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Didanosine
Aka: Didanosine, ddI, Videx
- See Also
- Anti-Retroviral Therapy
- Nucleoside Reverse Transcriptase Inhibitor
- Mechanism
- Nucleoside Reverse Transcriptase Inhibitor
- Purine analogue
- Degraded at an acidic pH (all preparations have buffer)
- Pharmacokinetics
- Crosses the Blood brain barrier
- Actively excreted by the Kidney
- Efficacy
- Delays HIV progression to AIDS
- Transiently increases CD4 Counts
- Partially suppresses p24 Antigenemia
- Patients with HIV disease and CD4 Count < 300 cells
- Received varying lengths of AZT therapy
- Dosing
- Didanosine 200 mg PO bid ($186/month)
- Take on an empty Stomach
- Avoid concurrent Alcohol (exacerbates toxicity)
- Take Medications requiring acidic pH 2 hours after ddI
- Adverse Effects
- See nRTI for adverse effects attributed to the class
- Adverse effects are increased when used in combination with Stavudine
- Peripheral Neuropathy
- Pancreatitis - most serious toxicity!
- Incidence
- Dose 500 mg/day: 7% Pancreatitis
- Dose 750 mg/day: 9% Pancreatitis
- Increased risk if Hyperamylasemia
- Dose 500-750 mg/day: 18% Hyperamylasemia
- Interrupt therapy if suspect Pancreatitis
- Avoid other pancreatic toxins (e.g. Pentamidine)
- Eye related changes
- Retinal changes
- Optic Neuritis
- Hyperamylasemia
- Hyperuricemia
- Dry Mouth
- Gastrointestinal changes
- Gastrointestinal upset
- Hepatic toxicity
- Noncirrhotic Portal Hypertension
- Electrolyte imbalances (rare)
- Cardiac Arrhythmias (rare)
- References
- (1998) Med Lett Drugs Ther 40(1041):115 [PubMed]
- (2009) Treat Guidel Med Lett 7(78): 11-22 [PubMed]
- Reust (2011) Am Fam Physician 83(12): 1443-51 [PubMed]