WHO Temporarily Pauses Hydroxychloroquine Trials Owing to Safety Concerns

Hydroxychloroquine trial has come to a standstill while WHO is reviewing the data collected from the ongoing trials and studies on the benefits and harms of hydroxychloroquine sulfate, an anti-malaria drug in the treatment of COVID-19.

During a press conference, WHO’s Director-General Tedros Adhanom said, "The Executive Group of the Solidarity Trial, representing 10 of the participating countries, met on Saturday and has agreed to review a comprehensive analysis and critical appraisal of all evidence available globally."

In the international solidarity trial, WHO has been studying the efficacy of various medications like remdesivir, hydroxychloroquine, lopinavir ritonavir in fighting off COVID-19.
As per Lancet observational study on May 22, over 100,000 coronavirus patients who were treated with hydroxychloroquine showed no signs of recovery and were even at a higher risk of death and irregular heartbeats.

The final word on the benefits and side effects of hydroxychloroquine will be put out once the Data Safety Monitoring Board has reviewed the available data and evidence.
For the patients who were randomized to HCQ treatment will continue to take the medicine until they finish their course of therapy. This drug is considered to be safe to use on patients with malaria or autoimmune diseases.

The medical community also stands divided in this matter. While some countries are reporting more evidence on the potential harms and limited benefits of hydroxychloroquine, countries like Brazil, the US, and India are continuing with its widespread use. US President Donald Trump sought supplies from India and uses HCQ as a preventive therapy against coronavirus.

On the same day as the Lancet study was published, the clinical research body of India ICMR explained the use of hydroxychloroquine as prophylaxis against COVID-19. They recommended the use of HCQ for frontline workers, healthcare workers, and policemen as a preventive therapy. However, keeping the contraindications in mind, they suggested one EPG during the course of therapy. ICMR also presented three observational studies from government hospitals showing that the healthcare workers who took HCQ had fewer chances of developing SARS-CoV-2 infection in comparison with those who were not on prophylaxis.

WHO has warned physicians against the use of unproven medication medications on the COVID-19 patients and also cautioned people not to use any medications either.

However, WHO has not prohibited the countries from using such drugs. Every country is free to act how they want but must follow the guidelines of their respective health ministries.

There are probably more than 150 case studies and trials going worldwide to determine the efficacy of hydroxychloroquine sulphate in COVID-19 treatment.

As a part of WHO’s international Solidarity Trial, more than 3500 patients have been recruited from over 17 countries. Around 400 hospitals are recruiting patients daily to perform the trial. The largest trial is going in the United Kingdom that is examining the possible effects of HCQ on the death risk in COVID-19 patients.

The final decision of the Data Safety Monitoring Board on the use of hydroxychloroquine may be out by mid -June.

Read:- Brief on Hydroxychloroquine sulphate

Multiple Myeloma: Everything You Need to Know About the Cancer of Plasma Cells

Multiple myeloma is a type of blood cancer that forms in plasma cells found in the bone marrow. Plasma cells are a type of white blood cell that produces antibodies in the bone marrow to help your body fight infections and diseases.

While there is no cure available for this disease, you can use multiple myeloma medications to ease the pain or slow down its progression.

In multiple myeloma, plasma cells become abnormal and reproduce very quickly. The rapid multiplication of these cancerous cells overwhelms the production of normal cells in the bone marrow. Unlike healthy cells, the cancer cells do not mature and die on their own. Eventually, they accumulate in the bone marrow producing abnormal antibodies called M proteins that cause kidney damage and other complications.

The cause of this disease is still unknown. What is known is that myeloma starts with the development of one malignant plasma cell. Targeted therapy destroys the protein in the cancer cells using a list of multiple myeloma medications and causes them to die.

Symptoms

The symptoms of myeloma can vary from person to person and the initial symptoms may not be even noticeable. However, as cancer progresses, one may experience any of the following major symptoms:

• Calcium (elevated)
• Renal failure
• Anemia
• Bone lesions

Other symptoms may include:

• Nausea
• Constipation
• Loss of appet
• Fatigue
• Frequent infections
• Excessive thirst
• Weakness or numbness in legs
• Weight loss
• Vomiting
• Problems in urinating

If these symptoms persist, make an appointment with your doctor or schedule a checkup.

Diagnosis

Your doctor may even detect the presence of this disease accidentally when you undergo a routine checkup or blood test. Your doctor will decide when you need the treatment based on your signs and symptoms.

Here are the tests that can diagnose multiple myeloma:

• Blood tests
• Urine tests
• Imaging tests
• Biopsy
• Staging
• Bone marrow examination

Risk Factors

People are more likely to develop this disease if they are in the following categories:

• Male
• Black race
• Over the age of 50
• Overweight or obese
• Have a family history of multiple myeloma
• Have a history of MGUS (monoclonal gammopathy of undetermined significance)

Multiple Myeloma Treatment

If the disease progresses and the symptoms get worse, your doctor will have to choose from the following treatment options:

Chemotherapy
It is an aggressive form of therapy in which high doses of anti-cancer drugs are given to the patient. These medications help in killing fast-growing cells and are given before performing bone marrow transplant surgery.

Targeted therapy
This treatment primarily focuses on the substances within malignant cells that cause them to survive. Drugs like bortezomib and carfilzomib injection are used to break down the protein and kill the cancer cells. You can either take these drugs in the form of pills or inject them in your body through the veins in your arms.

Radiation therapy
Strong energy beams like protons or X-rays are used to damage myeloma cells in a specific area of the body and inhibit their growth.

Biological therapy
This therapy includes using your immune system for attacking myeloma cells. Thalidomide, lenalidomide, and pomalidomide are some of the biological therapy drugs that help in boosting your immune system.
Taking lenalidomide 25 mg with dexamethasone is more potent than thalidomide and also has fewer side effects.

Corticosteroids
Corticosteroid drugs like prednisone and dexamethasone can balance your immune system by lowering inflammation. They work as active agents to destroy myeloma cells and can be taken in pill form.

Bone marrow transplant
It is a treatment in which unhealthy bone marrow is replaced with a healthy one. This procedure is also called a stem cell transplant. Before the transplant, the doctor collects healthy blood-forming stem cells from your blood. You are then given high doses of chemotherapy drugs to attack the deceased bone marrow. The collected stem cells are infused in your blood from where they travel to the bones and start rebuilding a healthy bone marrow.

FAQ's

Is multiple myeloma cancer?

Multiple myeloma (MM) specifically is a sort of blood cancer. It basically affects plasma cells, which are a type of WBC that grow in the bone marrow. Healthy plasma cells form antibodies in order to help your body fight infection. Cancerous myeloma cells usually grow out of control in the bone marrow, making tumors that kill bone tissue. The overproduction of the myeloma antibodies may clog the circulation (hyperviscosity syndrome). The myeloma cells may also form tumors in the other body tissues.

What causes multiple myeloma?

Like most other existing cancers, it is not fully specified what causes MM. It begins with the plasma cells multiplying quicker than normal. Genetic changement in the cells may be responsible for triggering quickly and out of controlled growth, but the reason these DNA changes appear is unspecified.

