Common use of Indinavir
Indinavir is an HIV-1 protease inhibitor used as part of combination antiretroviral therapy (ART). It is never used alone; pairing with nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) and often with a pharmacokinetic booster (ritonavir) improves potency and durability. By inhibiting HIV protease, indinavir prevents cleavage of viral polyproteins, yielding immature, noninfectious virions and lowering plasma viral load. Clinically, sustained suppression helps slow disease progression, preserve CD4+ T-cell counts, and reduce the risk of opportunistic infections and HIV transmission.
While many modern regimens favor once-daily agents with fewer adverse effects, indinavir can be considered in special circumstances, including historical continuity of care, intolerance or resistance to alternatives, or access considerations. The choice to include indinavir should be individualized based on prior treatment history, resistance profiles, comorbidities, and potential drug–drug interactions. Close monitoring of viral load, CD4 counts, metabolic parameters, and kidney and liver function is integral to safe, effective use.
Indinavir dosage and directions
The commonly referenced adult dose for indinavir monotherapy in a fully suppressive combination regimen is 800 mg by mouth every 8 hours. Administration matters: take each dose on an empty stomach (1 hour before or 2 hours after food) or with a light, low-fat meal to optimize absorption; avoid high-fat/high-protein meals that can decrease drug levels. Adequate hydration is essential to reduce the risk of kidney stones—aim for at least 1.5–2 liters of fluid per day, unless otherwise directed by your clinician.
A ritonavir-boosted regimen is often used to simplify dosing and stabilize drug levels: a commonly used approach is indinavir 800 mg with ritonavir 100 mg twice daily. Follow clinician instructions carefully, as individualized adjustments may be made for hepatic impairment or other clinical factors. If you are also prescribed didanosine (ddI), separate dosing to prevent absorption issues—your clinician will provide specific timing guidance. Do not alter doses or dosing intervals without medical advice; subtherapeutic exposure can promote resistance, while excessive exposure increases toxicity risk.
Precautions
Indinavir requires attention to hydration and kidney health. It can precipitate in the urinary tract, causing nephrolithiasis (kidney stones) with flank pain, hematuria, and renal colic. Maintain consistent fluid intake unless contraindicated. Inform your clinician about any prior kidney stones or chronic kidney disease. Monitor for signs of liver dysfunction—indinavir can cause indirect hyperbilirubinemia and transaminase elevations, particularly in patients with underlying hepatitis B or C. Periodic liver function tests are recommended.
Metabolic effects (insulin resistance, hyperglycemia, dyslipidemia, and changes in body fat distribution) may occur with protease inhibitors; baseline and follow-up lipid and glucose assessments are prudent. People with hemophilia can experience increased bleeding. Immune reconstitution inflammatory syndrome (IRIS) can unmask underlying infections shortly after ART initiation. Dizziness or fatigue may affect the ability to drive or operate machinery. Pregnancy and breastfeeding require individualized discussion; while protease inhibitors have been used in pregnancy, indinavir is generally not preferred today due to safety and practicality concerns. Breastfeeding is usually discouraged in settings where safe formula feeding is available, to minimize HIV transmission risk. Always share a complete medication and supplement list with your care team to avoid harmful interactions.
Contraindications
Indinavir is contraindicated in anyone with a known hypersensitivity to indinavir or formulation components. Do not use indinavir with potent CYP3A inducers that can severely reduce plasma concentrations and cause virologic failure—for example, rifampin and products containing St. John’s wort. Likewise, coadministration with drugs highly dependent on CYP3A for clearance, where elevated concentrations could be dangerous, is contraindicated. Examples include certain antiarrhythmics (e.g., amiodarone, dronedarone), ergot derivatives (ergotamine, dihydroergotamine), oral midazolam, triazolam, pimozide, and some statins (lovastatin, simvastatin).
Caution is needed with hepatic impairment; dose adjustments and enhanced monitoring may be warranted. Concomitant use with agents that raise indinavir levels can increase toxicity risk; conversely, agents that lower levels can compromise antiviral efficacy. Before starting or stopping any prescription, over-the-counter medication, or herbal supplement, consult your clinician or pharmacist to ensure safety.
Possible side effects
Common adverse effects of indinavir include gastrointestinal upset (nausea, abdominal pain, diarrhea), headache, fatigue, taste disturbances, and rash. Indirect hyperbilirubinemia can cause jaundice or scleral icterus; while often benign, it warrants evaluation to rule out other causes. Kidney stone formation is a hallmark risk; symptoms include severe flank pain, blood in urine, painful urination, or urinary obstruction—seek prompt care. Crystalluria may also occur.
