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Enfuvirtide

 
Drug Info: Enfuvirtide

Brand names: Fuzeon®

Chemical formula:



Enfuvirtide injection

What is Enfuvirtide injection?

ENFUVIRTIDE (Fuzeon™) is a medicine used to treat HIV, the virus that causes AIDS. Enfuvirtide blocks HIV's ability to infect healthy infection-fighting cells (CD4 cells or T-cells). Enfuvirtide must be taken with other anti-HIV medicines. When enfuvirtide is given with other anti-HIV medicine it lowers the amount of virus in your blood (the viral load) and increases the number of CD4 cells (or T-cells). Enfuvirtide will not cure HIV infection or AIDS. People taking enfuvirtide may still develop opportunistic infections or other conditions associated with HIV. Generic enfuvirtide injection is not available.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:
• cigarette smoker
• lung disease or breathing difficulties
• use IV drugs
• an unusual reaction to Enfuvirtide, mannitol, medicines, foods, dyes, or preservatives
• pregnant or trying to get pregnant
• breast-feeding

How should this medicine be used?

Enfuvirtide is for injection under the skin. You will be giving yourself 2 injections of enfuvirtide every day. Your health care provider will give you instructions and show you and/or your caregiver how to give this medicine. Make sure that you and your caregiver understand how to prepare and inject the dose. Use twice daily exactly as directed. Rotate your injection site so that each site is not used more than once every 1—2 months. Do not give an injection into any are of skin that has an active injection site reaction. Do not use more enfuvirtide than prescribed. Do not use more or less often than prescribed. If you or your caregiver have any questions about how to give this medicine, call your health care provider before giving the medicine.

Make sure you get a puncture-resistant container to take home for throwing away the used syringes and needles. Do not reuse any needles or syringes.

Contact your pediatrician or health care professional regarding the use of this medicine in children. Special care may be needed.

What if I miss a dose?

If you miss a dose, use it as soon as you can. If it is almost time for your next dose, use only that dose. Do not use double or extra doses.

What drug(s) may interact with Enfuvirtide?

No interactions have been found.

Tell your prescriber or health care professional about all other medicines you are taking, including non-prescription medicines, nutritional supplements, or herbal products. Also tell your prescriber or health care professional if you are a frequent user of drinks with caffeine or alcohol, if you smoke, or if you use illegal drugs. These may affect the way your medicine works. Check with your health care professional before stopping or starting any of your medicines.

What should I watch for while taking Enfuvirtide?

You must visit your prescriber or health care professional for regular checks on your progress.

Taking enfuvirtide does not reduce the risk of passing HIV infection to others through sexual or blood contact. It is best to avoid sexual contact so that you do not spread the disease to others. For any sexual contact, use a condom. Be careful about cuts, abrasions and other possible sources of blood contact. Never share a needle or syringe with anyone.

Skin reactions where you inject enfuvirtide are common during treatment. The injection site reactions are usually mild to moderate, but can be severe. Injection site reactions usually happen within the first week of using enfuvirtide and usually continue to happen as you keep using enfuvirtide. The reactions usually do not last longer than 7 days. The reactions may be worse when injections are given in the same place on the body or when the injection is given deeper than it should be (for example, into the muscle).

What side effects may I notice from receiving Enfuvirtide?

Enfuvirtide causes injection site reactions in almost every person who uses it. Reactions are usually mild to moderate, but they can be severe. Reactions on the skin where enfuvirtide is injected include:
• bumps
• hardened skin
• itching
• pain or tenderness
• swelling
• redness

Side effects that you should report to your prescriber or health care professional as soon as possible:
• an injections site reaction (see above) that is severe, infected, or in any way worrisome to you
• signs of infection - such as fever or chills, cough, difficulty breathing
• signs of allergic reaction including: difficulty breathing, fever with vomiting and skin rash, blood in the urine, swelling of the feet

Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):
• constipation
• decreased appetite
• depression
• inability to sleep
• muscle pain
• pain or numbness in the feet or legs
• weakness or loss of strength

Where can I keep my medicine?

Keep out of the reach of children in a container that small children cannot open.

Store vials of enfuvirtide that have not been mixed with sterile water at room temperature, 15—30 degrees C (59—86 degrees F). Enfuvirtide can also be stored in a refrigerator 2—8 degrees C (36—46 degrees F); do not freeze. After enfuvirtide has been mixed with sterile water, the vial should be stored in a refrigerator at 2—8 degrees C (36—46 degrees F) for up to 24 hours. Return individual vials to room temperature before use. Throw away any unused medicine after the expiration date.

Do not inject the solution if it is not clear or if there are particles present. Return it to the pharmacy. Use the solution within 24 hours of dissolving the enfuvirtide powder with the sterile water. If you have not used the mixed medicine within 24 hours, throw it away.

Store needles and syringes out of the reach of children. Make sure you receive a puncture-resistant container to dispose of the needles and syringes once you have finished with them. Do not reuse these items. Return the container to your prescriber or health care professional for proper disposal.

