Last update: July 2008
Crixivan – brand name
indinavir – generic name
Crixivan belongs to a class of HIV drugs called protease inhibitors (PIs).
The PIs block protease, a protein that HIV needs to make more copies of itself. This may slow down HIV disease.
The Food and Drug Administration (FDA) has approved Crixivan for use in combination with other HIV drugs for the treatment of HIV infection in adults and adolescents over 18 years old.
Crixivan comes in:
- 100 milligram (mg), 200 mg, 333 mg, and 400 mg capsules
The standard adult dose of Crixivan can be taken the following ways:
- Two 400 mg capsules of Crixivan three times a day (every eight hours)
- Two 400 mg capsules of Crixivan combined with one or two 100 mg capsules of Norvir (ritonavir) twice a day
If you take Crixivan by itself, you should take it on an empty stomach:
- Take Crixivan one hour before, or two hours after eating.
- If Crixivan upsets your stomach, it can be taken with a light meal, such as dry toast or cornflakes with skim milk.
Do not take Crixivan with grapefruit juice.
Many people find Crixivan’s food restrictions and three-times-daily dosing schedule inconvenient, but “boosting” with Norvir allows you to take Crixivan twice daily with no food restrictions.
Drink at least 48 ounces (six eight-ounce glasses) of water every day.
Crixivan must be used with other medications to treat HIV.
Tell your doctor if you have liver disease, kidney disease, or diabetes.
As with all HIV drugs, it is important to take Crixivan as prescribed by your doctor. Missing or skipping doses can cause your blood levels of the drug to fall too low and resistance can develop. When your virus becomes resistant to an HIV medication, that drug may stop working.
Crixivan may be used for people being treated for the first time.
Crixivan may be used for people who are switching from other drugs that no longer work, but Crixivan may not work as well if HIV is resistant to certain other protease inhibitors.
Your doctor can run a resistance test to help determine whether Crixivan is likely to work for you.
Crixivan crosses the blood-brain barrier (which protects the brain and spinal cord), so it may be able to fight HIV in the brain.
If your virus develops resistance to Crixivan then it may stop working or not work as well for you. You also may not get as much benefit from the other PIs. However, by “boosting” Crixivan with Norvir, you may be able to continue to get some benefit.
Sometimes taking more than one medication can cause drug interactions. Taking certain drugs (including some antifungals, other HIV drugs, antidepressants, drugs to treat erectile dysfunction such as Viagra, and cholesterol-lowering drugs) with Crixivan can change the amount of each drug in your blood. Your doctor may need to adjust the doses of your drugs to avoid under- or overdosing. You should not take the following drugs with Crixivan:
- Versed (midazolam)
- Propulsid (cisapride)
- Cordarone (amiodarone)
- Halcion (triazolam)
- Xanax (alprazolam)
- Ergot medications (e.g., Wigraine, Cafergot, D.H.E. 45, Migranal, Ergotrate, and Methergine)
- Rifampin (also known as Rifadin, Rifamate, Rifater, or Rimactane)
- Mevacor (lovastatin)
- Zocor (simvastatin)
- St. John’s Wort
- St. John’s Wort
- Reyataz (atazanavir)
Be sure your doctor knows about all the medications you are taking (including over-the-counter, prescription, street drugs, and herbs), even if you only use them occasionally.
For more information and additional resources to check interactions between the particular drugs you are taking, see our info sheet on drug interactions.
It is not uncommon to experience Crixivan side effects. However, they are likely to be temporary and go away as your body adjusts to the medication. If you experience any of the side effects listed below, call your doctor for advice. Do not just stop taking your medication.
- Abdominal pain
- Fatigue (unusual tiredness)
- Insomnia (inability to sleep)
- Skin rash
- Dry skin
More serious side effects:
- Kidney stones: these may cause pain in your back or sides or blood in your urine. You can reduce the risk by drinking plenty of water.
- Crixivan can cause jaundice (yellowing of the skin or eyes) by increasing levels of bilirubin (a blood pigment).
- Rare hemolytic anemia (destruction of red blood cells).
- Lipodystrophy, which may include elevated blood sugar (glucose), elevated lipid levels ( cholesterol and triglycerides), and fat gain or loss in certain areas. The exact causes of lipodystrophy are not known, but may include HIV and/or HIV drugs. It is unclear if Crixivan will cause or impact symptoms of lipodystrophy. For more information on lipodystrophy, see our info sheet.
