Académique Documents
Professionnel Documents
Culture Documents
437
Mechanism
of Action
Clinical Applications
Pharmacokinetics &
Interactions
Activated by viral
thymidine kinase (TK) to
forms that inhibit viral
DNA polymerase
Treatment and
prophylaxis for HSV-I,
HSV-2, and VZV
None of these drugs is
active against TK strains
Viral activation of
ganciclovir to form
inhibiting DNA
polymerase; no viral
bioactivation of cidofovir
and foscarnet
Treatment of CMV
infections in immunosuppression (eg, AIDS)
and organ
transplantation
Ganciclovir: Bone
marrow suppression,
hepatic and neurologic
dysfunction
Cidofovir and foscarnet:
Nephrotoxicity
Foscarnet: CNS effects
and electrolyte
imbalance
Suppressive treatment
of HBV (all drugs except
ribavirin) treatment of
HCV (ribavirin +/ IFN-)
IFN-: Parenteral
Adefovir, entacavir,
lamivudine, and ribavirin: Oral
Ribavirin: Inhalational
Amantadine and
rimantidine: block of M2
proton channels
Oseletamivir and
zanamivir inhibit
neuraminidase
M2 blockers virtually
obsolete others
prophylaxis vs most
current flu strains and
shorten symptoms
Oseltamivir:
Gastrointestinal effects
Zanamivir:
Bronchospasm in
asthmatics
Duration of action
usually longer than
half-life most undergo
renal elimination
especially, didanosine,
emtricitabine,
lamivudine, stavudine,
tenofovir, and
zidovudine
Inducers of CYP450
isozymes (eg, phenytoin,
rifampin) and inhibitors
(eg, azoles, PIs) alter
NNRTI duration of action
note etravirine
Toxicities
Antiviral Drugs
Antiherpes drugs
Acyclovir
Valacyclovir (prodrug)
Penciclovir
Famciclovir (prodrug)
Antihepatitis drugs
Interferon- (IFN-)
Adefovir-dipivoxil
Entecavir
Lamivudine
Ribavirin
Anti-influenza drugs
Amantadine
Rimantadine
Oseltamivir
Zanamivir
Antiretroviral Drugs
Nucleoside/nucleotide reverse transcriptase inhibitor (NRTIs)a
Abacavir
Didanosine
Emtricitabine
Lamivudine
Stavudine
Tenofovir
Zalcitabine
Zidovudine
(Continued)
438
Mechanism
of Action
Clinical Applications
Pharmacokinetics &
Interactions
Atazanavir, fosamprenavir,
lopinavir, nelfinavir,
saquinavir: GI distress and
diarrhea
Atazanavir: Peripheral
neuropathy
Amprenavir: Rash
Indinavir: Hyperbilirubinemia
and nephrolithiasis
Extrahepatic hydrolysis
of enfuvirtide
(subcutaneous
injection) P450
metabolism (maraviroc)
Enfuvirtide:
Hypersensitivity Maraviroc:
Muscle/joint pain, diarrhea,
and increased liver enzymes
Toxicities
Entry inhibitors
Enfuvirtide
Maraviroc
NRTIs, nucleoside/nucleotide reverse transcriptase inhibitors: Risk of lactic acidosis with hepatic steatosis is characteristic of the group.
PIs, inhibitors: Risk of hyperlipidemia, fat maldistribution, hyperglycemia, and insulin resistance is characteristic of the group, with possible
exception of fosamprenavir.
c
Ritonavir is a potent inhibitor of the 3A4 isoform of CYP450, an action used to advantage in boosting effects of other PIs. Drugdrug
interactions between PIs and many other medications occur commonly.
b