Indinavir

Also indexed as: Crixivan®

Indinavir is an antiviral drug used to treat HIV infection, and is in a class of medications known as protease inhibitors.

Summary of Interactions with Vitamins, Herbs, and Foods
In some cases, a herb or supplement may appear in more than one category, which may seem contradictory. For clarification, read the full article for details about the summarized interactions.

Avoid: Reduced drug absorption/bioavailability—Avoid these supplements when taking this medication since the supplement may decrease the absorption and/or activity of the medication in the body.	Food St. John’s wort
Depletion or interference	None known
Side effect reduction/prevention	None known
Supportive interaction	None known
Adverse interaction	None known

An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

Interactions with Herbs

St. John’s wort (Hypericum perforatum)
Studies have shown that taking indinavir together with St. John’s wort results in increased breakdown and dramatically reduced blood levels of indinavir.¹ ² Therefore, people taking indinavir should not take St. John’s wort.

Indinavir is a protease inhibitor used to treat people with HIV infection. A pharmacological study gave indinavir to healthy volunteers for two days.³ On day 3, volunteers added 900 mg of St. John’s wort extract per day. At the end of the study, it was found that St. John’s wort led to a significant reduction in serum levels of indinavir. Until more is known, people taking indinavir or other antiretroviral drugs for HIV infection should avoid using St. John’s wort.

Interactions with Foods and Other Compounds

Food
Taking indinavir with a meal high in calories, protein, and fat dramatically reduces the absorption of the drug.⁴ One controlled trial showed that taking indinavir with a high-fat breakfast greatly reduced blood levels of the drug, while two types of low-fat meals had no effect.⁵ Therefore, indinavir should be taken either with a low-fat meal or on an empty stomach.

References
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1. Piscitelli SC, Burstein AH, Chaitt D, et al. Indinavir concentrations and St. John’s wort. Lancet 2000;355:547–8 [letter].

2. Moore LB, Goodwin B, Jones SA, et al. St. John’s wort induces hepatic drug metabolism through activation of the pregnane X receptor. Proc Natl Acad Sci USA 2000;97:7500–2.

3. Piscitelli SC, Burstein AH, Chaitt D, et al. Indinavir concentrations and St. John’s wort. Lancet 2000;355:547–8 [letter].

4. Sifton DW, ed. Physicians’ Desk Reference. Montvale, NJ: Medical Economics Company, Inc., 2000, 1772–6.

5. Yeh KC, Deutsch PJ, Haddix H, et al. Single-dose pharmacokinetics of indinavir and the effect of food. Antimicrob Agents Chemother 1998;42:332–8.

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The information presented in Healthnotes is for informational purposes only. It is based on scientific studies (human, animal, or in vitro), clinical experience, or traditional usage as cited in each article. The results reported may not necessarily occur in all individuals. For many of the conditions discussed, treatment with prescription or over the counter medication is also available. Consult your doctor, practitioner, and/or chemist for any health problem and before using any supplements or before making any changes in prescribed medications. Information expires March 2007.

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Interactions with Foods and Other Compounds