If you are experiencing persistent, unusual, or serious side effects, call your doctor right away.
Being one of the first protease inhibitors, Crixivan has been studied in thousands of women.
Studies of Crixivan pharmacokinetics (how the drug is processed by the body) have produced conflicting results. One study found that women had blood drug levels 13 percent lower than men. Other research suggests that drug levels vary over the course of the menstrual cycle, and may be lower in pregnant women. Research on therapeutic drug monitoring (a method of measuring blood drug levels so doses can be adjusted on an individual basis) found that women more often than men should have their Crixivan dose lowered to reduce side effects.
Study 028 included 996 participants, of whom 278 (or 28 percent) were women. This study found that people taking Crixivan plus Retrovir (zidovudine or AZT) had one-third the rate of AIDS progression of those taking Retrovir alone, and that people taking Crixivan alone had half the rate of AIDS progression of those taking Retrovir alone. (But from later studies, we know now that Crixivan should not be used alone.)
Another study also found that Retrovir plus Crixivan worked better than either Crixivan or Retrovir alone. This study included 15 women out of 97 total participants.
Study ACTG 320 compared Retrovir plus Epivir (lamivudine or 3TC) plus Crixivan to Retrovir plus Epivir in people who had not taken protease inhibitors before. This trial included 17 percent women, or about 196 women out of 1,156 total participants. In this study, people who took Crixivan had increased CD4 cell counts, lower viral loads, and were about half as likely to progress to AIDS.
More recent studies have compared three-drug regimens, which is how we usually use Crixivan today. The CHEESE study compared Retrovir plus Epivir plus Crixivan to Retrovir plus Epivir plus Fortovase (soft-gel saquinavir) in 70 people, 13 percent (about 9) of whom were women. It found that both drug regimens worked about equally well.
Study DMP266-006 compared Retrovir plus Epivir plus Sustiva (efavirenz) to Retrovir plus Epivir plus Crixivan to Sustiva plus Crixivan in people who had not taken non-nucleoside reverse transcriptase inhibitors (NNRTIs) or protease inhibitors before. This study included 17 percent women, or about 215 women out of 1,266 total participants.
After 48 weeks, more people taking Retrovir plus Epivir plus Sustiva had undetectable viral loads than those taking either Retrovir plus Epivir plus Crixivan or Sustiva plus Crixivan. More people in the Crixivan groups stopped treatment due to side effects (although more people in the Sustiva group developed a rash or nervous system side effects). At 72 weeks, Retrovir plus Epivir plus Sustiva still worked better, but at three years, the rates of treatment failure in the Sustiva and Crixivan groups were similar.
In terms of side effects, some research suggests that women—especially pregnant women—may be more likely than men to develop kidney problems when taking Crixivan. One study of 72 people, 21 (or 29 percent) of whom were women, found that women were nearly four times more likely than men to have elevated blood levels of creatinine, a chemical that may indicate kidney damage. Another study found that women were about twice as likely as men to show signs of kidney stones (such as flank pain).
In addition, some studies suggest that the metabolic side effects (lipodystrophy) associated with PIs may be somewhat different in women and men. However, it is still unclear if women are more likely to gain or lose body fat in certain areas than men.
Studies have shown that pregnant women who use HIV drugs can greatly reduce the risk of passing HIV on to their babies. However, Crixivan is not recommended for HIV+ pregnant women. When taken during pregnancy, Crixivan levels in the bloodstream can become lower than normal, which can lead to drug resistance.
Check with your doctor about the best treatment options for you and your baby if you are thinking of getting pregnant.
Click this link for more information about pregnancy.
People who are starting HIV treatment for the first time may develop Immune Reconstitution Syndrome or IRS (also called Immune Reconstitution Inflammatory Syndrome or IRIS). IRS can happen as a result of the immune system getting stronger and responding to an HIV-related infection such as Mycobacterium avium infection (MAC), cytomegalovirus (CMV), Pneumocystis jirovecii pneumonia (PCP), or tuberculosis (TB). People may have been treated for these infections in the past or not even know they have them. If you notice any unusual symptoms soon after starting HIV drugs for the first time, let your doctor know right away so you can be evaluated and, if necessary, treated.