Orange (HRSA, Rockville, MD), Neal Hoffman (Montefiore Medical Cen- Ave, MSB F570A, Newark, NJ 07103-2714. ter, Bronx, NY), Walter Hughes (St Jude Children’s Research Hos- PEDIATRICS (ISSN 0031 4005). Copyright © 1998 by the American Acad- pital, Memphis, TN), George Johnson (Medical University of emy of Pediatrics. Downloaded from www.aappublications.org/news byPEDIATRICS guest on September Vol. 24, 102 2021 No. 4 October 1998 1005 (based on age-related CD41 T-lymphocyte count TABLE 1. Principles of Therapy of HIV Infection thresholds) and/or who had HIV-associated symp- 1. Ongoing HIV replication leads to immune system damage toms. Zidovudine (ZDV) monotherapy was recom- and progression to AIDS. HIV infection is always harmful, mended as the standard of care for initiation of ther- and true long-term survival free of clinically significant apy. Routine antiretroviral therapy for infected immune dysfunction is unusual. 2. Plasma HIV RNA levels indicate the magnitude of HIV children who were asymptomatic or had only mini- replication and its associated rate of CD41 T-cell destruction, mal symptoms (eg, isolated lymphadenopathy or whereas CD41 T-cell counts indicate the extent of HIV- hepatomegaly) and normal immune status was not induced immune damage already suffered. Regular, periodic 1 recommended.1 measurement of plasma HIV RNA levels and CD4 T-cell counts is necessary to determine the risk of disease Since the Working Group developed these recom- progression in an HIV-infected individual and to determine mendations, dramatic advances have been made in when to initiate or modify antiretroviral treatment regimens. laboratory and clinical research. The rapidity and 3. As rates of disease progression differ among individuals, treatment decisions should be individualized by level of risk magnitude of HIV replication during all stages of 1 infection are greater than believed previously and indicated by plasma HIV RNA levels and CD4 T-cell counts. account for the emergence of drug-resistant viral 4. The use of potent combination antiretroviral therapy to variants when antiretroviral treatment does not max- suppress HIV replication to below the levels of detection of imally suppress replication.2,3 New assays that quan- sensitive plasma HIV RNA assays limits the potential for titate plasma HIV RNA copy number
Load more

Recommended publications
  • Injectable PLGA Adefovir Microspheres; the Way for Long Term Therapy of T Chronic Hepatitis-B ⁎ Margrit M
    European Journal of Pharmaceutical Sciences 118 (2018) 24–31 Contents lists available at ScienceDirect European Journal of Pharmaceutical Sciences journal homepage: www.elsevier.com/locate/ejps Injectable PLGA Adefovir microspheres; the way for long term therapy of T chronic hepatitis-B ⁎ Margrit M. Ayouba, , Neveen G. Elantounyb, Hanan M. El-Nahasa, Fakhr El-Din S. Ghazya a Department of Pharmaceutics and Industrial Pharmacy, Faculty of Pharmacy, Zagazig University, Zagazig, Egypt b Department of Internal Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt ARTICLE INFO ABSTRACT Keywords: For patient convenience, sustained release Adefovir Poly-d,l-lactic-co-glycolic acid (PLGA) microspheres were Adefovir formulated to relieve the daily use of the drug which is a problem for patients treated from chronic hepatitis-B. Biodegradable microspheres PLGA microspheres were prepared and characterized by entrapment efficiency, particle size distribution and Poly-lactic-co-glycolic acid scanning electron microscopy (SEM). In-vitro release and in-vivo studies were carried out. Factors such as drug: Entrapment efficiency polymer ratio, polymer viscosity and polymer lactide content were found to be important variables for the preparation of PLGA Adefovir microspheres. Fourier transform infrared (FTIR) analysis and differential scanning calorimetry (DSC) were performed to determine any drug-polymer interactions. One way analysis of variance (ANOVA) was employed to analyze the pharmacokinetic parameters after intramuscular injection of the pure drug and the selected PLGA microspheres into rats. FTIR and DSC revealed a significant interaction between the drug and the polymer. Reports of SEM before and after 1 and 24 h release showed that the microspheres had nonporous smooth surface even after 24 h release.