Is multiple myeloma hereditary?

A family history of MM in a parent/sibling is a risk factor for the MM, indicating heredity plays a crucial role. Although, having a family history of multiple myeloma does not mean you will develop this cancer for sure. It means that you inherited a genetic predisposition in order to develop it. One of the major risk factors for this cancer is age. Multiple myeloma most commonly affects people aged 65 years and older. There are also certain other risk factors, which may include:

• African American race
• Exposure to radiation or certain chemicals
• Male gender
• Obesity
• Other plasma cell diseases that may be precursors to myeloma including MGUS. 

Ensure, having all these risk factors does not spontaneously mean you will have MM.

And people without any certain risk factors may develop this cancer. Discuss with your healthcare practitioner in order to learn about your risks.

Is multiple myeloma curable?

Every disease has a cure, and the multiple myeloma is often controllable. By considering stem cell transplant and maintenance therapy it is possible to eliminate the cancer, temporary. Sometimes, this temporary remission may even last for several years. But eventually, the myeloma will return. Goal of the maintenance therapy is basically to prolong the period of time patients are free of myeloma, preserve a standard quality of life, and ultimately, increased survival.

What is new in MM research?

There are numerous currently active areas of research in MM as well as its treatment. The scientists continuously study the disease process in order to understand how myeloma begins and invades. This research is helping in order to identify new targets for medication therapy. Researchers are also evaluating the genetics of the myeloma cells and how they can be hazardous for the immune system to fight them. Additionally, findings are looking at the better ways in order to use drugs and stem cell transplants to increase response as well as remission. Apart from that, there are also several new medications in multiple phases of the clinical trials.

If you are looking forward to participating in a clinical trial, discuss with your healthcare practitioner. 

NOTE: The piece of information provided about "Multiple Myeloma: Everything You Need to Know About the Cancer of Plasma Cells" in this article is for informational purposes and is not served as a substitute for the medical treatment, consultation, diagnosis of an experienced or qualified healthcare professional.

Read:- How Fatal is multiple myeloma

HIV vs AIDS

One of the main differences between HIV and AIDS is that, one is a virus, and the other one is a condition. A person who is with HIV may or may not have AIDS. On the other hand a person with AIDS will always have HIV in the blood.

HIV:

• HIV is a virus.
• HIV has no symptoms.
• A person who is HIV positive does not yet have AIDS may seem to be perfectly healthy.
• A person who is HIV positive does not have AIDS may have an effective as well as active immune system.
• An HIV positive person who does not have AIDS can work and support his or her family.
• Although HIV is of two types HIV-1 and HIV-2

AIDS: 

• AIDS is a disease.
• A person with AIDS may have the symptoms of various diseases which he has acquired, such as TB, meningitis, and cancer.
• A person who carried AIDS may be thin and weak. He or she may feel and look sick.
• The immune system of a person who is with AIDS is rapidly decreased and becomes less effective in order to protect his or her body.

What kind of infections does a person get as HIV begins leading to AIDS?

We are surrounded by disease-causing viruses, fungi, bacteria, and other germs. Some of such even present within our bodies, even without causing any illness. For instance, numerous people carry the latent TB germ in their bodies. However, these germs will not be successful in causing a disease in a person with a healthy immune system. It is only when the immune system is weakened by malnutrition, illness, or a condition like HIV infection, that these germs find an opportunity to cause disease. Such infections are called opportunistic infections.
Some OIs (opportunistic infections) that could be occur as HIV progresses to AIDS include:

• Encephalitis (inflammation in the brain)
• Candidiasis (or thrush, a fungal infection of the mouth or vagina)
• Gastroenteritis (a digestive illness)
• Meningitis
• Pneumonia
• Herpes
• Kaposi’s sarcoma ( a kind of skin cancer)
• Tuberculosis

Important Information: 
People with HIV, who pay attention to their nutrition needs and eat a balanced diet are more likely to develop AIDS later, and also such patients die later than those who are malnourished.
A person who is HIV positive should get information on nutrition from many sources, should discuss with others living successfully with HIV, and talk to the healthcare professionals before deciding what would be the best diet for her/him.

Read:- What are the symptoms of HIV and how to control HIV

Voriconazole administration and its side effects

Voriconazole is an antifungal medication that is used in the treatment of fungus infection.  Along with fungus infection treatment, it is also helpful in preventing the fungal infection in patients with an undergoing BMT. Voriconazole is the most recommended medication used in the treatment of CNS fungal infections that is transmitted by the injection of contaminated steroids.

Voriconazole medication was approved in the United States in 2002 for medical use. Voriconazole is one of the safest and effective medicines. It is also in the list of the World Health organization's list of essential medicines.

Dosage and administration: 

Voriconazole is present in three different forms which are mentioned below:

• Tablets: 50mg, 200mg
• Injections : 200mg
• Oral suspensions: 45mg

Tablets: Each tablet of voriconazole contains 50 mg or 200 mg of active ingredient (Voriconazole). Other inactive ingredients are lactose monohydrate, starch, magnesium stearate, pregelatinized starch, etc.

Voriconazole is administered in the human body by intravenous infusion small vials containing 200mg voriconazole are supposed to be mixed with sterile water for injection.

The oral suspension of voriconazole contains 45 grams of powder that is suspended into the water to produce 40mg/ml voriconazole. The inactive ingredients of the oral suspension are colloidal Silicon dioxide, Titanium dioxide, sodium citrate dihydrate, sodium benzoate, citric sucrose, sucrose, natural Orange flavor.

Side effects: Some common side effects of voriconazole injection are:

• Rash
• Blurred vision 
• Headache 
• Vomiting
• Diarrhea
• Chills 
• Fever 
• Nausea

Some serious adverse reactions of voriconazole 200 mg injection are:

• Embryo-Fetal Toxicity: voriconazole should not be recommended to pregnant women as it may cause fetal damage
• The patient suffering from hereditary galactose intolerance Lapp lactase deficiency: this medication is not used in case of a patient suffering from the hereditary disease 
• Arrhythmias and QT Prolongation: potassium and magnesium concentration should be correct in the body.
• Infusion-related reactions: this medication may mainly cause severe infusions.
• Dermatological reactions: if any dermatological problems occur then the use of voriconazole should be discontinued.
• Skeletal Events: Fluorosis and periostitis may cause long term voriconazole medications.

Drug interaction: Voriconazole 200 mg interacts with many drugs in the body. Voriconazole is contraindicated to be used with rifampin, rifabutin, sirolimus, quinidine. Dose adjustment of voriconazole is done when coadministered with other drugs such as tacrolimus, fluconazole, cyclosporine, and warfarin.

Read:- About Sirolimus - A transplant medication

ALL YOU NEED TO KNOW ABOUT TACROLIMUS

Tacrolimus is an immunosuppressive drug that is used to suppress the immune system to avoid organ rejection mainly liver, kidney, or heart.  It is also used in the treatment of T cell-mediated diseases such as psoriasis, eczema, exacerbation of minimal change disease, severe refractory uveitis, and Kimura's disease.
Tacrolimus work by inhibiting the activity of calcineurin that is involved in the production of interleukin-2. Interleukin-2 helps in the proliferation and development of t cells which are the key function to strengthen the immune system.
Tacrolimus is recommended in the patient having liver for heart transplantation as sirolimus use is not approved in such cases.

Dosage and administration: 

Tacrolimus is available in two forms:

• Capsule: 0.5 mg, 1 mg and 5 mg  
• Injection: 5 mg/mL ( containing dehydrated and alcohol hydrogenated castor oil)      Tacrolimus injection before use must be diluted with 5% dextrose injection for 0.9% sodium chloride injection.

When the patient is injected with tacrolimus injection a constant Observation for at least 30 minutes should be kept off the infusion. if any symptoms of anaphylaxis occur then the infusion is stopped immediately and an aqueous solution of epinephrine is provided.

The dosage of tacrolimus capsules depends upon body weight, age, and type of transplantation.
The oral administration of tacrolimus should be taken with or without food. However, the availability of food may degrade the performance of tacrolimus.
Firstly the dose of tacrolimus is given in capsule form. When the patient is unable to take oral administration of tacrolimus then only tacrolimus is intravenously injected into the patient body. With the injection of tacrolimus, the whole body's blood transfusion is monitored.
Tacrolimus should not be injected into pregnant women as it may cause fetal damage or birth abnormality.

Side effects of Tacrolimus: 

Side effects in cases of different organ transplantation are mentioned below:

• Kidney transplantation: The most common side effects are hypertension, constipation, diarrhoea, headache, abdominal pain, Insomnia, urinary tract infection, hyperlipidemia, hypokalemia anaemia, hypomagnesemia, infection.
• Liver transplant: some adverse reactions of tacrolimus 1 mg are headache diarrhoea hypertension abdominal pain nausea abnormal knee renal function anaemia Insomnia fever pain paraesthesia hypokalemia hyperglycemia hypomagnesemia.
• Heart transplant: some common side effects are hyperglycemia, Diabetes mellitus, hypertension, abnormal renal function, leukopenia, bronchitis, hyperglycemia
• Some other severe side effects of tacrolimus 0.5mg are:
• Polyomavirus Infections: sometimes fatal outcomes such as polyoma virus-associated nephropathy(PVAN).
• Cytomegalovirus (CMV) Infections: Enhanced danger of CMV viremia and disease.
• Diabetes after transplant: blood glucose level is monitored constantly
• Neurotoxicity: acute or chronic nerve problem exists.
• Neurotoxicity: some neurologic abnormality is found such as the risk of posterior reversible encephalopathy syndrome.
• Hypokalemia: potassium level is monitored carefully
• Hypertension: may occur due to drug-drug interaction patients may require antihypertensive drugs.
• Myocardial Hypertrophy: May leads to dosage discontinuation or reduction.
• Pure red cell aphasia: discontinuation of tacrolimus is recommended.
• Immunization: use of live vaccines are avoided.

Drug interaction: 
The interaction of tacrolimus 5mg drug with other medications are listed below:

• Mycophenolic Acid Products: Can increase MPA exposure
• Nelfinavir and Grapefruit Juice: Increased tacrolimus concentrations.
• CYP3A Inhibitors: Increased tacrolimus concentration.
• CYP3A4 Inducers: Decreased tacrolimus concentrations

Tacrolimus uses are contraindicated with other medications as it is not used with a combination of other medications having the same substitute or same constituent of tacrolimus.

The cost of tacrolimus is quite decent and affordable. A respective patient can purchase it through any legitimate pharmaceutical company.

Read:- About Mycophenolate Mofetil a transplant medication

Indications of Abacavir Sulfate

Abacavir, a nucleoside analog reverse-transcriptase inhibitor (NRTIs), is indicated in antiretroviral combination therapy for the treatment of Human Immunodeficiency Virus (HIV) infection in adults, adolescents, and children.

The demonstration of the advantages of this drug mainly depends upon the outcomes of such studies which performed with a twice daily regimen, in treatment-naïve adult patients on combination therapy.
Before initiating treatment with abacavir sulfate, screening for carriage of the HLA-B*5701 allele (which is associated with drug-induced inflammatory disease of the skin) should be performed in such patients who are with HIV-infection, irrespective of racial origin. Individuals with B57 are more sensitive to the drug abacavir and should not be used this medicine in patients known to carry the HLA-B*5701 allele.

This medication should be prescribed by physicians experienced in the management of HIV infection. Abacavir 300 mg can be taken with or without food.

The administration should be performed by taking an entire dose, the tablet should ideally be gulped without crushing.
Oral solution of this drug is existing for use in such children who are over 90 days of age and weighing less than 14 kg.  It is basically recommended for those patients for whom the tablets are inappropriate.
Apart from this, for such patients who are not able to gulp tablets, the tablet can be crushed and added to a small amount of semi-solid liquid or food, all of which should be taken immediately.

How Does it Work:
Abacavir is an NRTI which is a potent selective inhibitor of Human Immunodeficiency Virus-1 (HIV-1) and Human Immunodeficiency Virus-2 (HIV-2). Abacavir mainly metabolised intracellularly to the active moiety, TP (carbovir 5’- triphosphate). In vitro observations have specified that its mechanism of action in relation to Human Immunodeficiency Virus is inhibition of the HIV reverse transcriptase enzyme, an event which demonstrates in chain termination as well as interruption of the viral replication cycle. The existing antiviral functions and activity of this medicine in cell culture was not antagonized when come with the NRTIS (nucleoside reverse transcriptase inhibitors) emtricitabine, didanosine, lamivudine, stavudine, zidovudine or tenofovir, the NNRTI (non-nucleoside reverse transcriptase inhibitor) nevirapine, or the PI (protease inhibitor) amprenavir.

Common Side Effects: The most common symptoms of Abacavir 300 mg are: Fever (high temperature) and skin rash.
Other common symptoms are nausea (feeling sick), vomiting (being sick), diarrhoea, abdominal (stomach) pain and severe tiredness.
Some other possible symptoms include Pains in the joints or muscles, swelling of the neck, shortness of breath, sore throat, cough, occasional headaches, inflammation of the eye (conjunctivitis), mouth ulcers, tingling or numbness of the hands or feet and low blood pressure.
.

Check detailed about side effects of Abacavir Sulfate

All you need to know about Mycophenolate mofetil

Mycophenolate Mofetil Tablets are used to prevent your body from rejecting a transplanted kidney, heart, or liver. Mycophenolate Mofetil is used together with other medicines known as ciclosporin and corticosteroid.

How to take Mycophenolate Mofetil Tablets: 

Always take Mycophenolate Mofetil exactly as your doctor has told you. Tablets must be swallowed whole with the glass of water. Do not break or crush them. The amount you take depends on the type of transplant you have had. The usual doses are shown below. Treatment shouldn't be interrupted for as long as you need to prevent you from rejecting your transplant organ.

Adults with Kidney transplant:

• The initial dose should be given within 3 days of the transplant operation.
• Daily dose should be 4 tablets and should be taken as 2 separate doses.
• Take 2 tablets in the morning and then 2 tablets in the evening.

Children (aged 2 to 18 years) with Kidney Transplant: 
The dose should vary depending on the size of the child.
Your healthcare professional will decide the most appropriate and precise dose based on your child’s height and weight.

Adults with a Heart transplant: 

• The initial dose should be given within 5 days of the transplant operation.
• The daily dose should be 6 tablets, should be taken as 2 separate doses. 
• Take 3 tablets in the morning and then 3 tablets in the evening.

Children with a Heart transplant:
There is no information for the use of Mycophenolate 250 mg in children with a heart transplant.

Adults with Liver transplant: 

• The initial dose of Mycophenolate Acid should be taken at least 4 days after the transplant operation and when you are able to swallow oral medicines.
• The daily dose should be 6 tablets, taken as 2 separate doses. 
• Take 3 tablets in the morning and then 3 tablets in the evening. 

Possible Side Effects of Mycophenolate Mofetil:

Like all medicines, this medicine can cause side effects, although not everybody gets them.

Very common: These side effects are as follows:

• Feeling sick (nausea)
• Vomiting
• Fewer white cells or red cells in your blood
• Stomach and gut infections
• Urinary system infections
• Mouth infections

Common: 
Common side effects with Mycophenolate Tablets medication may occur as:

• Lung infections
• Skin infections
• Cancer of the lymphoid tissues and skin.
• Fever, feeling very tired, difficulty sleeping
• Stomach pain, chest chest, joint or muscle, pain on passing urine. 
• Headache, flu symptoms and swelling.
• Acne, cold sores, shingles, skin growth, hair loss, rash, itching.
• Kidney problems or the urgent need to pass water (urine).
• Swelling of the gums and mouth ulcers
• Inflammation of the pancreas, colon or stomach
• Gut problems including bleeding, liver problems 
• Constipation, indigestion, loss of appetite, flatulence, diarrhoea
• Feeling dizzy, drowsy or numb 
• Tremor, muscle spasms, convulsions 
• Feeling depressed or anxious. 
• Changes in your mood or thoughts.
• Weight loss, gout, high blood sugar. 

FAQ:

If I take an overdose of Mycophenolate Mofetil Tablets then what will happen?

Ans:-
If you take more Mycophenolate 500 mg tablets than you have been told to take, or if someone else accidentally takes Mycophenolate Mofetil Tablets, immediately connect with a doctor or go to a hospital straight away. Take the medicine pack with you.

If I forget to take a dose of Mycophenolate then what should I do?

Ans:-
If you forget to take Mycophenolate 500 mg tablets at any time, take it as soon as you remember, then continue to take it at the usual times. Never takes a double dose to make up for a missed dose.

How to store Mycophenolate Mofetil Tablets?

Ans:-
Do not store above 25°C. Always should be protected from light. Do not use Mycophenolate 500 mg medicine after the expiry date, which is stated on the carton (EXP). You shouldn't throw away any of your medicines via household waste or wastewater. Discuss with your healthcare providers how to throw away drugs you no longer use. These measures will help in order to protect the environment.

How toxic is HIV medications?

Antiretroviral therapy (ART) has transformed the Human Immunodeficiency Virus (HIV) infection into a manageable chronic disease. There is a long list of HIV medications that have the potential to cause short-term and long-term adverse effects. The spectrum of potential ARV (antiretroviral) drug toxicity is broad, including renal toxicity, mitochondrial and metabolic effects, gastrointestinal symptoms, cardiovascular effects, hypersensitivity, skin reactions, insomnia, or other neuropsychiatric manifestations, and many other complications. Furthermore, as life expectancy for individuals with HIV has increased, the long-term safety of antiretroviral therapy has garnered increasing attention. On the other hand, newer antiretroviral medications have improved as well as enhanced safety profiles compared with the older antiretroviral medications, and this is reflected in the recommendations issued in the Adult and Adolescent ARV Guidelines. If you're in ambivalence in order to know how to control HIV infection then if you're living with HIV you should have an understanding of the basic toxicity profile of  ARV drugs (antiretroviral). Apart from this, you should keep in mind that the potential side effects of most ARV medications are less toxic than the effects of untreated HIV.

The illustration of groupwise probable drug toxicity is as follows:

Nucleoside Reverse Transcriptase Inhibitors: 

The nucleoside reverse transcriptase inhibitors (NRTIs) have several notable class-wide mitochondrial and metabolic effects, though these adverse effects rarely occur with the newer NRTI agents. Any potential impact of the NRTIs on human mitochondria is important, since mitochondria play an essential role in producing energy for the cell in the form of adenosine triphosphate. Mitochondrial toxicity caused by NRTIs induces a wide range of adverse effects, such as lactic acidosis, hepatic steatosis, myopathy, cardiomyopathy, peripheral neuropathy, pancreatitis, and possibly lipodystrophy syndrome. Chronic use of older NRTIs, such as didanosine, stavudine, and zidovudine, can inhibit gamma-DNA polymerase-gamma, the key enzyme responsible for mitochondrial DNA replication; this inhibition can decrease cellular oxidative phosphorylation, increase intracellular lipids, and cause accumulation of lactic acid. The probability of neuropathy and lipoatrophy generally appears with the long-term use of these older NRTIs. These complications only partially reverse, or do not reverse at all, with discontinuation of the offending medication. Such adverse effects are extremely rare with modern NRTIs, such as tenofovir alafenamide, tenofovir DF, abacavir, lamivudine, and emtricitabine. Some other terms may occur as toxicity, which are as follows:

• Hyperlactatemia and Lactic Acidosis
• Peripheral Neuropathy
• Hyperlipidemia
• Lipoatrophy
• Hypersensitivity Reaction
• Cardiovascular Risk
• Nephrotoxicity
• Risk Factors for Nephrotoxicity
• Bone Marrow Suppression
• Myopathy
• Proteinuria

Non-Nucleoside Reverse Transcriptase Inhibitors: 

There are six non-nucleoside reverse transcriptase inhibitors (NNRTIs) that have been FDA approved for use: doravirine, efavirenz, etravirine, nevirapine, and rilpivirine. Some toxic reactions with this group of drugs are as follows:

• Cardiac QTc Interval Prolongation
• Dyslipidemia
• Hepatotoxicity
• Neuropsychiatric
• Rash
• Teratogenicity
• Hypersensitivity Reaction
• Elevated Serum Creatinine
• Neuropsychiatric

Integrase Strand Transfer Inhibitors: 

The (INSTIs) generally are well tolerated and drug interactions are minimal. Based on the clinical trials, most frequently reported adverse reactions were headache, nausea, diarrhea, insomnia, and fatigue, but generally were not significant enough to warrant stopping therapy. Behalf of some studies that have specified the integrase strand transfer inhibitors, mainly dolutegravir, lead to greater weight gain than other classes of antiretrovirals, but the mechanism and clinical significance are unclear. Rare cases of INSTIs mood changes or new onset of psychiatric disorders have been observed with INSTIs. A few more toxic effects of INSTIs are elaborated as follows:

• Potential Neural Tube Defects
• Elevated Serum Creatinine
• Insomnia
• Myopathy and Elevated Creatine Phosphokinase
• Elevated Creatine Kinase
• Proximal Myopathy
• Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis. 

