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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
05.03.01  Expand sub section  Protease inhibitors
05.03.01  Expand sub section  Non-nucleoside reverse transcriptase inhibitors
Efavirenz (Sustiva)
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Formulary
  • Available as tablets
  • Rash usually in the first 2 weeks, is the most common side-effect; discontinue if sever rash with blistering, desquamation, mucosal involvement or fever; if rash mild or moderate, may continue withoug interruption - usually resolves within 1 month.
  • Administration at bedtime especially in the first 2-4 weeks reduces CNS effeccts.
  • Patients or their carers should be advised to seek immediate medical attention if symptoms such as sever depression, psychosis or suicidal ideation occur.
 
   
Nevirapine oral solution (Viramune)
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Restricted Drug Restricted
  • Nevirapine 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)
 
   
Nevirapine tablets (Viramune)
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Formulary
  • Potentially life-threatening hepatoxicity including fatal fulminant hepatitis reported usually in first 6 weeks; discontinue permanently if abnormalities in LFTs accompanied by hypersensitivity reaction; suspend if severe abnormalities in LFTs but no hypersensitivity reaction - discontinue permanently if significant liver function abnormalities recur; monitor patient closely if mild to moderate abnormalities in LFTS with no hypersensitivity reaction.
  • Rash usually in the first 6 weeks is the most common side effect; incidence reduced if introduced at low dose and dose increased gradually over 14 days. Discontinue permanently if severe rash or if rash is accompanied by blistering, oral lesions, conjunctivitis, facial oedema, general malaise or hypersensitivity reaction. If rash mild or moderate may continue without interruption but dose hould not be increased until rash resolves.
  • Patients or their carers should be told how to recognise hypersensitivity reactions and advised to discontinue treatment and seek immediate medical attention if severe skin reactions or symptoms of hepatitis develop.
  • If a dose is more than 8 hours late with the 'immediate release' preparation or more than 12 hours late with teh 'modified release' preparation, the missed dose hsould not be taken and the next dose should be taken at the usual time.
 
   
Rilpivirine hydrochloride (Edurant)
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  • Available as tablets
  • If a 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.
 
   
05.03.01  Expand sub section  Other antiretrovirals to top
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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
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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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