    [Show full text]
  • Hepsera, INN- Defovir Dipivoxil
    SCIENTIFIC DISCUSSION This module reflects the initial scientific discussion for the approval of Hepsera. For information on changes after approvalplease refer to module 8B 1. Chemical, pharmaceutical and biological aspects Composition Hepsera is presented as an immediate release tablet containing 10 mg of adefovir dipivoxil, as active substance. The other ingredients in this formulation are commonly used in tablets Hepsera is supplied in high-density polyethylene bottle (HDPE), with silica gel desiccant canisters or sachets, and polyester fiber packing material. The closure system consists of a child-resistant polypropylene screw cap lined with an induction activated aluminium foil liner. Active substance Adefovir dipivoxil is an ester prodrug of the nucleotide analogue, adefovir. A structural modification of the parent drug has been carried out in order to increase the lipophilicity and to enhance the oral bioavailability of adefovir. The active substance is a white to off-white crystalline powder. It is soluble in ethanol, sparingly soluble in 0.1N HCl and very slightly soluble in water adjusted to pH 7.2 but relatively highly soluble at physiological pH. The active substance does not contain any chiral center and does not exhibit any optical isomerism. In laboratory studies the anhydrate crystal form has been observed to convert gradually into a dihydrate crystal form when adefovir dipivoxil was exposed to high humidity conditions (75% R.H., 25ºC) over an approximately one-month period. However, the only crystal form produced during the active substance synthesis and utilised in non-clinical and clinical studies has been the anhydrous crystal form. Adefovir dipivoxil undergoes also hydrolysis in aqueous solution and to a smaller degree in the solid state after exposure to humidity and heat for extended periods.
    [Show full text]
  • COVID-19) Pandemic on National Antimicrobial Consumption in Jordan
    antibiotics Article An Assessment of the Impact of Coronavirus Disease (COVID-19) Pandemic on National Antimicrobial Consumption in Jordan Sayer Al-Azzam 1, Nizar Mahmoud Mhaidat 1, Hayaa A. Banat 2, Mohammad Alfaour 2, Dana Samih Ahmad 2, Arno Muller 3, Adi Al-Nuseirat 4 , Elizabeth A. Lattyak 5, Barbara R. Conway 6,7 and Mamoon A. Aldeyab 6,* 1 Clinical Pharmacy Department, Jordan University of Science and Technology, Irbid 22110, Jordan; [email protected] (S.A.-A.); [email protected] (N.M.M.) 2 Jordan Food and Drug Administration (JFDA), Amman 11181, Jordan; [email protected] (H.A.B.); [email protected] (M.A.); [email protected] (D.S.A.) 3 Antimicrobial Resistance Division, World Health Organization, Avenue Appia 20, 1211 Geneva, Switzerland; [email protected] 4 World Health Organization Regional Office for the Eastern Mediterranean, Cairo 11371, Egypt; [email protected] 5 Scientific Computing Associates Corp., River Forest, IL 60305, USA; [email protected] 6 Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK; [email protected] 7 Institute of Skin Integrity and Infection Prevention, University of Huddersfield, Huddersfield HD1 3DH, UK * Correspondence: [email protected] Citation: Al-Azzam, S.; Mhaidat, N.M.; Banat, H.A.; Alfaour, M.; Abstract: Coronavirus disease 2019 (COVID-19) has overlapping clinical characteristics with bacterial Ahmad, D.S.; Muller, A.; Al-Nuseirat, respiratory tract infection, leading to the prescription of potentially unnecessary antibiotics. This A.; Lattyak, E.A.; Conway, B.R.; study aimed at measuring changes and patterns of national antimicrobial use for one year preceding Aldeyab, M.A.
