8 GAY PEOPLE'S Chronicle AUGUST 14, 1998
COMMUNITY GROUPS
Helpful suggestions for using Norvir liquid
by the Boston AIDS Writers Group
Abbott Labs has announced that a complication in the drug manufacturing process has forced it to temporarily stop production of the capsule formulation of the protease inhibitor Norvir (ritonavir). Until the problem with the capsule formulation is resolved, patients using Norvir will be offered the drug's liquid formulation. Norvir capsules currently at pharmacies are not affected and can be safely taken by those on the drug.
Expect supplies of these capsules to begin running out in mid-August, although many pharmacies may have enough to last beyond then. Those on Norvir may want to ask their pharmacist how much of the capsules they have stockpiled. Once a pharmacy runs out of Norvir capsules, patients will be given the liquid formulation of the drug when they have their Norvir prescriptions refilled. Abbott believes there will be enough Norvir liquid available in pharmacies at that time to meet the expected demand.
The problem
After a batch of Norvir is produced, the batch is routinely tested to insure that it meets FDA approved specifications. When Abbott tested its most recently completed batches of Norvir capsules it was discovered that they dissolved too slowly.
The cause appeared be the "formation of a Norvir crystalline structure which is affecting how the capsule dissolves," according to Arthur Higgins, of Abbott Laboratories.
The company, however, has no idea what is causing the crystalline formation and finding it may take time. Abbott says it may be several months and possibly longer before Norvir capsule production can begin again. Then an additional month or so before those new capsules actually reach pharmacies.
Norvir liquid
When picking up your Norvir liquid at the pharmacy you will notice a small cup on the top of the bottle. The cup has markings on it in milliliters, for your proper dosing of Norvir liquid. If you are unsure which measurement of the drug is your prescribed dose, ask the pharmacist to show you. That information should also be written on the bottle. Some may have difficulty reading the cap. Those with limited or no eyesight will likely need assistance every time they dose.
Warning: Using the proper dose of Norvir liquid is important. Insufficient dosing is dangerous. It could lead to inadequate drug levels in the body, the development of resistance, and threaten the effectiveness of your antiviral regimen.
Below are conversions that may also be helpful for remembering your dose. Measure correctly!
6 Norvir capsules (100 mg each) equals 7.5 ml of Norvir liquid (11⁄2 teaspoons).
5 Norvir capsules (100 mg each) equals 6.25 ml of Norvir liquid (11⁄4 teaspoons). 4 Norvir capsules (100 mg each) equals 5 ml of Norvir liquid (1 teaspoon).
Storage
In addition, when you pick up your Norvir liquid at the pharmacy you may notice that the pharmacist kept it refrigerated. When you bring it home, do not refrigerate it as you did the capsules. Norvir liquid requires no refrigeration; it is best stored at room temperatures between 68° and 77° F. If your Norvir liquid cannot be kept at temperatures below 86° F, then it should be refrigerated until such time that it can be. The bottle containing Norvir liquid is specially formulated for that purpose. Do not store the Norvir in any other container.
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Norvir liquid has a short shelf life, so it should be used within 30 days.
It is also important to shake Norvir liquid before you measure each dose. Thoroughly clean the cap after each use. Norvir liquid should taken with food, especially fatty foods if you are using it in combination with Fortovase or saquinavir. If you are dosing Crixivan (indinavir) in combination with Norvir, it is recommended that you first take your Crixivan dose without food. Then about 60 minutes later take Norvir liquid with food. The taste of Norvir liquid
Many find the taste of the liquid formulation unpleasant. There is concern that those who dislike Norvir liquid may interrupt their dosing, or stop taking it. Warning: Doing so can be dangerous, leading to the development of drug resistance and threaten the effectiveness your drug regimen!
To help avoid the unpleasant taste of Norvir liquid, Abbott recommends adding it to milk, Ensure, or Advera, but only just before each dose, not well ahead of time. Be sure to mix it well, and drink it quickly, before the Norvir floats to the top. To insure you get all of the Norvir that sticks to the sides of the glass, refill the glass or container with the beverage (milk or Advera), stir and drink its contents, then lick the spoon. Chocolate flavored beverages seem to do a better job at masking the taste of Norvir liquid, so use chocolate milk or chocolate flavored Advera, or Ensure. Medicaid, as well as private insurance, sometimes covers the cost of protein beverages like Ensure or Advera. A doctor's prescription will likely be required, though.