Protease Inhibitors: 

There are currently 10 FDA-approved HIV protease inhibitors (PIs), but in the Adult and Adolescent ARV Guidelines, none are designated in the category of Recommended Initial Regimens for Most People with HIV. PIs may be responsible for some other toxic reaction, which are given as:

• Gastrointestinal Adverse Effects
• Cardiovascular Risk
• Cardiac Conduction Abnormalities
• Bleeding Risk in Persons with Hemophilia
• Lipo-accumulation
• Hyperbilirubinemia
• Nephrolithiasis
• Cholelithiasis
• Hyperlipidemia
• Diarrhea
• Alcohol in Liquid Formulation

Entry Inhibitors:

• Rash
• Hepatotoxicity
• Impact of Host Immune Function

Pharmacologic Boosters: 

Ritonavir and cobicistat are pharmacokinetic enhancers to boost the concentration of other antiretroviral agents used in HIV treatment. Both medications work by interacting with the hepatic metabolism of antiretroviral drugs through the cytochrome P450 (CYP450) system; however, because of this mechanism of action, they can also affect the levels of other medications that are coadministered, leading to clinically significant (and occasionally unpredictable) drug interactions and potential adverse effects. This class of medications associated with several toxic reactions, which are as follows:

• Abdominal pain
• Diarrhea
• Nausea
• Vomiting
• Gastrointestinal Symptoms

NOTE:  Numerous existing antiviral HIV/AIDS medications, were being researched as COVID‑19 treatments, with some moved into clinical trials.
And according to clinical studies some HIV medications are also helpful in COVID 19.

All you need to know about the side effects of Ribavirin

Ribavirin contains the active substance ribavirin. This medicine stops the multiplication of hepatitis C virus. Ribavirin must not be used alone.
Depending on the genotype of the hepatitis C virus that you have, your doctor may choose to treat you with a combination of this medicine with other medicines.
The combination of Ribavirin and other medicines is used in order to treat adult patients who have chronic hepatitis C (HCV).
Like all medicines, Ribavirin 200 mg used in combination with other medicines can cause side effects, although not everyone gets these adverse reactions. Apart from this, not all of these undesired adverse reactions may occur, and if they do occur, immediately seek medical attention.

• Severe stomach pain
• Black or tar-like stools
• Blood in stool or urine
• Severe bleeding from your nose
• Chills or fever.
• Lower back or side pain
• Painful or difficult urination
• Problems with your eyesight or hearing,
• Severe skin rash or redness

Contact your healthcare provider immediately if you observe any of the following side effects occurring during combination treatment with other medicines:

• Chest pain or persistent cough; changes in the way your heart beats, fainting. 
• Confusion, feeling depressed, suicidal thoughts. 
• Attempt suicide, aggressive behaviour.
• Feelings of numbness or tingling. 
• Trouble sleeping, thinking or concentrating. 
• Severe stomach pain, black or tar-like stools, blood in stool or urine, lower back or side pain. 
• Painful or difficult urination. 
• Irregular or no menstrual period, disorder of vagina, inflammation of the vagina, development of male body traits, testis pain. 
• Eczema, increased or decreased sensitivity to touch, acne, bruising, increased sweating, increase in muscle movement, tense muscle, irritation or itching at the site of injection, nail disorder, limb pain. 

Very commonly reported side effects:
Very common side effects are as follows:

• Decreases in the number of red blood cells (that may cause fatigue, shortness of breath, dizziness), decrease in neutrophils (that make you more susceptible to different infections).
• Difficulty in concentrating, feeling nervous, feeling depressed or irritable, mood swings, tired feeling, staying asleep, trouble falling. 
• Cough, dry mouth, pharyngitis (sore throat). 
• Dizziness, diarrhoea, fever, flu-like symptoms, nausea, headache, shaking chills, virus infection, weakness, vomiting. 
• Loss of weight, loss of appetite and stomach pain. 
• Dry skin, irritation, hair loss, itching, muscle pain, muscle aches, pain in joints and muscles, rash.

Commonly reported side effects: 
The following mentioned are not the full list of commonly reported side effects:

• Bruising and spontaneous bleeding, decrease in certain white blood cells, low calcium level in the blood, severe anaemia. 
• Fungal or bacterial infections, crying, agitation, amnesia, memory impaired, nervousness, abnormal behaviour, aggressive behaviour, anger, feeling confused, lack of interest, mental disorder, mood changes, unusual dreams, wanting to harm yourself, trouble sleeping, feeling sleepy, lack of interest in sex or inability to perform, spinning feeling (vertigo). 
• Blurred or abnormal vision, eye irritation or pain or infection, dry or teary eyes, changes in your hearing or voice, ringing in ears, ear infection, earache, cold sores (herpes simplex), change in taste, taste loss, bleeding gums or sores in mouth, burning sensation on tongue, sore tongue, inflamed gums, tooth problem, migraine, respiratory infections, sinusitis, nose bleed, nonproductive cough, rapid or difficult breathing, stuffy or runny nose, thirst, tooth disorder. 

Uncommonly reported side effects:
The uncommonly reported side effects in patients with Ribavirin capsule are as follows:

• Abnormal behaviour, emotional disorder, fear, nightmare. 
• Bleeding of the mucous membrane that lines the inner surface of the eyelids, blurred vision, drowsiness, intolerance to light, itchy eyes, facial pain, inflamed gums. 
• Chest discomfort, difficult breathing, lung infection, nasal discomfort, pneumonia, wheezing. 
• Low blood pressure. 
• Enlarged liver. 
• Painful menstruation. 
• Pain in the skin, peeling of skin, redness, swelling, paleness. 

Read:- How Ribavirin is helpful in the treatment of Hepatitis C

Brief on side effects of Lamivudine

Lamivudine is a nucleoside analogue which has activity against HIV-1, HIV-2 and hepatitis B virus.
Lamivudine must be converted intracellularly to its triphosphate form, which then competes with cytosine triphosphate for incorporation into the developing viral DNA strand. This results in chain termination and ceases viral DNA replication.

Like other medicines, Lamivudine 300 mg Tablets can cause several side effects or adverse effects, although not everybody gets them.
When treating HIV-infection, it is not always possible to differentiate between undesired adverse effects caused by Lamivudine medication, and those caused by any other medicines you may be taking at the same time, and by the Human Immunodeficiency Virus (HIV)disease. For such circumstances, it is quite necessary that you should talk to your healthcare provider or doctor of any kind of change in your health or body.

The major side effects of Lamivudine Tablets are lactic acidosis and hepatomegaly, severe
worsening of hepatitis B, hepatic decompensation, pancreatitis, immune reconstitution syndrome
and redistribution/accumulation of body fat.
Major side effects have also occurred in patients with HIV-1 and hepatitis B co-infection, and in patients who use other lamivudine- and emtricitabine containing products with Lamivudine Tablets.

