Fosamprenavir Calcium and Voltaren

• Generic Name: fosamprenavir
• Dosage Forms: n.a.
• Other Brand Names: Lexiva, Telzir

Treatment of HIV-1 infection in adults, adolescents, and certain pediatric patients ≥4 weeks of age; used in conjunction with other antiretrovirals.

Used in conjunction with low-dose ritonavir (ritonavir-boosted fosamprenavir) or without low-dose ritonavir (unboosted fosamprenavir); usually used in PI-based regimens that include a PI and 2 nucleoside reverse transcriptase inhibitors (NRTIs).

For initial treatment in antiretroviral-naive adults or adolescents, experts state fosamprenavir (with or without low-dose ritonavir) not recommended. Regimens that include unboosted fosamprenavir may be associated with virologic failure and may result in selection of mutations that confer resistance to fosamprenavir and darunavir; clinical trial data for ritonavir-boosted fosamprenavir more limited compared with data available for other ritonavir-boosted PIs.

For initial treatment in antiretroviral-naive pediatric patients, experts state ritonavir-boosted fosamprenavir not recommended in any age group because other more advantageous ritonavir-boosted PIs are available. Fosamprenavir (without low-dose ritonavir) also not recommended for pediatric patients of any age because of concerns related to inconvenient dosing and possibility of selection of resistance mutations.

Consider the following factors when initiating ritonavir-boosted fosamprenavir: Data insufficient to determine whether a regimen that includes ritonavir-boosted fosamprenavir is as effective as a regimen that includes the fixed-combination of lopinavir and ritonavir (lopinavir/ritonavir) in adults who previously received PIs (PI-experienced). Once-daily ritonavir-boosted fosamprenavir not recommended in PI-experienced adults or in any pediatric patient.

Postexposure prophylaxis of HIV infection following occupational exposure (PEP) in health-care personnel and others exposed via percutaneous injury (e.g., needlestick, cut with sharp object) or mucous membrane or nonintact skin (e.g., chapped, abraded, dermatitis) contact with blood, tissue, or other body fluids that might contain HIV.

USPHS recommends a 3-drug regimen of raltegravir and emtricitabine and tenofovir disoproxil fumarate (tenofovir DF) as preferred regimen for PEP following occupational exposures to HIV. Fosamprenavir (with or without low-dose ritonavir) and 2 NRTIs can be considered an alternative regimen, but use for PEP only with expert consultation. Preferred dual NRTI option for PEP regimens is emtricitabine and tenofovir DF; alternatives are tenofovir DF and lamivudine, zidovudine and lamivudine, or zidovudine and emtricitabine.

Management of occupational exposures to HIV is complex and evolving; consult infectious disease specialist, clinician with expertise in administration of antiretroviral agents, and/or National Clinicians’ Postexposure Prophylaxis Hotline (PEPline at 888-448-4911) whenever possible. Do not delay initiation of PEP while waiting for expert consultation.

Postexposure prophylaxis of HIV infection following nonoccupational exposure (nPEP) in individuals exposed to blood, genital secretions, or other potentially infectious body fluids that might contain HIV when the exposure represents a substantial risk for HIV transmission. Used in conjunction with other antiretrovirals.

When nPEP indicated in adults and adolescents ≥13 years of age with normal renal function, CDC states preferred regimen is either raltegravir or dolutegravir used in conjunction with emtricitabine and tenofovir DF (given as emtricitabine/tenofovir DF; Truvada); recommended alternative in these patients is ritonavir-boosted darunavir used in conjunction with emtricitabine/tenofovir DF.

CDC states that fosamprenavir is an alternative antiretroviral that can be used in nPEP regimens, but use in such regimens only with expert consultation.

Consult infectious disease specialist, clinician with expertise in administration of antiretroviral agents, and/or the National Clinicians’ Postexposure Prophylaxis Hotline (PEPline at 888-448-4911) if nPEP indicated in certain exposed individuals (e.g., pregnant women, children, those with medical conditions such as renal impairment) or if considering a regimen not included in CDC guidelines, source virus is known or likely to be resistant to antiretrovirals, or healthcare provider is inexperienced in prescribing antiretrovirals. Do not delay initiation of nPEP while waiting for expert consultation.

• Generic Name: diclofenac
• Dosage Forms: tablet, delayed release
• Other Brand Names: Voltaren, Voltaren-XR, also Cambia, Cataflam, Zipsor, Zorvolex, Dyloject, Cambia

Voltaren (diclofenac) is a nonsteroidal anti-inflammatory drug (NSAID). Voltaren works by reducing substances in the body that cause pain and inflammation.

Voltaren oral tablets are used to treat mild to moderate pain, or signs and symptoms of osteoarthritis or rheumatoid arthritis. Voltaren is also used to treat ankylosing spondylitis.

Voltaren ophthalmic eyedrops are used to treat pain, inflammation, and light sensitivity after eye surgery or for certain eye conditions.

Voltaren gel is used to treat osteoarthritis of the knees and hands.

You should not use Voltaren if you have a history of allergic reaction to aspirin or NSAIDs (non-steroidal anti-inflammatory drugs).

Voltaren can increase your risk of fatal heart attack or stroke, especially if you use it long term or take high doses, or if you have heart disease. Even people without heart disease or risk factors could have a stroke or heart attack while taking this medicine.

Voltaren may also cause stomach or intestinal bleeding, which can be fatal. These conditions can occur without warning while you are using Voltaren, especially in older adults.