Last updated: 9/30/2002 3:40:00 PM

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

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Wikipedia: Enfuvirtide
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Enfuvirtide
Systematic (IUPAC) name
Acetyl-YTSLIHSLIEESQNQ QEKNEQELLELDKWASLWNWF-amide
Identifiers
CAS number 159519-65-0
ATC code J05AX07
PubChem 16130199
DrugBank BTD00106
Chemical data
Formula C202H298N50O64 
Mol. mass 4492.1 g/mol
Pharmacokinetic data
Bioavailability 84.3% (SC)
Protein binding 92%
Metabolism Hepatic
Half life 3.8 hours
Excretion unknown
Therapeutic considerations
Pregnancy cat.

B2 (Au), B (U.S.)

Legal status

S4 (Au), POM (UK), ℞-only (U.S.)

Routes Subcutaneous (SC)

Enfuvirtide (INN) is an HIV fusion inhibitor, the first of a novel class of antiretroviral drugs used in combination therapy for the treatment of HIV-1 infection. It is marketed under the trade name Fuzeon (Roche).

Enfuvirtide therapy costs an estimated USD$25,000 per year in the United States. Its cost and inconvenient dosing regimen are factors behind its use as a reserve, for "salvage" therapy in patients with multi-drug resistant HIV.

Contents

Structural formula

Enfuvirtid.svg

Ac-Tyr-Thr-Ser-Leu-Ile-His-Ser-Leu- Ile-Glu-Glu-Ser-Gln-Asn-Gln-Gln-Glu- Lys-Asn-Glu-Gln-Glu-Leu-Leu-Glu- Leu-Asp-Lys-Trp-Ala-Ser-Leu-Trp-Asn- Trp-Phe-NH2

History

Enfuvirtide originated at Duke University, where researchers formed a pharmaceutical company known as Trimeris. Trimeris began development on enfuvirtide in 1996 and initially designated it T-20. In 1999, Trimeris entered into partnership with Hoffmann-La Roche to complete the development of the drug. It was approved by the U.S. Food and Drug Administration (FDA) on March 13, 2003 as the first HIV fusion inhibitor, a new class of antiretroviral drugs. It was approved on the basis of two studies (TORO 1 and TORO 2) which compared the effect of optimized regimens of antiretroviral medication with and without the addition of enfuvirtide on serum viral load.

Pharmacology

Mechanism of action

Enfuvirtide works by disrupting the HIV-1 molecular machinery at the final stage of fusion with the target cell, preventing uninfected cells from becoming infected. A biomimetic peptide, enfuvirtide was rationally designed to mimic components of the HIV-1 fusion machinery and displace them, preventing normal fusion. Drugs that disrupt fusion of virus and target cell are termed entry inhibitors or fusion inhibitors.

HIV binds to the host CD4+ cell receptor via the viral protein gp120; gp41, a viral transmembrane protein, then undergoes a conformational change that assists in the fusion of the viral membrane to the host cell membrane. Enfuvirtide binds to gp41 preventing the creation of an entry pore for the capsid of the virus, keeping it out of the cell.[1]

Microbiology

Enfuvirtide is considered to be active against HIV-1 only. Low activity against HIV-2 isolates has been demonstrated in vitro.[2]

Variable susceptibility to enfuvirtide has been observed in clinical isolates, with acquired resistance the result of a mutated 10 amino acid motif in viral gp41. Primary resistance, however, has yet to be observed.[3]

Clinical use

Indications

Enfuvirtide is indicated for the treatment of HIV-1 infection, in combination therapy with other antiretrovirals, in patients where all other treatments have failed.[4]

Dosage forms

By virtue of its peptide nature, enfuvirtide is marketed in injectable form. The lyophilised enfuvirtide powder must be reconstituted by the patient and administered twice daily by subcutaneous injection.

Adverse effects

Common adverse drug reactions (≥1% of patients) associated with enfuvirtide therapy include: injection site reactions (pain, hardening of skin, erythema, nodules, cysts, itch; experienced by nearly all patients, particularly in the first week), peripheral neuropathy, insomnia, depression, cough, dyspnoea, anorexia, arthralgia, infections (including bacterial pneumonia) and/or eosinophilia. Various hypersensitivity reactions occur infrequently (0.1–1% of patients), symptoms of which include rash, fever, nausea, vomiting, chills, rigors, hypotension, elevated hepatic transaminases; and possibly more severe reactions including respiratory distress, glomerulonephritis and/or anaphylaxisrechallenge is not recommended.[4]

References

  1. ^ Lalezari JP, Eron JJ, Carlson M, et al. A phase II clinical study of the long-term safety and antiviral activity of enfuvirtide-based antiretroviral therapy. AIDS 2003;17:691—8.
  2. ^ Roche Products Pty Ltd. Fuzeon (Australian Approved Product Information). Dee Why (NSW): Roche; 2005.
  3. ^ Greenberg ML, Cammack N. Resistance to enfuvirtide, the first HIV fusion inhibitor. J Antimicrob Chemother 2004;54(2):333-40. PMID 15231762
  4. ^ a b Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006. ISBN 0-9757919-2-3

 
 
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