Indinavir, a protease inhibitor, received FDA approval in 1996 for use in adults with HIV infection. Long-term clinical data support its durability and potency. In addition, multiple mutations are required for resistance. It is not widely used nowadays because of better alternatives. However, indinavir remains a good choice in resource-limited settings due to its excellent efficacy and low cost.  

 

Indinavir is an inhibitor of cytochrome P450 3A4 (CYP3A4), and may alter serum concentrations of other drugs metabolized by this pathway. Additionally, indinavir is also metabolized by CYP3A4, drugs that affect this enzyme system, such as rifampin, and rifabutin, may significantly affect indinavir levels. Several protease inhibitors and the nonnucleoside reverse transcriptase inhibitors also affect indinavir concentrations. 

 

Indinavir should be taken on an empty stomach or with a light snack, but not within 1 hour before or 2 hours after a full meal. Combination with low-dose ritonavir allows less-frequent dosing of indinavir and elimination of food restrictions. The most common adverse effects associated with indinavir are nephrolithiasis, asymptomatic hyperbilirubinemia and hepatitis. Nephrolithiasis can be prevented with adequate hydration of at least 1.5 liters of liquids daily. No dose adjustment is necessary in renal insufficiency.