Viracept (Nelfinavir Mesylate) Drug Information: Overdosage and Contraindications

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May 27, 2012

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OVERDOSE

Human experience of acute overdose with VIRACEPT is limited. There is no specific antidote for overdose with VIRACEPT. If indicated, elimination of unabsorbed drug should be achieved by emesis or gastric lavage. Administration of activated charcoal may also be used to aid removal of unabsorbed drug. Since nelfinavir is highly protein bound, dialysis is unlikely to significantly remove drug from blood.

CONTRAINDICATIONS

Coadministration of VIRACEPT is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events. These drugs and other contraindicated drugs (which may lead to reduced efficacy of nelfinavir) are listed in Table 3 [also see DRUG INTERACTIONS, Table 6].

Table 3: Drugs That Are Contraindicated With VIRACEPT

Drug Class	Drugs Within Class That Are Contraindicated With VIRACEPT	Clinical Comment
Alpha 1-adrenoreceptor antagonist	Alfuzosin	Potentially increased alfuzosin concentrations can result in hypotension.
Antiarrhythmics	Amiodarone, quinidine	Potential for serious and/or life-threatening cardiac arrhythmia.
Antimycobacterial Agents	Rifampin	Plasma concentrations of nelfinavir can be reduced by concomitant use of rifampin. This may lead to loss of therapeutic effect and possible development of resistance to VIRACEPT or other coadministered antiretroviral agents.
Ergot Derivatives	Dihydroergotamine, ergotamine, methylergonovine	Potential for serious and/or life threatening reactions such as ergot toxicity characterized by peripheral vasospasm and ischemia of the extremities and other tissues.
GI Motility Agent	Cisapride	Potential for serious and/or life threatening reactions such as cardiac arrhythmias.
Herbal products	St. John's wort (Hypericum perforation)	Plasma concentrations of nelfinavir can be reduced by concomitant use of the herbal preparation St. John's wort. This may lead to loss of therapeutic effect and possible development of resistance to VIRACEPT or other coadministered antiretroviral agents.
HMG-CoA Reductase Inhibitors	Lovastatin, Simvastatin	Potential for serious reactions such as myopathy including rhabdomyolysis.
Neuroleptics	Pimozide	Potential for serious and/or life threatening reactions such as cardiac arrhythmias.
PDE5 Inhibitors	Sildenafil (Revatio®) [for treatment of pulmonary arterial hypertension]^a	A safe and effective dose has not been established when used with nelfinavir. There is increased potential for sildenafil-associated adverse events (which include visual disturbances, hypotension, prolonged erection, and syncope).
Sedative/Hypnotics	Triazolam, oral midazolam	Potential for serious and/or life threatening reactions such as prolonged or increased sedation or respiratory depression.
^a See DRUG INTERACTIONS Table 6 for coadministration of sildenafil and tadalafil when dosed for erectile dysfunction.