II. Indications

  1. HIV Infection (part of combination therapy)

III. Contraindications

  1. Moderate to severe hepatic Impairment (Child-Pugh Class B, C)
    1. May use without dose adjustment in mild hepatic Impairment (Child-Pugh Class A)

IV. Mechanism

V. Efficacy

  1. Originally used as first line agent, but later replaced by more potent agents
  2. Similar to Ritonavir or Indinavir

VI. Dosing

  1. Take with a meal or light snack (>500 calories, >11 g fat) for best absorption
  2. Tablets may be dissolved in a small amount of liquid
  3. Adult
    1. Take 750 mg orally three times daily OR
    2. Take 1250 mg orally twice daily
  4. Child (age >=2 years old)
    1. Other Protease Inhibitors with better potency in children are recommended instead
    2. Give 20-30 mg/kg orally three times daily OR
    3. Give 45-55 mg/kg orally twice daily

VII. Adverse Effects

  1. Well tolerated
  2. Diarrhea

VIII. Safety

  1. Pregnancy Category B
  2. Avoid in Lactation

IX. Drug Interactions

  1. Statins
    1. Use lowest effective dose for Rosuvastatin
    2. Limit Atorvastatin to 40 mg max dose
    3. Pravastatin and Fluvastatin do not significantly interact with Nelfinavir
  2. Oral Contraceptives
    1. Decreased efficacy
  3. Antacids
    1. Avoid with Proton Pump Inhibitor
    2. Buffered Didanosine should be taken at least 1 hour before or 2 hours after Nelfinavir

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