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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.
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 perforatum)||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/Hypnotic s||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.|
Last reviewed on RxList: 4/27/2015
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