Metabolic effects such as elevated blood glucose, insulin resistance, hypertriglyceridemia, and hypercholesterolemia can develop over time; periodic lab monitoring and lifestyle changes or medications may be needed. Less common but serious events include hepatotoxicity, pancreatitis, severe skin reactions, hemolytic anemia, and uveitis. Report new or worsening symptoms promptly. Patients initiating ART may experience IRIS, with transient fever or localized inflammatory symptoms as the immune system rebounds—your clinician will differentiate and treat accordingly. Most side effects are manageable with dose timing adjustments, supportive care, and, when needed, regimen modification.
Drug interactions
Indinavir is extensively metabolized by CYP3A4, so inhibitors and inducers can significantly alter its levels. Strong CYP3A inducers (rifampin, carbamazepine, phenytoin, phenobarbital, St. John’s wort) can cause loss of virologic suppression and must be avoided. Potent CYP3A inhibitors (ketoconazole, itraconazole, clarithromycin) can raise indinavir exposure and toxicity risk; dose adjustments or alternative agents may be appropriate. Ritonavir intentionally boosts indinavir via CYP3A inhibition, but it also magnifies interactions with other drugs—expert pharmacist input is invaluable.
Sedative–hypnotics like triazolam and oral midazolam are contraindicated due to profound sedation and respiratory depression risk. Certain antiarrhythmics (amiodarone, dronedarone), ergot alkaloids, and pimozide should not be combined. Statin selection matters: avoid simvastatin and lovastatin; consider pravastatin or low-dose atorvastatin with monitoring. Phosphodiesterase-5 inhibitors (sildenafil, tadalafil) require lower doses to avoid hypotension and priapism. Oral contraceptives may be less effective; use additional contraception. Antacids and buffered didanosine can impair indinavir absorption—separate administration as directed. Always provide a complete medication list at every visit to ensure safe, effective therapy.
Missed dose
If you miss a dose of indinavir, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and resume your regular schedule. Do not double up to catch up. Because indinavir has a short dosing interval when unboosted, adherence is crucial to maintain therapeutic drug levels and prevent resistance. Consider practical adherence supports: phone reminders, pill organizers, aligning dosing with consistent daily routines, or discussing a ritonavir-boosted schedule if appropriate for your clinical situation. If frequent missed doses occur, notify your clinician promptly—an alternative regimen with a simpler schedule may be safer and more effective.
Overdose
Symptoms of indinavir overdose can include severe gastrointestinal distress, jaundice or marked hyperbilirubinemia, dizziness, cardiac rhythm disturbances, and signs of acute kidney injury such as flank pain, reduced urine output, or hematuria. There is no specific antidote. If an overdose is suspected, seek immediate medical care or contact Poison Help at 1-800-222-1222 in the United States. Management typically involves supportive measures: ensuring airway, breathing, and circulation; correcting hydration and electrolyte imbalances; monitoring renal and hepatic function; and treating complications such as nephrolithiasis or arrhythmias. Because indinavir is highly protein-bound and hepatically metabolized, hemodialysis is unlikely to be effective for drug removal. Bring a list of all medications and supplements to the emergency department to guide safe management.
Storage
Store indinavir at room temperature, generally 68–77°F (20–25°C), with brief excursions permitted per product labeling. Protect from moisture; keep capsules in the original container with the desiccant and the lid tightly closed. Do not store in the bathroom or other humid environments. Keep out of reach of children and pets, ideally in a locked cabinet. Do not use after the expiration date. If your medication has been exposed to excessive heat, cold, or humidity, consult your pharmacist about potency and replacement. For travel, carry doses in original labeled containers, pack desiccant, and avoid leaving medicine in a hot car. Dispose of unused or expired capsules via community take-back programs or per pharmacist guidance—do not flush unless instructions specifically state it is safe.
U.S. Sale and Prescription Policy
In the United States, indinavir is a prescription-only medication. Federal and state regulations require evaluation by a licensed clinician to ensure the drug is appropriate, safe, and part of a complete, modern antiretroviral regimen tailored to your clinical needs. Dispensing occurs through licensed pharmacies that can verify dosing, screen interactions, and support adherence.
HealthSouth Rehabilitation Hospital of Tallahassee offers a legal and structured solution for accessing HIV care: you can schedule a clinician-led evaluation (in person or via telehealth where available), undergo necessary labs, and—if indinavir is appropriate—receive a prescription with coordinated pharmacy fulfillment. The hospital team can also help navigate insurance coverage, manufacturer assistance programs, and medication counseling. This pathway does not bypass medical oversight or prescription requirements; instead, it streamlines compliant access to care while prioritizing safety, efficacy, and continuity. If indinavir is not the best option, your provider will recommend alternative regimens that align with current guidelines, your resistance profile, and your individual preferences.