Very commonly reported (greater than 1 in every 10 patients treated) side effects are as follows:

• headache 
• malaise
• fatigue
• fever or chills
• nausea 
• vomiting
• diarrhea
• anorexia
• decreased appetite
• neuropathy
• insomnia (trouble sleeping) and other sleep disorders
• dizziness,
• nasal signs and symptoms,
• cough, and musculoskeletal pain. 
• Commonly reported (greater than 1 in every 100 patients treated) side effects are mentioned as follows:
• abdominal pain or cramps
• dyspepsia
• depressive disorders
• skin rashes
• myalgia, and arthralgia. 

Uncommonly reported (between 1 in 1,000 and 1 in 100 patients treated) side effects are pancreatitis.
Combination antiretroviral therapy may be responsible for a condition often known as lactic acidosis, which is a build-up of lactic acid in the body, which may cause dehydration, liver damage, and also coma have been observed on the rare occasions in patients with NRTIs. Deep, rapid breathing, drowsiness, and no specific symptoms such as nausea, vomiting and stomach pain, may indicate the development of lactic acidosis. A majority of these cases have been in women. If you are very overweight (obese) you may be at higher risk for this rare but serious side effect. If you have liver disease or prolonged nucleoside exposure you may also be at greater risk of getting this condition. Treatment with lamivudine should be stopped if you develop symptoms or laboratory results suggestive of lactic acidosis or pronounced liver toxicity.

Read:- Lamivudine for HIV as well as Hepatitis B treatment

Brief on side effects of Atazanavir ritonavir tablets

Atazanavir-ritonavir combination drug is an antiretroviral medication that is used in the treatment of HIV or AIDS. Both of these drugs belong to the protease inhibitor class and work by inhibiting the HIV protease activity. In this combination, ritonavir works as a pharmacokinetic booster that is used in a very low amount for boosting the concentration of atazanavir in human blood.

Atazanavir ritonavir tablet is consumed as a replacement of lopinavir-ritonavir combination drug and is taken orally.

Side effects of Atazanavir Ritonavir tablets: 

Some common side effects of atazanavir ritonavir combination tablet are:

• Vomiting 
• Stomach pain 
• Diarrhoea
• Nausea 
• Fever 
• Muscle pain 
• Headache 
• Insomnia 
• Depression
• Numbness 
• Burning sensation in hand and feet
• Tingling
• Elevation in Bilirubin
• Heartburn 
• Loss of appetite
• Mood swings
• Change in taste

Some very common side effects of this tablet are:

• Trouble sleeping
• Nausea 
• Fever 
• Sleepiness 
• Sadness 
• Difficulty in concentrating 
• Back pain
• Weakness 
• Pain in joints 
• Increase in the level of cholesterol

Few serious adverse reactions of atazanavir ritonavir tablets include: 
Chronic kidney diseases include kidney stone and gallbladder problems

• Kidney stone: the symptoms of kidney stones are a pain in the lower stomach, blood in urine, or pain while urinating. 
• Gallbladder problems: the symptoms of gallbladder problems can be a pain in lower stomach, fever, nausea, and vomiting.
• Jaundice: yellowing of nails and skins occur.
• Hyperglycemia: elevation in sugar level in the blood. 
• Immune reconstitution inflammatory syndrome(IRIS): the immune system strengthens itself to fight against the previous infection. 
• Haemophilia: an increase in bleeding problems in people caused haemophilia. 
• Renal problems: several problems have been detected in the renal tubule while or during the treatment.
• Dislocation of body fat or redistribution of body fat: body fat of several areas are dislocated.
• Vision change: Things appear blur
• Sign of infection: symptoms of infection are reported.
• Symptoms of an increase in the thyroid gland. 
• Several nerve problems. 

Brief on side effects of Atazanavir Sulphate

Atazanavir sulphate is an antiretroviral medication that is used in the prevention and treatment of HIV or AIDS. It is generally used in combination with other antiretroviral medications. The efficiency of atazanavir is known by antiretroviral therapy (ART) treatment.

Atazanavir sulphate works by binding HIV protease and inhibiting it's for the synthesis and multiplication.

Side effects of Atazanavir Sulphate: 

Some common side effect reactions of this tablet are:

• Pain in joint 
• Muscle stiffness 
• Body ache
• Unsteadiness 
• Weakness
• Difficulty in movement of hand and legs
• Numbness
• Burning sensations
• Painful sensation
• Rash 
• Elevated AST
• Lipodystrophy syndrome
• Dyspepsia
• Dizziness 
• Peripheral neurological symptoms

Some very common side effect of atazanavir 300 mg (atazanavir sulphate) tablet are:

• Nausea 
• Fever 
• Vomiting 
• Headache
• Extra body fat
• Irritability
• Back pain
• Trouble sleeping
• Drowsiness
• Depression 
• Insomnia
• Trouble concentrating 
• Jaundice
• Myalgia
• Elevated bilirubin
• Elevated total cholesterol

Few serious or rare adverse reactions of Atazanavir Sulphate are as follows:

• Kidney stones: patients may develop kidney stones and extreme pain over the lower abdomen, so in these cases, the drug should be discontinued and health provider information should be taken.
• Rash: itchiness or redness of skin occurs.
• Gallbladder problems: If pain in the middle-upper stomach area occurs then and there may be a problem in the regular functioning of the gallbladder. 
• Hyperglycemia: elevation in blood sugar level. 
• Hepatosplenomegaly: swelling and enlargement of liver or spleen might be caused due to uptake of atazanavir sulphate tablet. 
• Edema: puffiness caused by fluid trapped in body cells.
• Eczema: Rash or itchy inflammation that occurs on the skin. 
• Myopathy: negative effects on muscles occur when atazanavir sulphate tablet is used for a long duration.
• Ketoacidosis: atazanavir can cause a serious diabetic problem in which the body produces excess acids.
• Vasodilation: broadening of blood vessels has been noted.
• Cardiac conduction abnormality: PR interval prolongation may occur in some patients. 
• Hepatotoxicity: people suffering from hepatic impairment are prone to damage. 
• Haemophilia: spontaneous bleeding may occur.

Read more

All you need to know about Bosutinib

Bosutinib is a src tyrosine kinase inhibitor that is used in the treatment of chronic myelogenous leukemia, which has resistance intolerance to prior therapy. Bosutinib inhibits the activity of platelet-derived growth factor and vascular endothelial growth factor.

On September 4, 2012, and 27 March 2013, Bosutinib was approved by US FDA and EU European Medicines Agency approval
respectively in order to treat adult patients with Philadelphia chromosome-positive (Ph+) chronic myelogenous leukemia (CML) with resistance, or intolerance to prior therapy.

Dosage and Administration: 

Bosutinib tablets are present in two different concentrations that are 100 mg and 500 mg. The recommended dose of Bosutinib tablets is 500 mg daily. Hepatic impairment reduces the dose of the bosutinib tablets to 200 mg.
The dose is adjustable in case of hematologic and non- hematologic toxicity.