The AIDS Writers Group asked Dr. Tina Tan, a Chicago pediatrician experienced in treating children with Norvir liquid, for additional tips on how to make the drug go down easier. She recommends trying the following:
Sucking on a Popsicle before you take your dose will help numb your taste buds,
desensitizing them to the taste of liquid Norvir.
Take a spoonful of chocolate syrup before your dose. Then a spoonful of chocolate syrup after your dose. The syrup should overwhelm your taste buds so you taste less of the Norvir mixture.
Eat salty foods such as pretzels or potato chips before and after the dosing. The salt will also help cover the taste of the Norvir.
Drink the Norvir liquid mix through a straw placed to the back of the throat so the drug bypasses the taste buds. Or, use a Medibottle, a special bottle with a straw attached. They can be purchased at medical supply houses. A bike water bottle may also work.
If you are unable to take Norvir liquid regularly as prescribed due to intolerance of the drug or vomiting, contact your doctor immediately. Warning: Staying on an antiviral regimen that includes Norvir when Norvir cannot be taken successfully could result in the development of resistance and the failure of that regimen.
One final point. Norvir liquid is 45% alcohol, and it tastes like it. Those using Norvir who are in recovery should be aware of this before using the liquid. They should perhaps discuss this issue with their doctor, or a counselor, or support group.
If you have questions about your Norvir prescription do not hesitate to call your doctor, or the Norvir information hotline at 800-637-2400. The Norvir web site is at http://www.norvir.com.
For more information on anything in this article call Search for a Cure at 617536-2474. ♡
The Boston AIDS Writers Group is made up of AIDS physicians and researchers, including Robert Folan-Johnson and David Scondras of Search for a Cure. This article was reviewed by John James, editor and publisher of AIDS Treatment News, and Tony Japour of Abbott Labs.
It's league time again: ready, steady, bowl!
Columbus-Summer winds to a hesitant close, softball leagues are finishing up, and you ask yourself, "What am I to do in the fall?"
We in the bowling community have a great idea. Join one of our four winter bowling leagues. We have different nights and schedules designed for just about anyone. This past year the Columbus bowling community was mentioned in two stories featured in the Advocate and Outmagazine. The Advocate article listed Columbus at number six on the top ten list of surprise cities. Whether the mention of Columbus' bowling leagues was meant as a slam or complement is in doubt, but those in the bowling community
love the attention. Out listed Columbus as having the most gay bowling teams in the country.
Here's a quick history and description of the leagues. The oldest league is the Not Ready for Prime Time League. Bowling on Monday nights at 8:30 pm, it is the oldest and largest of the city's gay leagues. At 21 years old, it boasts 30 teams of 4 players.
The Polyester Bowling Academy is the youngest and shortest of the bunch. The Academy meets Tuesday evenings at
8:30pm with three people on a team for a maximum of 18 weeks. This was designed for beginner bowlers and people who didn't feel comfortable with the standard 28 week league.
The Friday Four Play league meets also at 8:30 pm Fridays and bowls a total of 22 weeks. The league is limited to 14 teams and bowls an interesting schedule. As a lot of Columbus bowlers attend out of town GBL bowling tournaments, this league will take the Friday off for those to tourneys close Columbus. The final fall league is the Sunday Brunch league bowling at 3:00 pm Sunday afternoons. This league has 20 teams of 4 people bowling 28 weeks. We are having a bowling sign up party at our home lanes of Mr Bill's Northern Lights, 3523 Cleveland Avenue on August 22 from 1:00 to 4:00 pm. Bring your bowling equipment, as bowlers joining leagues will be able to bowl a game or two free of charge compliments of Mr Bill's. All leagues will have representatives to help sign up individuals and teams to fill openings. Additional information can be obtained by calling the bowling hotline at 614-276-3185 or you can sign up your team if unable to attend the party. All leagues star after Labor Day, Sept 7.