    [Show full text]
  • Treating Opportunistic Infections Among HIV-Infected Adults and Adolescents
    Morbidity and Mortality Weekly Report Recommendations and Reports December 17, 2004 / Vol. 53 / No. RR-15 Treating Opportunistic Infections Among HIV-Infected Adults and Adolescents Recommendations from CDC, the National Institutes of Health, and the HIV Medicine Association/ Infectious Diseases Society of America INSIDE: Continuing Education Examination department of health and human services Centers for Disease Control and Prevention MMWR CONTENTS The MMWR series of publications is published by the Epidemiology Program Office, Centers for Disease Introduction......................................................................... 1 Control and Prevention (CDC), U.S. Department of How To Use the Information in This Report .......................... 2 Health and Human Services, Atlanta, GA 30333. Effect of Antiretroviral Therapy on the Incidence and Management of OIs .................................................... 2 SUGGESTED CITATION Initiation of ART in the Setting of an Acute OI Centers for Disease Control and Prevention. Treating (Treatment-Naïve Patients) ................................................. 3 Management of Acute OIs in the Setting of ART .................. 4 opportunistic infections among HIV-infected adults and When To Initiate ART in the Setting of an OI ........................ 4 adolescents: recommendations from CDC, the National Special Considerations During Pregnancy ........................... 4 Institutes of Health, and the HIV Medicine Association/ Disease Specific Recommendations ....................................
    [Show full text]
  • Enhancing the Antihepatitis B Virus Immune Response by Adefovir Dipivoxil and Entecavir Therapies
    Cellular & Molecular Immunology (2011) 8, 75–82 ß 2011 CSI and USTC. All rights reserved 1672-7681/11 $32.00 www.nature.com/cmi RESEARCH ARTICLE Enhancing the antihepatitis B virus immune response by adefovir dipivoxil and entecavir therapies Yanfang Jiang1,4, Wanyu Li1,4, Lei Yu1, Jingjing Liu1, Guijie Xin1, Hongqing Yan1, Pinghui Sun2, Hong Zhang1, Damo Xu3 and Junqi Niu1 Chronicity of hepatitis B (CHB) infection is characterized by a weak immune response to the virus. Entecavir (ETV) and adefovir dipivoxil (ADV) are effective in suppressing hepatitis B virus (HBV) replication. However, the underlying immune mechanism in the antiviral response of patients treated with nucleoside or nucleotide analogs is not clearly understood. In this study, regulatory T cells (Tregs) and intracellular cytokines, including IL-2, interferon (IFN)-c, tumor-necrosis factor (TNF)-a and IL-4, were measured prior to and at 12, 24, 36 and 48 weeks after treatment with ETV or ADV. The cytokines were increased from 24 to 48 weeks after treatment. Higher levels of Th1 cytokines were observed with ETV (n529) versus ADV (n528) treatment. By contrast, the numbers of Tregs in both groups were decreased. The altered cytokine profile and cellular component was accompanied by a decrease in HBV DNA levels in both groups, which may contribute to their therapeutic effect in CHB infection. Our findings suggest that the antiviral effect of the drugs may be attributed not only to their direct effect on virus suppression but also to their immunoregulatory capabilities. Cellular
    [Show full text]
  • Tenofovir Alafenamide Rescues Renal Tubules in Patients with Chronic Hepatitis B
    life Communication Tenofovir Alafenamide Rescues Renal Tubules in Patients with Chronic Hepatitis B Tomoya Sano * , Takumi Kawaguchi , Tatsuya Ide, Keisuke Amano, Reiichiro Kuwahara, Teruko Arinaga-Hino and Takuji Torimura Division of Gastroenterology, Department of Medicine, Kurume University School of Medicine, Kurume, Fukuoka 830-0011, Japan; [email protected] (T.K.); [email protected] (T.I.); [email protected] (K.A.); [email protected] (R.K.); [email protected] (T.A.-H.); [email protected] (T.T.) * Correspondence: [email protected]; Tel.: +81-942-31-7627 Abstract: Nucles(t)ide analogs (NAs) are effective for chronic hepatitis B (CHB). NAs suppress hepatic decompensation and hepatocarcinogenesis, leading to a dramatic improvement of the natural course of patients with CHB. However, renal dysfunction is becoming an important issue for the management of CHB. Renal dysfunction develops in patients with the long-term treatment of NAs including adefovir dipivoxil and tenofovir disoproxil fumarate. Recently, several studies have reported that the newly approved tenofovir alafenamide (TAF) has a safe profile for the kidney due to greater plasma stability. In this mini-review, we discuss the effectiveness of switching to TAF for NAs-related renal tubular dysfunction in patients with CHB. Keywords: adefovir dipivoxil (ADV); Fanconi syndrome; hepatitis B virus (HBV); renal tubular Citation: Sano, T.; Kawaguchi, T.; dysfunction; tenofovir alafenamide (TAF); tenofovir disoproxil fumarate (TDF); β2-microglobulin Ide, T.; Amano, K.; Kuwahara, R.; Arinaga-Hino, T.; Torimura, T. Tenofovir Alafenamide Rescues Renal Tubules in Patients with Chronic 1.
