Recommendations for the Use of Antiretroviral Drugs in Pregnant Women with HIV Infection and Interventions to Reduce Perinatal HIV Transmission in the United States

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

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Protease Inhibitors

Indinavir (Crixivan, IDV)

Last Updated: December 7, 2018; Last Reviewed: December 7, 2018

Excerpt from Table 10a
Generic Name
(Abbreviation)
Trade Name
Formulation Dosing Recommendations Use in Pregnancy
Indinavir
(IDV)
Crixivan

Note:
Must be combined with low-dose RTV boosting in pregnancy.
IDV (Crixivan) 
Capsules:
  • 200 mg
  • 400 mg
Standard Adult Dose
Without RTV Boosting:
  • IDV 800 mg every 8 hours, taken 1 hour before or 2 hours after meals; may take with skim milk or low-fat meal.
With RTV Boosting:
  • IDV 800 mg plus RTV 100 mg twice daily without regard to meals

PK in Pregnancy:
  • IDV exposure markedly reduced when administered without RTV boosting during pregnancy. IDV exposure low with IDV 400 mg/RTV 100 mg dosing during pregnancy; no PK data available on alternative boosted dosing regimens in pregnancy.

Dosing in Pregnancy:
  • Use of unboosted IDV is not recommended during pregnancy.
Minimal placental transfer to fetus.b

No evidence of human teratogenicity in cases reported to the Antiretroviral Pregnancy Registry (can rule out 2-fold increase in overall birth defects).

Must be given as low-dose, RTV-boosted regimen in pregnancy.

Theoretical concern regarding increased indirect bilirubin levels, which may exacerbate physiologic hyperbilirubinemia in neonates. Minimal placental passage mitigates this concern.

Given the available alternative ARVs, IDV is not recommended for treatment of pregnant women in the United States.

a Individual ARV drug dosages may need to be adjusted in patients with renal or hepatic insufficiency (for details, see the Adult and Adolescent Guidelines Appendix B, Table 8).
b Placental transfer categories are determined by the mean or median cord blood/maternal delivery plasma drug ratio:
          High: >0.6
          Moderate: 0.3–0.6
          Low: <0.3

Key to Acronyms: ARV = antiretroviral; IDV = indinavir; PK = pharmacokinetic; RTV = ritonavir

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