| Generic (& other names) | Brand name | Classification |
| saquniavir mesylate | Invirase | protease inhibitor |
| Dosage, usual for adults | 600 mg orally three times a day. |
| Dosage strength / form | 200 mg capsule
|
| Capsules per full dose | 3 capsules each dose; 9 capsules total per day.
|
| Storage | Room temperature. Tightly closed bottle.
|
| Enhancing drug levels |
- Bioavailability is low. Formulation is a hard gel capsule. How much of the drug that can get absorbed and used is called bioavailability and it is low at about 4% of potential when taken within 2 hours of a meal. A new formulation called Fortovase, showing a 10 fold increase in bioavailability, was submitted to the FDA in July 1997 and is now available.
- Because bioavailability of the current formulation is low, paying attention to how to increase it is important: timing, kinds of foods, or working with your doctor, other prescriptive drugs.
- Timing of meals & food For optimal absorption, saquinavir should be taken within 5 minutes to 2 hours after a full meal. In studies there was no difference between taking the medication 5 minutes or 2 hours after the meal.
- Full meal defined. Take saquinavir after a full meal or substantial snack, that is HIGH IN CALORIES, FAT AND PROTEIN. According to the drug's package insert, bioavailability increases 5-10 fold improvement when saquinavir was taken with food compared to no food. The nutritional breakdown for those meals with the best absorption rates reported were:
- 1006 calories
- 48 g protein
- 57 g fat
- 60 g carbohydrate
- Sample meal plan. See below.
- Grapefruit juice was shown to increase absorption of saquinavir. A study showed a 50% increase in absorption when HIV negative volunteers took saquinavir with 5 ounces of ordinary reconstituted frozen grapefruit juice, and then another 5 ounces one hour later. When double strength grapefruit juice was used, following the same schedule, the absorption of saquinavir was increased to 220%. If you choose to add grapefruit juice to your regimen, please consider the following:
- - Let your primary care provider know. Grapefruit juice may alter levels of other drugs you are taking.
- - Bioavailability varies from person to person.
- - Without a specific blood test there is no way for the person to know if the grapefruit juice is working.
- - The use of double strength grapefruit juice may be irritating to some people and not tolerated.
- - Studies have not been done to clarify significance of using grapefruit juice & concern exists at what range of drug levels if drug resistance becomes a greater risk.
- Other drugs ketoconazole (Nizoral), as well as ritonavir (Norvir) increase drug levels. Your doctor must coordinate the dosages of these prescriptions carefully.
|
| Sample high calorie / high fat meals |
1 cup whole milk
3 egg omelet
1 ounce cheese
1 pat butter
1 sausage link
2 slices toast
2 pats butter
1 tablespoon jam
1 orange
| 1 1/2 cups whole milk
1 cup cooked pasta
1 cup marinara sauce
3 tablespoons parmesan cheese
3 soft bread sticks
1 pat butter
1 cup snap green beans
2 tablespoons Italian salad dressing
| 1 cup whole milk
2 servings baked sole or flounder
1 cup summer squash, steamed
2 pats butter
1 cup brown rice
1 pat butter
1 whole wheat roll
1 pat butter
1 tossed green salad
2 tablespoon salad dressing
1 cup French vanilla ice cream
|
| Totals |
883 calories
40 g protein
54 g fat
62 g carbohydrate
| 1102 calories
30 g protein
55 g fat
115 g carbohydrate
| 1288 calories
85 g protein
57 g fat
112 g carbohydrate |
| Some high fat snack ideas |
- 1/4 c Brazil nuts, 1 oz cheddar cheese, 5 Ritz crackers (452 calories, 14 g protein, 36 g fat)
- 1 avocado, 2 oz Monterey jack cheese on whole wheat bread with mayonnaise
- Peanut butter & jam sandwich on whole wheat (3 tbsp of PB, 2 of jam) with Scandishake (a food supplement) using whole milk (1092 calories, 29 g protein, 52 g fat)
- 1 serving of commercial frozen pizza (160 calories, 5 g protein, 6 g fat
- 1/2 c macadamia nuts (471 calories, 5.5 g protein, 50 g fat)
|
| Possible meal / med schedule |
7 AM
9:30-10 AM
12 PM
2:30 PM
6-8 PM
10 PM
11 PM |
Breakfast (high fat, high protein) and saquinavir
Snacks (low to non-fat, ex. fruit, juice, non fat yogurt, plus protein)
Lunch (moderate to low fat, high protein)
Snack (high fat) and saquinavir
Supper (moderate to low fat, high protein)
Evening snack (high fat, high protein)
Saquinavir
|
| Fluids |
- Recommendation. There is not a specific recommendation for increased fluid intake with saquinavir. However, people living with HIV do have increased need in general for more fluid. Intake goals of safe drinking water are 10-12 cups (8 oz/cup) of water for men and 9-11 cups of water for women.
- Coffee!. Be aware that caffeine in coffee and other foods can speed up the gastrointestinal tract, creating looser stools with a potential fluid loss from both excretion and urination. Also, many people experience a reduction of appetite after caffeine containing foods. Watch that you don't skip meals or snacks when you have the opportunity to eat.
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| Common reactions that may affect nutritional status |
| Specifically |
- Diarrhea, abdominal discomfort, and nausea are considered mild in intensity.
- Watch for any symptoms of high blood sugar (high blood glucose).
|
| Generally, any reactions effecting (or may effect) nutrition
| Tell your primary care provider if and when anything abnormal occurs to determine what is its actual cause and what to do about it. Work with your primary care provider and your registered dietitian to manage and reduce their effects on your nutritional health. |
| Tips to taking meds on time | - Write down your own regular meal and medication schedule (see worksheet).
- Figure out a daily routine of eating and taking meds that work for you. Practice your routine each day.
- If you can't keep to your routine talk to a health care professional or even a friend about where it gets hard. Make adjustments and try again.
- Make eating and taking meds your priority.
- Use a timer to remind you when to take your meds and when to eat.
- Use a pill box with compartments.
- Use a daily check list or journal to track that you have taken each med and snack.
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- Eat to live.
- Buy lots of portable snacks that donÌt spoil easily
- Keep food easy to reach: at the side of your bed, by the phone, by your TV or computer.
- Put a snack in your pack anytime you leave home: to work, appointments, errands, socializing.
- Communicate your needs to anyone with a demand on your time. Say, for example: I need to eat first.
- Set up meals with friends during times you can eat.
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