    [Show full text]
  • Annex I Summary of Product Characteristics
    ANNEX I SUMMARY OF PRODUCT CHARACTERISTICS 4 1. NAME OF THE MEDICINAL PRODUCT VISTIDE 2. QUALITATIVE AND QUANTITATIVE COMPOSITION Each vial contains cidofovir equivalent to 375 mg/5 ml (75 mg/ml) cidofovir anhydrous. The formulation is adjusted to pH 7.4. 3. PHARMACEUTICAL FORM Concentrate for solution for infusion 4. CLINICAL PARTICULARS 4.1 Therapeutic Indication Cidofovir is indicated for the treatment of CMV retinitis in patients with acquired immunodeficiency syndrome (AIDS) and without renal dysfunction. Until further experience is gained, cidofovir should be used only when other agents are considered unsuitable. 4.2 Posology and Method of Administration Before each administration of cidofovir, serum creatinine and urine protein levels should be investigated. The recommended dosage, frequency, or infusion rate must not be exceeded. Cidofovir must be diluted in 100 milliliters 0.9% (normal) saline prior to administration. To minimise potential nephrotoxicity, oral probenecid and intravenous saline prehydration must be administered with each cidofovir infusion. Dosage in Adults • Induction Treatment. The recommended dose of cidofovir is 5 mg/kg body weight (given as an intravenous infusion at a constant rate over 1 hr) administered once weekly for two consecutive weeks. • Maintenance Treatment. Beginning two weeks after the completion of induction treatment, the recommended maintenance dose of cidofovir is 5 mg/kg body weight (given as an intravenous infusion at a constant rate over 1 hr) administered once every two weeks. Cidofovir therapy should be discontinued and intravenous hydration is advised if serum creatinine increases by = 44 µmol/L (= 0.5 mg/dl), or if persistent proteinuria = 2+ develops. • Probenecid.
    [Show full text]
  • Effectiveness and Safety of Antiviral Or Antibody Treatments for Coronavirus
    medRxiv preprint doi: https://doi.org/10.1101/2020.03.19.20039008; this version posted March 23, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . Effectiveness and safety of antiviral or antibody treatments for coronavirus A rapid review Prepared for Public Health Agency of Canada Submitted 2/25/2020 Prepared By: Knowledge Translation Program Li Ka Shing Knowledge Institute St. Michael’s Hospital Contact: Dr. Andrea Tricco E: [email protected] T: 416-864-6060 ext.77521 NOTE: This preprint reports new research that has not been certified by peer review and should not be used to guide clinical practice. medRxiv preprint doi: https://doi.org/10.1101/2020.03.19.20039008; this version posted March 23, 2020. The copyright holder for this preprint (which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. It is made available under a CC-BY-NC-ND 4.0 International license . Contributors: Patricia Rios, Amruta Radhakrishnan, Jesmin Antony, Sonia Thomas, Matthew Muller, Sharon E. Straus, Andrea C. Tricco. Acknowledgements: Jessie McGowan (literature search), Tamara Rader (literature search), Krystle Amog (report preparation), Chantal Williams (report preparation), Naveeta Ramkissoon (report preparation) Copyright claims/Disclaimers The intellectual property rights in data and results generated from the work reported in this document are held in joint ownership between the MAGIC team and the named Contributors.
