Take once daily on an empty stomach; swallow whole. <20kg: use oral soln. 20kg to <25kg: 200mg. 25kg to <60kg: 250mg. ≥60kg: 400mg. Renal impairment (CrCl 30–59mL/min): <60kg: 125mg. ≥60kg: 200mg. CrCl 10–29mL/min: 125mg. CrCl <10mL/min or dialysis: <60kg: use oral soln; ≥60kg: 125mg.
Suspend if signs or symptoms of pancreatitis (discontinue if confirmed), lactic acidosis, or hepatotoxicity (eg, hepatomegaly or steatosis) occurs. Increased risk of pancreatitis (eg, alcohol abuse, advanced HIV disease, elderly, renal impairment); monitor. Women, obesity, or prolonged nucleoside exposure: increased risk of toxicity. Advanced HIV disease, history of neuropathy, or concomitant neurotoxic drugs: consider reducing dose or discontinuing if peripheral neuropathy occurs. Monitor for non-cirrhotic portal hypertension; discontinue if occurs. Hepatic dysfunction. Hyperuricemia. Do periodic retinal exam. Elderly. Pregnancy (Cat.B); monitor for lactic acidosis if used with stavudine. Nursing mothers: not recommended.
See Contraindications. Avoid with hydroxyurea and stavudine. Potentiated by ganciclovir, tenofovir (reduce dose of didanosine; monitor). Antagonized by methadone. For pediatric pwd: caution with magnesium- or aluminum-containing antacids. Separate dosing of delavirdine, indinavir, nelfinavir by 1 hour; give drugs affected by gastric pH (eg, ketoconazole, itraconazole) 2 hours prior. May antagonize quinolones, tetracyclines. Give at least 6 hours before or 2 hours after ciprofloxacin. See literature for dosing with concomitant tenofovir.
GI disturbances, headache, rash; elevated liver enzymes, amylase, and lipase; pancreatitis, lactic acidosis/hepatomegaly with steatosis, retinal changes, optic neuritis, peripheral neuropathy, hyperuricemia, fat redistribution, immune reconstitution syndrome, non-cirrhotic portal hypertension.
Register pregnant patients exposed to didanosine by calling (800) 258-4263.