by Liz Highleyman
January 2004 (Reviewed and Revised December 2005)
Rescriptor – brand name
delavirdine – generic name
Rescriptor belongs to a class of HIV drugs called non-nucleoside reverse transcriptase inhibitors (NNRTIs), also known as non-nucleoside analogs or “non-nukes.”
The NNRTIs block reverse transcriptase, 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 Rescriptor for use in combination with other HIV drugs for the treatment of HIV infection in adults and adolescents over 16 years old.
Rescriptor is available in:
- 100 milligram (mg) and 200 mg tablets
The usual dose is 400 mg three times a day (morning, afternoon, and evening).
The 100 mg tablets can be dissolved in water so that they are easier to swallow.
The 200 mg tablets are swallowed whole with a glass of water, juice, soda, or milk.
If your doctor has told you that you do have not enough stomach acid, a minor medical condition called achlorhydria, you should take Rescriptor with orange or cranberry juice.
Rescriptor must be used with other medications to treat HIV.
There is not a lot of information on the use of Rescriptor in children.
You can take Rescriptor with food or on an empty stomach.
Speak to your doctor if you have liver problems.
Rescriptor must be taken three times a day, which is more frequent than most of the other HIV drugs. Even though this can be inconvenient, it is important to take Rescriptor as prescribed. 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.
Rescriptor is not recommended if you are starting HIV treatment for the first time due to lack of information on effectiveness and its difficult dosing schedule.
Rescriptor can be used if you’ve been on treatment before, however, it will not work well for people whose virus is already resistant to the other NNRTIs: Viramune (nevirapine) and Sustiva (efavirenz).
Rescriptor in combination with a protease inhibitor (PI) may be a good option for people who have failed several other drug regimens. This is because Rescriptor causes the blood levels of most PIs to increase (in the same way Norvir does), which can make the entire drug combination more effective against HIV.
Your doctor can run a resistance test to help determine whether Rescriptor is likely to work for you.
If your virus develops resistance to Rescriptor then it may stop working or not work as well for you. You are also not likely to benefit from the other NNRTIs.
Sometimes taking more than one medication can cause drug interactions. Taking certain drugs (such as PIs and methadone) with Rescriptor 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.
Do not take antacids within one hour of a dose of Rescriptor.
Certain medications, including some sedatives, antihistamines, antibiotics, anti-fungal drugs, TB drugs, cholesterol-lowering drugs, acid reflux/heartburn drugs, and migraine headache medications, should not be taken with Rescriptor.
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.
Some people experience Rescriptor side effects, especially skin rash. However, side effects are likely to be temporary and go away as your body adjusts to the medication. Side effects may include:
- Skin rash
- Fatigue (unusual tiredness)
Your doctor may give you an antihistamine medication to help relieve the rash. If the side effects do not go away or become intolerable, call your doctor for advice. Don’t just stop taking your medication.
More serious side effects:
- In rare cases Rescriptor can cause a life-threatening hypersensitivity reaction (Stevens-Johnson syndrome). Symptoms may include a severe rash, blisters, mouth sores, swelling, fever, and weakness.
- Liver toxicity: this may be indicated by elevated liver enzymes or yellowing of the skin and eyes (jaundice).
Call your doctor right away if you are experiencing any of the more serious side effects.
If you must stop treatment with Rescriptor because you have these types of serious reactions, do not take the drug again.
Overall, research has shown that Rescriptor is not as effective as other HIV drugs, so it is no longer studied in many clinical trials. Studies of Rescriptor pharmacokinetics (how the drug is processed by the body) show that blood levels of the drug tend to be higher in women than in men (30 percent higher in one study that included 12 women and 55 men, and nearly twice as high in another study that included 139 women and 579 men).
Several studies have tested Rescriptor along with nucleoside reverse transcriptase inhibitor (NRTIs) drugs. In study 0021 part 2, participants who had not taken HIV drugs before were given Retrovir (zidovudine or AZT) plus Rescriptor or Retrovir plus Epivir (lamivudine or 3TC) or Retrovir plus Epivir plus Rescriptor. This trial included 13 percent women, or about 48 women out of 373 total participants. After 52 weeks, the three-drug combination worked significantly better than either of the two-drug combinations.
In study 13C, researchers compared Retrovir plus Rescriptor to Retrovir without Rescriptor in people who were also taking Videx (didanosine or ddI) or Hivid (zalcitabine or ddC) or Epivir. This trial included 34 percent women, or about 117 women out of 345 total participants. The participants who took Rescriptor had greater decreases in HIV viral load and increases in CD4 cell counts.
But other research has shown that while Rescriptor may sometimes help reduce viral load in combination with other drugs (at least in the short term), it does not seem to increase CD4 counts very much. Because it is less potent than other HIV medications, the U.S. federal government’s HIV treatment guidelines do not recommend Rescriptor for people starting HIV treatment for the first time.
In terms of side effects, about 35 percent of participants taking Rescriptor in pivotal trials experienced a rash of any degree of severity, compared with 18 percent of those taking other regimens. A severe rash occurred in 4 percent of people taking Rescriptor and none of those taking other regimens. Some research suggests that NNRTI-associated rash is more common in women than in men, but this mainly holds true for Viramune.
Studies have shown that pregnant women who use HIV drugs can greatly reduce the risk of passing HIV on to their babies. There have been no formal studies on the use of Rescriptor during pregnancy. Rescriptor should only be used in pregnancy if there are no other options available. 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.
Bellman, P.C., et. al. (1998). Clinical experience with adding delavirdine to combination therapy in patients in whom multiple antiretroviral treatment including protease inhibitors has failed. AIDS, 12(11). 1333-1340.
Gulick, R.M., et. al. (2000). Randomized study of saquinavir with ritonavir or nelfinavir together with delavirdine, adefovir or both in human immunodeficiency virus-infected adults with virologic failure on indinavir: AIDS Clinical Trials Group Study 359. Journal of Infectious Diseases, 182(5). 1375-1384.
Kuritzkes, D.R., et. al. (2000). Continued lamivudine versus delavirdine in combination with indinavir and zidovudine or stavudine in 3TC-experienced patients: results of Adult AIDS Clinical Trials Group protocol 370. AIDS, 14(11). 1553-1561.