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 Formulary Chapter 5: Infections - Full Chapter
Notes:
The development of this chapter for the George Eliot Formulary is in progress
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05.03.01  Expand sub section  HIV infection
 note 

Treatment aims to prevent the mortality and morbidity associated with chronic HIV infection whilst minimising drug toxicity. Although it should be started before the immune system is irreversibly damaged, the need for early drug treatment should be balanced against the risk of toxicity. Commitment to treatment and strict adherence over many years are required; the regimen chosen should take into account convenience and patient tolerance. Treatment also reduces the risk of HIV transmission to sexual partners, but the risk is not eliminated completely.

The optimum time for initiating antiretroviral treatment depends primarily on the CD4 cell count. The timing and choice of treatment should also take account of clinical symptoms, comorbidities and the possible effect of antiretroviral drugs on factors such as the risk of CV events. Treatment includes a combination of drugs known at 'highly active antretroviral therapy'.

05.03.01  Expand sub section  Nucleoside reverse transcriptase inhibitors
Abacavir
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Formulary
  • Available as tablets
  • Life-threatening hypersensitivity reactions have ben reported - characterised by fever or rash and possibly nausea, vomithing, diarrhoea, abdominal pain, dyspnoea, cough, lethargy, malaise, headache and myalgia; less frequently mouth ulceration, oedema, hypotension, sore throat, acute respiratory distress syndrome, anaphylaxis, parasthesia, arthralgia, conjunctivitis, lymphadenopathy, lymphocytopenia and renal failure; rarely myolysis. Laboratory abnormalities may include raised LFTs and CK; symptoms usually appear in the first 6 weeks, but may occur at any time.
  • Discontinue immediately if any symptom of hypersensitivity develops and do not rechallenge (risk of more severe reaction).
 
   
Abacavir and Lamivudine (Kivexa®)
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  • Available as tablets
 
   
Abacavir with Lamivudine and DolutegravirBlack Triangle (Triumeq®)
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Formulary
  • Available as tablets
  • If a dose is more than 20 hours late, the missed dose should not be taken an the next dose should be taken at the normal time.
 
Link  MHRA/CHM advice: Dolutegravir (Tivicay, Triumeq, Juluca): signal of increased risk of neural tube defects; do not prescribe to women seeking to become pregnant; exclude pregnancy before initiation and advise use of effective contraception
   
Bictegravir with Emtricitabine and Tenofovir Alafenamide (Biktarvy ®)
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  • Available as tablets
  • Manufacturer advises if a missed dose is more than 18 hours late, the missed dose should not be taken and the next dose should be taken at the normal time
 
   
Darunavir with Cobicistat, Emtricitabine and Tenofovir Alafenamide (Symtuza ® )
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  • Available in tablets
  • Pharmacokinetic data show mean exposure of Darunavir boosted with Cobicistat (available in combination in Rezolasta and Symtuza) to be lower during 6-12 weeks postpartum. Low Darunavir exposure may be associated with an increased risk of HIV-1 transmission to the unborn child.
 
   
Elvitegravir with cobicistat, emtricitabine and tenofovir alafenamideBlack Triangle (Genvoya®)
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Formulary
  • Available as tablets
  • Manufacturer advises effective contraception in women of childbearing potential; if using a hormonal contraceptive, it must contain drospirenone or norgestimate as the progestogen and at least 30mcg ethinylestradiol.
  • If a dose is more than 18 hours late, the missed dose should not be taken and the next dose should be taken at the normal time.
  • Patients and carers should be counselled on the effects on driving and performance of skilled tasks due to the increased risk of dizziness.
 
   
Elvitegravir with cobicistat, emtricitabine and tenofovir disoproxilBlack Triangle (Stribild®)
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Formulary
  • Available as tablets
  • Women of child-bearing potential should use effective contraception during treatment (if using a hormonal contraceptive, it must contain norgestimate as the progestogen and at least 30mcg ethinylestradiol).
  • If a dose is more than 18 hours late, the missed dose should not be taken and the next dose should be taken at the normal time.
 
   
Emtricitabine (Emtriva®)
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Formulary
  • Available as capsules
  • If a dose is more than 12 hours late, the missed dose should not be taken and the next dose should be taken at the normal time.
 
   
Emtricitabine with rilpivirine and tenofovir alafenamideBlack Triangle (Odefsey®)
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Formulary
  • Available as tablets
  • Patients and carers should be counselled on the effects on driving and performance of skilled tasks due to the increased risk of dizziness.
  • If vomiting occurs within 4 hours of taking a dose, a replacement dose should be taken.
 
   
Emtricitabine with tenofivir alafenamideBlack Triangle (Descovy®)
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Formulary
  • Available as tablets
  • Patients and carers should be counselled on the effects on driving and performance of skilled tasks due to the increased risk of dizziness.
 
   
Emtricitabine with tenofivir disoproxil (Truvada®)
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Formulary
  • Available as tablets
  • Patients with swallowing difficulties may disperse tablet in half a glass of water, orange juice, or grape juice (but bitter taste).
  • If a dose is more than 12 hours late, the missed dose should not be taken and the next dose should be taken at the normal time.
 
   
Emtricitabine, Rilpivirine and Tenofovir  (Eviplera®)
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Formulary
  • Available as tablets
  • If a dose is more than 12 hours late, the missed dose should not be taken and the next dose should be taken at the normal time.
 
   
Lamivudine oral solution (Epivir®)
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Restricted Drug Restricted
  • Lamivudine oral solution is not stocked in pharmacy but can be ordered in for use in neonates (2nd line agent for PEP in neonates as per BHIVA guidelines)
 
   
Lamivudine tablets (Epivir®)
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Tenofovir Disproxil (Viread®)
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Formulary
  • Available as tablets
  • If a dose in more than 12 hours late, the missed dose should not be taken and the next dose should be taken at the normal time.
 
Link  NICE CG165: Hepatitis B (chronic) - incorporates TA173
Link  NICE TA173: Tenofovir disoproxil for the treatment of chronic hepatitis B
   
Tenofovir, Efavirenz and Emtricitabine  (Atripla®)
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Formulary
  • Available as tablets
  • If a dose is more than 12 hours late, the missed dose should not be taken and the next dose should be taken at the normal time.
 
   
Zidovudine oral solution (Retrovir®)
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Restricted Drug Restricted
  • Zidovudine oral solution is not stocked in pharmacy but can be ordered in for use in neonates (1st and 2nd line agent for PEP in neonates as per BHIVA guidelines)
 
   
05.03.01  Expand sub section  Protease inhibitors
05.03.01  Expand sub section  Non-nucleoside reverse transcriptase inhibitors
05.03.01  Expand sub section  Other antiretrovirals to top
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
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Link to adult BNF
click to search medicines.org.uk
Link to children's BNF
click to search medicines.org.uk
Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Red SO

SPECIALIST ONLY - These drugs are deemed to be not appropriate for prescribing by GPs. Specialists should not ask GPs to prescribe these drugs.   

Green SI

SPECIALIST INITIATED - These drugs must be initiated, i.e. the first dose prescribed, by the specialist and then may be continued when appropriate by the patients GP following communication from the specialist.   

Green SA

SPECIALIST ADVISED – Specialists may simply advise a patients GP to initiate these drugs themselves after they have made an initial assessment.   

Amber SC

SHARED CARE - Responsibility for prescribing may be transferred from secondary to primary care with the agreement of an individual GP and when agreed shared care arrangements have been established. The specialist MUST stabilize the patient before asking for care to be transferred. Only specialists should initiate these drugs. Prescribing should be transferred to GPs according to an Shared Care Agreement [SCA]   

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