Raltegravir for HIV

About raltegravir

Raltegravir is an antiretroviral medicine. It is used for human immunodeficiency virus (HIV) infection. It slows the progress of HIV infection, but it is not a cure. HIV destroys cells in the body, called CD4 T cells. These cells are a type of white blood cell and are important because they are involved in protecting your body from infection. If left untreated, the HIV infection weakens your immune system so that your body cannot defend itself against bacteria, viruses and other germs. Raltegravir is known as an integrase inhibitor antiretroviral medicine. It works by stopping an enzyme which is produced by the virus from working. The virus produces the enzyme to help it multiply in the body, so by preventing it from working, raltegravir reduces the amount of virus in your body. This helps to maintain the health of your immune system.

Raltegravir will be prescribed for you by a doctor who is a specialist. It is given alongside a number of other antiretroviral medicines, as part of a combination therapy. Taking three or more antiretroviral medicines at the same time is more effective than taking one alone. Taking a combination of different medicines also reduces the risk that the virus will become resistant to any individual medicine. It is vital to take them exactly as prescribed to maintain success and to help to prevent the virus from becoming resistant to the medicines. These medicines are usually taken for life.

Before taking raltegravir

Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking raltegravir it is important that your doctor knows:

• If you are pregnant or breastfeeding.

• If you have any problems with the way your liver works.

• If you have ever had a mental health problem (such as depression).

• If you are taking any other medicines. This includes any medicines which are available to buy without a prescription, as well as herbal and complementary medicines.

• If you have ever had an allergic reaction to a medicine.

How to take raltegravir

• Before you (or your child) start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about raltegravir, and it will also provide you with a full list of the side-effects which can develop.

• Take raltegravir exactly as your doctor tells you to. You will usually be prescribed two doses to take each day. Space your doses out evenly during the day; the ideal times for taking your doses are first thing in the morning, and then early evening.

• For some people, your doctor may recommend taking a larger dose of raltegravir but only once each day. This could happen when you are starting treatment or if twice-daily dosing is working well to control your infection.

• Try to take the doses at the same times of day each day, as this will help you to remember to take raltegravir regularly. If you do forget to take a dose at your usual time, take it as soon as you remember (unless it is nearly time for your next dose, in which case leave out the missed dose). Do not take two doses together to make up for a forgotten dose.

• Raltegravir is available in four formulations. It is important that you take the same formulation each time - do not switch between them without your doctor knowing:

  • 400 mg 'standard' tablets which are prescribed for adults and children. Swallow the tablet whole with a drink of water. You can take the tablet either with or without food.

  • 600 mg 'standard' tablets which are prescribed when once-daily dosing is recommended (two 600 mg tablets). Swallow the tablets whole with a drink of water. You can take the tablets either with or without food.

  • 25 mg or 100 mg chewable tablets which are prescribed for older children. Chew the tablet before swallowing. You can take the tablet either with or without food.

  • 100 mg sachets of granules to make up into a liquid medicine prescribed for younger children. The medicine can be taken either with or without food. See below for directions on how to make up the medicine.

How to make up liquid medicine from sachets

1. Fill the mixing cup with drinking water. Then, fill the blue syringe with 10 ml of the drinking water, by putting the nozzle of the syringe into the water in the mixing cup and pulling back on the plunger until the syringe is full of water to the 10 ml mark. Throw away the remaining water in the cup so that the mixing cup is now empty.

2. Put the 10 ml of water from the syringe back into the mixing cup by pushing down on the plunger to empty the contents of the syringe into the cup.

3. Open one sachet and pour the entire contents into the mixing cup. Close the lid so that it snaps shut. Swirl the mixing cup gently for about a minute, so that the granules mix into the water. The liquid should now look cloudy.

4. Open the cup and using one of the dose syringes, measure out your child's dose in ml, by pulling back on the plunger to fill the syringe to the correct amount.

5. Place the dose syringe into your child's mouth (towards the cheek) and press the plunger gently to release the measured amount of medicine into their mouth. You must give the dose within 30 minutes of making up the liquid.

6. Wash and dry the mixing cup and syringe after each dose.

Getting the most from your treatment

• Keep your regular appointments with your doctor so that your progress can be monitored. You will need to have regular blood tests.

• It is important that you continue to take raltegravir and your other antiretroviral treatment regularly. This will help to prevent the HIV from becoming resistant to the medicines you are taking. Even if you miss only a small number of doses, the virus can become resistant to treatment.

• If you develop any infection soon after you start the treatment, let your doctor know. As a result of taking raltegravir, your immune system may start fighting an infection which was present before you started the treatment, but which you may not have been aware of.

• Some people taking antiretroviral medicines develop changes to the way body fat is distributed in the body. This can result in changes to body image. Your doctor will discuss the possibility of this with you.

• Follow carefully any advice your doctor gives to you about making lifestyle changes to reduce any risk of damage to your heart and blood vessels. These can include stopping smoking, eating healthily and taking regular exercise.

• Although treatment with antiretroviral medicines can reduce the risk of you passing HIV to others through sexual contact, it does not stop it. It is important that you use condoms.

• It is not uncommon for people with HIV to feel low or even depressed, especially soon after the diagnosis has been made and treatment has been started. If you have any feelings of depression you should speak with your doctor straightaway.

• Some people who have taken antiretroviral medicines (particularly over a long time) have developed a condition called osteonecrosis. This is a bone disease where bone tissue dies because there is a reduced blood supply to it. It leads to joint pains and stiffness, and can cause difficulties in movement. If you notice any of these symptoms, speak with your doctor.

• If you buy any medicines or herbal remedies 'over the counter', check with a pharmacist that they are suitable to take with raltegravir and your other medicines. This is because some medicines interfere with antiretrovirals and can stop them from working properly. For example, raltegravir should not be taken with some antacid remedies.

• Taking iron supplements at the same time can lower the level of raltegravir in your blood, making it less effective. Do not take iron supplements within the two hours before or the two hours after your raltegravir doses.

• If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking.

• Treatment for HIV is usually lifelong. Continue to take raltegravir regularly, even if you feel well. This is to keep your immune system healthy.

Can raltegravir cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with raltegravir. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Important: although it is common for people taking raltegravir to develop a skin rash, a severe rash with blisters may be a sign of a more serious allergic-type reaction. Let your doctor know straightaway if you develop the following:

• Severe blistering rash, high temperature (fever), muscle and joint aches or pains, feeling generally unwell, mouth ulcers, conjunctivitis, dark urine, stomach pain, yellowing of your skin or the whites of the eyes (jaundice).

If you experience any other symptoms which you think may be due to raltegravir, speak with your doctor or pharmacist for further advice.

How to store raltegravir

• Keep all medicines out of the reach and sight of children.

• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines