Newspapers / Q-notes (Charlotte, N.C.) / Sept. 5, 1998, edition 1 / Page 17
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reason for hope Drink up for good health by The AIDS Writers Group Special to Q-Notes Abbott Labs has announced that a compli cation in the manufacturing process has forced it to temporarily stop production of the cap sule form of the protease inhibitor Norvir (ritonavir). Until the problem with the capsule formulation is resolved, patients using Norvir will be offered the drug’s liquid formulation. The problem stems from Norvir’s failure to meet a required federal regulation on dosing. When Abbott tested its most recently com pleted batches of Norvir capsules, it was dis covered that they dissolved too slowly to meet FDA specifications. The cause appeared be the “formation of a Norvir crystalline structure which is effecting how the capsule dissolves,” according to Abbott spokesman Arthur Higgins. The company, however, has no idea what is causing the crystalline formation and correcting it may take time. Abbott says it may be several months — or possibly longer — be fore Norvir capsule production can begin again and an additional month or so before those new capsules actually reach pharmacies. Capsules already in pharmacies are not af fected and can be safely taken. However, sup plies were expected to begin running out in mid-August, although many pharmacies may have enough to last beyond then. Once a phar macy runs out of capsules, patients will be given the liquid variety of the drug when their pre scriptions are refilled. Abbott believes there will be enough Norvir liquid available in pharma cies at that time to meet the expected demand. Dosing and storing When picking up your Norvir liquid at the pharmacy, you will notice a small measuring cup on the top of the bottle marked in millili ters. If you are unsure which measurement of the drug is your prescribed dose, ask the phar macist to show you. The information should be written on the bottle. You may also want to save the “Dose Conversion Chart” provided with this article (see box below). Those with limited eyesight will likely need assistance ev ery time they take their medication. Using the proper dose of Norvir liquid is extremely im portant. Insufficient dosing can lead to inad equate drug levels in the body and the devel opment of drug-resistant and cross-resistant strains of virus, threatening the effectiveness of current and future antiviral regimens. When you bring your prescription home, do not refrigerate it as you did the capsules. Norvir liquid requires no refrigeration and is best stored at room temperatures between 68 and 77 degrees. If your supply cannot be kept at temperatures below 86 degrees, it should be refrigerated until conditions change. The bottle containing Norvir liquid is specially formulated for that purpose so you should not store the drug in anything else. Norvir liquid has a short shelf life so it should be used within 30 days. It is also im portant to shake the bottle before you measure each dose and thoroughly clean the cap after ward. Norvir liquid should be taken with food — especially fatty foods if you are using it in combination with Fortovase or saquinavir. If you are taking Crixivan (indinavir) in combi nation with Norvir, it is recommended you first take the Crixivan dose without food. Then, about an hour later, Norvir liquid with food. In bad taste Many find the taste of the liquid formula tion unpleasant. (There is concern that those who dislike Norvir liquid may interrupt their dosing or stop it altogether. Doing so can be dangerous and should be avoided.) To help avoid the unpleasant taste, Abbott recommends adding it to milk. Ensure or Advera, but only just before each dose. Be sure to mix it well and drink it quickly, before the Norvir floats to the top. To ensure you get all of the Norvir that sticks to the sides of the glass, refill the glass or container with the beverage, stir and drink its contents and then lick the spoon. Chocolate- flavored beverages seem to do a better job at masking the taste of Norvir liquid, so use choco late milk, chocolate-flavored Advera or Ensure. Medicaid, as well as private insurance, some times covers the cost of protein beverages like Ensure or Advera. A doctor’s prescription will likely be required though. Dr. Tina Tan, a Chicago pediatrician expe rienced in treating children with Norvir liquid, has some tips on how to make the drug go down easier. She recommends trying the following: • Suck on a popsicle before taking a dose to help numb your taste buds, desensitizing them to the taste of liquid Norvir. • Take a spoonful of chocolate syrup before your dose. Then another spoonful after your dose. The syrup should overwhelm your taste buds so you taste less of the Norvir mixture. • Eat salty foods such as pretzels or potato chips before and after dosing. The salt will help cover the taste of Norvir. • Drink the Norvir liquid mix through a straw placed to the back of the throat so the drug bypasses ,the taste buds. Or, use a Medibottle, a special bottle with a straw at tached. They can be purchased at medical sup ply houses. A bike water bottle may also work. If you are unable to take Norvir liquid regu larly as prescribed due to intolerance of the drug or vomiting, contact your doctor immediately. Note: Norvir liquid is 45 percent alcohol and tastes like it. Those who are in recovery should be aware of this before using the drug. They should, perhaps, discuss this with their doctor, addiction counselor or support group. If you have additional questions about Norvir or your prescription, call your doctor or the Norvir information hotline at 1-800- 637-2400. The Norvir site on the Internet is another good source of information and can be found at www.norvir.com. T [ The AIDS Writers Group is David Scondras of Search For a Cure and Robert Folan-JohnsonI\ Dose Conversion Chart 6 Norvir capsules (100 mg each) = 7.5 ml of Norvir liquid (1 1/2 teaspoons) 5 Norvir capsules (100 mg each) = 6.25 ml of Norvir liquid (1 1/4 teaspoons) 4 Norvir capsules (100 mg each) = 5 ml of Norvir liquid (1 teaspoon) Calhoun di^ouse "your diome in Charleston s di IS tone dj [strict Close to fine restaurants, great shopping and exciting nightlife. 273 Calhoun Street Charleston, SC 29401 (843) 722-7341 chs65@aol.com graphic design: Rod Designcn^ani cdiii
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