Side effects of Bosutinib: 

Some common side effects of the bosutinib 500mg tablet are:

• Diarrhoea 
• Nausea
• Vomiting
• Abdominal pain
• Rash
• Anemia
• Fatigue 
• Thrombocytopenia

On the other hand, some common side effects as Drug hypersensitivity, Dehydration, Hyperkalaemia (high blood potassium), low blood phosphate, Dizziness, Dysgeusia (distorted sense of taste), Pericardial effusion, Pleural effusion, QT interval prolongation, Shortness of breath, Gastritis (stomach swelling), Hepatotoxicity (liver dysfunction/damage), Abnormal LFTs, Elevated blood bilirubin levels, GGT increased, Acne, Itchiness, Hives, Myalgia (muscle aches), Back pain, Kidney failure, Chest pain, Muscle weakness, Increased blood creatinine, Increased lipase, Increased blood amylase level and Elevated blood creatine phosphokinase

Some serious adverse reactions of the bosutinib tablets are

• Gastrointestinal toxicity: if any symptom of toxicity appears then the drug use is discontinued.
• Myelosuppression: blood count measurement is necessary
• Hepatic toxicity:  monitor of the Liver enzyme is very necessary
• Embryo-fetal toxicity: causes damage to fetal and main cause toxicity.

How Does Bosutinib work: 

Bosutinib 500 mg is an ATP-competitive Bcr-Abl tyrosine kinase inhibitor with an additional inhibitory effect on SRc family kinases (including Src, Lyn, and Hck). This drug has enough potential against the receptors for vascular endothelial growth factor and platelet derived growth factor.
This medication basically inhibited imatinib-resistant forms of Bcr-Abl expressed in murine myeloid cell lines. The ratio is about 16 of 18 but did not inhibit V299L and T315I mutant cells. Bosutinib is metabolized through CYP3A4.

Drug Interactions:

• Drugs containing Proton pump inhibitors decrease the amount of Bosutinib 500 mg in the human body.
• Should be avoided the concurrent use of this medication with moderate Or strong CYP3A inhibitors and inducers.
• Bosutinib 500mg  is not recommended to be used in a person who has a problem of hypersensitivity.
• Bosutinib is basically known as the substrate and also an inhibitor of CYP3A4 and P-glycoprotein (P-gp). Hence CYP3A4 inhibitors and P-gp are able to increase the plasma levels of bosutinib. In this way, CYP3A4 inducers may reduce the existing plasma concentrations of bosutinib 500 mg. It can also alter the metabolism and uptake of other drugs that are substrates for CYP3A4 and P-gp. 

Read:- HIV treatment related guidelines

All you need to know about Ritonavir

Ritonavir (Norvir): Norvir was the first representative of a new class called protease inhibitors for the treatment of HIV-infected patients.

Ritonavir is basically indicated in combination with another antiretroviral nucleoside analogue (s) for treating the HIV-1 infected patients with advanced or progressive immunodeficiency”.

Some clinical studies shows that, ritonavir mainly used as a pharmacokinetic enhancer (low doses) in order to boost the plasma concentrations of other PIs (protease inhibitors) in Human Immunodeficiency Virus (HIV)-infected patients has become available. According to the review of CHMP of data on quality, efficacy, and safety, the CHMP (Committee for Medicinal Products for Human Use) considered by consensus that the benefit or risk profile of Ritonavir (Norvir) was quite favourable when it combines with other antiretroviral agents for the treatment of such patients who are HIV-1 infected (adults and children of 2 year age and older).

Ritonavir with Lopinavir:

The class of Lopinavir/ritonavir is an HIV protease inhibitor. The combination of Lopinavir ritonavir has antiviral activity against HIV-1.

Mechanism of Action: Lopinavir/ritonavir inhibits the HIV protease enzyme by forming an inhibitor-enzyme complex thereby preventing cleavage of the gag-pol polyproteins. Non-infectious viral particles (Immature) are subsequently produced.

Mechanism of Resistance: Greater levels of PIs (protease inhibitor) resistance result from the accumulation of multiple protease inhibitor-resistance mutations. There are several mechanisms of resistance. These include

• Effects on dimer stability.
• Alterations in enzyme catalysis. 
• Alterations in inhibitor binding kinetics. 
• Re-shaping of the active site.
• Reduced binding affinity between the protease enzyme and inhibitors.

Adverse Effects: Some side effects of this combined medication are as follows:

• Diarrhea
• Nausea
• Asthenia
• Abdominal pain
• Vomiting
• Headache
• Rash
• Hyperglycemia
• Uremia
• Hyperbilirubinemia
• Elevated AST or ALT
• Hypercholesterolemia
• Hypertriglyceridemia
• Elevated amylase
• Hypophosphatemia and Neutropenia

Dosage:

For adult patients the recommended dose of lopinavir and ritonavir tablets is 400/100mg (3 capsules or 5.0mL) twice daily, should be administered with food.

Contraindications Or Warnings: Lopinavir/ritonavir is contraindicated with the following medications:
astemizole, terfenadine, dihydroergotamine, ergonovine, ergotamine, methylergonovine,
cisapride, pimozide, midazolam, and triazolam.

Drug Interactions: In vitro, Lopinavir/ritonavir has been shown to be a substrate for, and inhibitor of, CYP3A. In vivo, this combined drug has shown induction and autoinduction of other drugs mainly metabolized by the CYP450 enzymes. The drug is generally metabolized through the enzyme named CYP450 which may interact with lopinavir/ritonavir.

Ritonavir with Atazanavir:

Atazanavir/ritonavir is a combination medication used in the treatment of HIV/AIDS. It combines atazanavir ritonavir. This combination can be preferred instead of the lopinavir/ritonavir.
Where Atazanavir works as Protease inhibitor and Ritonavir works as Protease inhibitor (pharmacokinetic booster).

Side Effects: Side effects with these combined medications are generally minimal.
They may include as follows:

• Abdominal pain
• Diarrhea
• Yellowish skin
• Muscle pains
• Headache.

Greater care is recommended in people with underlying liver problems.

Dosage: The recommended dose of Atazanavir Ritonavir tablets should be based on the prescription of your healthcare provider.

Ritonavir with Darunavir:

Combination of Darunavir Ritonavir:
This combination is also quite effective.
The combination often combines Darunavir and Ritonavir.  This antiretroviral medication is generally used in the treatment and prevention of HIV/AIDS.

Read:- How to cure Hepatitis B

How to cure Hepatitis B

Hepatitis B is an infectious disease, mainly caused by the HBV (hepatitis B virus) which involves in affecting the liver. It causes acute and also chronic infection. Initially, many people with this disease have no symptoms.

Treatment mainly depends on the severity. Chronic circumstances mainly require medications and sometimes a liver transplant. With the help of Medications (Antiviral drug) and Self-care (Avoid alcohol), Hepatitis B can be managed.

Some medications which are effective are elaborated as follows:

1. Antivirals (Nucleoside Analogues)

A) Entecavir (Baraclude): 

The pills of this drug should be taken once a day, with few side effects, for at least one year or longer. Treating a patient with the help of this antiviral is considered as a first-line treatment with a pretty handy resistance profile. The medication was approved in 2005 for medical use.

Entecavir (ETV), basically sold under the brand name Baraclude, is an antiviral medication used in the treatment of hepatitis B virus (HBV) infection. In those patients who are with HIV/AIDS as well as HBV, antiretroviral drugs can be also used.

