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(die-DAN-oh-SEEN)
Videx
Class: Anti-infective/Antiviral

 Action Inhibits replication of HIV by interfering with DNA synthesis.

 Indications Advanced HIV infection in patients with intolerance or significant clinical or immunologic deterioration during zidovudine therapy.

 Contraindications Standard considerations.

 Route/Dosage

ADULTS (< 60 KG): PO 125 mg (as 2 tablets) or 167 mg (powder for suspension q 12 hr. ADULTS (> 60 KG): PO 200 mg (as 2 tablets) or 250 mg (powder for suspension) q 12 hr. CHILDREN: PO 100 to 300 mg/m2/day bid as oral powder for suspension. Reduce dose by 20% for tablets. CHILDREN < 1 yr should receive 1-tablet dose; those > 1 yr should get a 2-tablet dose.

 Interactions

Drugs that cause peripheral neuropathy or pancreatitis: Increased risk of these toxicities. Food: Reduces absorption of didanosine by as much as 50%. Fluoroquinolones, tetracyclines: Do not administer within 2 hr of didanosine. Ketaconazole, dapsone, and other drugs whose absorption can be affected by gastric acidity: Administer ³ 2 hr before didanosine.

 Lab Test Interferences None well documented.

 Adverse Reactions

CNS: Peripheral neuropathy; asthenia; headache; pain; myopathy; seizure. DERM: Rash; pruritis; alopecia; sweating. EENT: Retinal depigmentation. GI: Pancreatitis; diarrhea; abdominal pain; nausea; vomiting; anorexia; dry mouth. HEMA: Leukopenia, thrombocytopenia, granulocytopenia, and decreased hemoglobin. HEPA Hepatic failure. RESP: Pneumonia; dyspnea; cough; epistaxis; hypoventilation; sinusitis. OTHER: Chills, fever; infection; sarcoma.

 Precautions

Pregnancy: Category B. Lactation: Undetermined. Special diets: Each tablet contains 22.5 mg phenylalanine and 265 mg sodium; single-dose powder packet contains 1380 mg sodium. Mutagenesis: May be genotoxic. Renal or hepatic impairment: Dosage may need to be reduced. Hepatic failure has occurred in pediatric patients. Pancreatitis: Major toxicity; has been fatal. Should be considered if patient develops abdominal pain, nausea, vomiting or lab test abnormalities. Peripheral neuropathy: Occurs frequently; may be dose-related.

PATIENT CARE CONSIDERATIONS

 Administration/Storage

  • Give on an empty stomach.
  • Have patients chew tablets or manually crush or disperse tablets in water (2 tablets per 1 oz water).
  • When dispersing tablets in water, stir until uniform dispersion occurs, then have patient drink entire amount immediately.
  • When preparing buffered powder for oral suspension, do not use fruit juice or other acid-containing liquid. Stir until completely dissolved in 4 oz liquid, then have patient drink entire amount immediately.
  • Pediatric powder for oral suspension is first mixed with purified water to obtain concentration of 20 mg/ml, then mixed with antacid to obtain final concentration of 10 mg/ml.
  • Pediatric oral solution admixture may be stored for up to 30 days if refrigerated. Shake well before use.

 Assessment/Interventions

  • Obtain patient history, including drug history and any known allergies. Note renal or liver impairment, history of pancreatitis and prior response to zidovudine therapy.
  • Ensure that liver and renal function tests are obtained before beginning drug therapy and repeat periodically.
  • Notify physician if diarrhea develops in patient receiving oral solution. Switching to tablets may alleviate symptoms.
  • If patient has abdominal pain, nausea or vomiting, or has elevated amylase or liver function test results, contact physician and withhold drug until pancreatitis can be excluded.
  • Observe for symptoms of peripheral neuropathy (distal numbness, tingling, pain in feet or hands) or evidence of opportunistic infections. Notify physician if these occur.
  • Monitor uric acid levels closely for possible asymptomatic hyperuricemia.
  • Monitor body temperature to detect possible infection.
  • Document any change in vision in pediatric patients. Dilated examination should be performed every 6 mo.

 Patient/Family Education

  • Advise patient to take drug on empty stomach and to chew or crush tablets.
  • Inform patient that drug does not completely eliminate HIV virus and therefore does not reduce risk of transmitting HIV. Appropriate precautions must be continued.
  • Emphasize that drug does not cure AIDS or AIDS-related complex (ARC) and that significant changes in health should be reported to physician.
  • Instruct patient to report these symptoms to physician: abdominal pain, diarrhea, nausea, vomiting, tingling pain or numbness in hands or feet, fever, sore throat or flu-like symptoms.
  • Advise patient to avoid intake of alcoholic beverages or taking otc medications without notifying physician.

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