    [Show full text]
  • Estonian Statistics on Medicines 2016 1/41
    Estonian Statistics on Medicines 2016 ATC code ATC group / Active substance (rout of admin.) Quantity sold Unit DDD Unit DDD/1000/ day A ALIMENTARY TRACT AND METABOLISM 167,8985 A01 STOMATOLOGICAL PREPARATIONS 0,0738 A01A STOMATOLOGICAL PREPARATIONS 0,0738 A01AB Antiinfectives and antiseptics for local oral treatment 0,0738 A01AB09 Miconazole (O) 7088 g 0,2 g 0,0738 A01AB12 Hexetidine (O) 1951200 ml A01AB81 Neomycin+ Benzocaine (dental) 30200 pieces A01AB82 Demeclocycline+ Triamcinolone (dental) 680 g A01AC Corticosteroids for local oral treatment A01AC81 Dexamethasone+ Thymol (dental) 3094 ml A01AD Other agents for local oral treatment A01AD80 Lidocaine+ Cetylpyridinium chloride (gingival) 227150 g A01AD81 Lidocaine+ Cetrimide (O) 30900 g A01AD82 Choline salicylate (O) 864720 pieces A01AD83 Lidocaine+ Chamomille extract (O) 370080 g A01AD90 Lidocaine+ Paraformaldehyde (dental) 405 g A02 DRUGS FOR ACID RELATED DISORDERS 47,1312 A02A ANTACIDS 1,0133 Combinations and complexes of aluminium, calcium and A02AD 1,0133 magnesium compounds A02AD81 Aluminium hydroxide+ Magnesium hydroxide (O) 811120 pieces 10 pieces 0,1689 A02AD81 Aluminium hydroxide+ Magnesium hydroxide (O) 3101974 ml 50 ml 0,1292 A02AD83 Calcium carbonate+ Magnesium carbonate (O) 3434232 pieces 10 pieces 0,7152 DRUGS FOR PEPTIC ULCER AND GASTRO- A02B 46,1179 OESOPHAGEAL REFLUX DISEASE (GORD) A02BA H2-receptor antagonists 2,3855 A02BA02 Ranitidine (O) 340327,5 g 0,3 g 2,3624 A02BA02 Ranitidine (P) 3318,25 g 0,3 g 0,0230 A02BC Proton pump inhibitors 43,7324 A02BC01 Omeprazole
    [Show full text]
  • FOSCAVIR (Foscarnet Sodium) INJECTION
    ® FOSCAVIR (foscarnet sodium) INJECTION WARNING RENAL IMPAIRMENT IS THE MAJOR TOXICITY OF FOSCAVIR. FREQUENT MONITORING OF SERUM CREATININE, WITH DOSE ADJUSTMENT FOR CHANGES IN RENAL FUNCTION, AND ADEQUATE HYDRATION WITH ADMINISTRATION OF FOSCAVIR IS IMPERATIVE. (See ADMINISTRATION section; Hydration.) SEIZURES, RELATED TO ALTERATIONS IN PLASMA MINERALS AND ELECTROLYTES, HAVE BEEN ASSOCIATED WITH FOSCAVIR TREATMENT. THEREFORE, PATIENTS MUST BE CAREFULLY MONITORED FOR SUCH CHANGES AND THEIR POTENTIAL SEQUELAE. MINERAL AND ELECTROLYTE SUPPLEMENTATION MAY BE REQUIRED. FOSCAVIR IS INDICATED FOR USE ONLY IN IMMUNOCOMPROMISED PATIENTS WITH CMV RETINITIS AND MUCOCUTANEOUS ACYCLOVIR­ RESISTANT HSV INFECTIONS. (See INDICATIONS section). DESCRIPTION FOSCAVIR is the brand name for foscarnet sodium. The chemical name of foscarnet sodium is phosphonoformic acid, trisodium salt. Foscarnet sodium is a white, crystalline powder containing 6 equivalents of water of hydration with an empirical formula of Na3 CO5 P•6 H2O and a molecular weight of 300.1. The structural formula is: FOSCAVIR has the potential to chelate divalent metal ions, such as calcium and magnesium, to form stable coordination compounds. FOSCAVIR INJECTION is a sterile, isotonic aqueous solution for intravenous administration only. The solution is clear and colorless. Each milliliter of FOSCAVIR contains 24 mg of foscarnet sodium hexahydrate in Water for Injection, USP. Hydrochloric acid may have been added to adjust the pH of the solution to 7.4. FOSCAVIR INJECTION contains no preservatives. VIROLOGY Mechanism of Action Foscarnet exerts its antiviral activity by a selective inhibition at the pyrophosphate binding site on virus-specific DNA polymerases at concentrations that do not affect cellular DNA polymerases. Foscarnet does not require activation (phosphorylation) by thymidine kinase or other kinases.
    [Show full text]
  • EUROPEAN PHARMACOPOEIA 10.0 Index 1. General Notices
    EUROPEAN PHARMACOPOEIA 10.0 Index 1. General notices......................................................................... 3 2.2.66. Detection and measurement of radioactivity........... 119 2.1. Apparatus ............................................................................. 15 2.2.7. Optical rotation................................................................ 26 2.1.1. Droppers ........................................................................... 15 2.2.8. Viscosity ............................................................................ 27 2.1.2. Comparative table of porosity of sintered-glass filters.. 15 2.2.9. Capillary viscometer method ......................................... 27 2.1.3. Ultraviolet ray lamps for analytical purposes............... 15 2.3. Identification...................................................................... 129 2.1.4. Sieves ................................................................................. 16 2.3.1. Identification reactions of ions and functional 2.1.5. Tubes for comparative tests ............................................ 17 groups ...................................................................................... 129 2.1.6. Gas detector tubes............................................................ 17 2.3.2. Identification of fatty oils by thin-layer 2.2. Physical and physico-chemical methods.......................... 21 chromatography...................................................................... 132 2.2.1. Clarity and degree of opalescence of
    [Show full text]
  • Foscarnet Salvage Therapy for Patients with Late- Stage HIV Disease And
    Antiviral Therapy 11:561–566 Foscarnet salvage therapy for patients with late- stage HIV disease and multiple drug resistance Ana Canestri 1, Jade Ghosn1, Marc Wirden 2, Françoise Marguet 1, Nadine Ktorza1, Imane Boubezari 1, Stéphanie Dominguez 1, Philippe Bossi 1, Eric Caumes1, Vincent Calvez 2 and Christine Katlama1* 1Département des Maladies Infectieuses, Hôpital Pitié-Salpétriêre, Paris, France 2Département de Virologie, Hôpital Pitié-Salpétriêre, Paris, France *Corresponding author: Tel: +33 1 4216 0130; Fax: +33 1 4216 0126: E-mail: [email protected] Objective: To evaluate the efficacy of foscarnet on HIV 2 and 12 associated with resistance to nucleoside reverse infection in patients with late-stage HIV disease and transcriptase inhibitors (NRTIs), non-NRTIs and protease multiple drug resistance. inhibitors, respectively. One patient discontinued Methods: Three drugs experienced patients with plasma foscarnet at W2 because of renal toxicity. In an intent- viral load (pVL) >50,000 copies/ml and CD4+ T-cell counts to-treat analysis, the median change in pVL from baseline 3 <100/mm were eligible for this open-label, single-arm, was -1.99 log10 copies/ml at W2 and -1.79 log10 add-on pilot study. Foscarnet induction therapy consisted copies/ml at W6. Eight out of eleven patients had a fall of 5 g intravenously twice daily for 6 weeks, in addition in pVL of at least 1 log10 at W6, and six started mainte- to a stable antiretroviral regimen. Patients with at least nance therapy. The median fall in pVL after 12 weeks of 1 log10 decrease in pVL at week 6 (W6), were given maintenance therapy was -0.85 log10 copies/ml in the foscarnet 5 g intravenously twice daily on two consecu- four patients who reached W12, and the median increase tive days each week.
    [Show full text]