Entecavir basically belongs to the family of nucleoside reverse transcriptase inhibitors (NRTIs) medications. It functions by preventing the hepatitis B virus from multiplying by blocking reverse transcriptase.

It is also effective in order to prevent the HBV reinfection after the liver transplant and in the treatment of HIV patients infected with HBV. It's  efficacy has been studied in numerous randomized, double-blind, and multicentre trials. When Entecavir is administered by mouth, it is more effective and well-tolerated.

Side Effects: 
The majority of people with entecavir have little to no side effects. The most common side effects include:

• Headache
• Fatigue
• Dizziness
• Nausea

Less common adverse effects include diarrhea, trouble sleeping, vomiting and gastrointestinal symptoms such as sour stomach.

Dosage: Entecavir tablets mainly comes as the strength of:

• Entecavir 0.5 mg
• Entecavir 1 mg

Related:- Check what is the difference between Entecavir 0.5 mg and 1 mg


Entecavir should be given on an empty stomach at least a couple of hours prior or after the meal, generally, it should be taken at the same time every day. It is not recommended to use in those children who are less than 2 years of age. For people with decreased kidney function, dose adjustment can be recommended.

B) Tenofovir disoproxil (Viread): 

This pill of this medication should be taken once a day. A few side effects may pop up due to the consumption of this ART. This ART is considered as a first-line treatment with a good resistance profile. The medication was approved in 2008 for medical use.

C) Tenofovir alafenamide (Vemlidy): 

The pills of this drug are recommended to be taken once a day. A few side effects may appear due to the consumption of this antiviral. Vemlidy is considered as a first-line treatment with a good resistance profile. The medication was approved in 2016 for medical use.

D) Telbivudine (Tyzeka or Sebivo): 

The pills of this medication should be taken once a day, A few side effects may occur due the consumption of Telbivudine. This is considered a second-line treatment option. The medication was approved in 2006 for medical use.

E) Adefovir Dipivoxil (Hepsera): 

The pills of this drug should be taken once a day. A few adverse effects may appear due to the consumption of Adefovir Dipivoxil. Treatment with this drug is generally considered a second-line treatment option. The patients are advised to monitor their kidney functions, regularly. The medication was approved in 2002 for medical use.

F) Lamivudine (Epivir): 

The pills of this medication (Lamivudine)should be taken once a day, The few side effects may occur in patients due the consumption of lamivudine. This is basically not used or less used in the U.S. because it is less potent than the newer drugs and most people develop drug resistance within a year or sometimes two. The medication was approved in 1998 for medical use.

2. Immune Modulators (Interferons)

Pegylated Interferon (Pegasys): 

This should be given by injection once a week usually for 6 months to  1 year. Pegylated Interferon may cause adverse/side effects such as depression and flu-like symptoms. The medication was approved in 2005 for medical use.

Read:- Oseltamivir phosphate and its Administration

Favipiravir is on trial for the treatment of COVID 19:- A brief Discussion

In 2014 the Favipiravir, an antiviral was approved for medical use in Japan, which sold under the brand name Avigan. This antiviral medication is indicated for the treatment of influenza in Japan. Apart from this, the medicine is also being studied in order to the treatment of several other viral infections. The indication of Favipiravir is for novel influenza instead of seasonal influenza.
Novel influenza is basically strains, that are responsible in order to cause more severe disease. So far, the probability of resistance developing appears low.

In order to the experimental treatment of the emergent COVID-19, in February 2020 Favipiravir was being studied in China. In Japan, trials of this medication are also being planned.

In China, Favipiravir has been approved in order for use in the clinical trials of coronavirus disease in 2019.

After China, Italy also approved the drug for experimental use against COVID-19 in March 2020. These trials were conducted in the three major regions that were affected by the pandemic. The IPA (Italian Pharmaceutical Agency), has reminded the public that the existing evidence in support of this drug is scant and preliminary.

On 20'th April 2020, three hospitals in Massachusetts made a decision to study.  A trial in London, UK, going to be held by early May 2020.

According to the statement of Glenmark Pharmaceuticals, they have received the Indian drug controller's approval in order to conduct the clinical trials on Favipiravir. This antiviral drug is being used for treating Covid-19 in some countries across the world. Approximately 150 patients will be enrolled for this clinical trial and every participant's going to receive favipiravir plus standard supportive care or only standard supportive care. In trials, the duration of the treatment is a maximum of 14 days and the total study duration will be a maximum of 28 days from randomisation.

Fujifilm Toyama Chemical confirmed that the medication has potential against influenza viruses. In Japan, Avigan has been approved for use in the treatment of novel influenza virus infections. On the other hand, Fujifilm has started the phase-3 trial and increased the production of this drug.
The Executive Vice President of Global R&D, Glenmark Pharmaceuticals Limited, Mr. Sushrut Kulkarni stated as, "Glenmark has been all set in order to initiate the immediate clinical trials on Favipiravir on COVID-19 patients in India. These clinical trials will help by showing the efficacy of this molecule on the COVID-19 patients.” He also added, "if the outcome of these clinical trials will be effective and positive, favipiravir could become a potential treatment for Covid-19 patients.

Read:- List of HIV Medications which are helpful for the treatment of COVID-19

All you need to know about the combination of Lopinavir and Ritonavir

In the year of 2000, in the United States, the Lopinavir ritonavir was approved as a single medication for use in the medical. This fixed-dose combination medication is on the WHO's (World Health Organization's) List of Essential Medicines, the safest and most effective medicines needed in a health system.

The combination of Lopinavir and Ritonavir, both the medications are HIV protease inhibitors. Where Ritonavir mainly works by slowing down the breakdown of lopinavir.

This fixed-dose combination drug sold under the brand name Kaletra. It is basically recommended for the treatment as well as prevention of HIV/AIDS. In this combined medication, the dose of ritonavir should be low. These HIV protease inhibitors must be used with other antiretrovirals. It could be also used for prevention after a needlestick injury or other potential exposure. Till 2006, lopinavir/ritonavir was the most recommended and also most preferred fixed-dose combination medicine for Human Immunodeficiency Virus (HIV) as a first-line therapy by the U.S Department of Health and Human Services.

Apart from this as like several other Human Immunodeficiency Virus (HIV) protease inhibitors, its blood levels are greatly increased by low doses of ritonavir, a potent inhibitor of intestinal and hepatic CYP3A4, (basically an important enzyme in the body, mainly found in the liver and in the intestine. It oxidizes small foreign organic molecules (xenobiotics), such as toxins or drugs) which would otherwise reduce drug levels through catabolism.

Thus, lopinavir was only formulated and marketed as a fixed-dose combination with ritonavir.

Dosage of Lopinavir Ritonavir: 

The recommended daily dosage should be given as 800/200 mg once or twice daily. Also this combination medication can be given as once daily or twice daily regimen. The increased dose of lopinavir and ritonavir should be used when it  combines with the efavirenz, nevirapine, or nelfinavir. The combined Lopinavir and Ritonavir tablets shouldn't be recommended for once-daily dosing in pediatric patients who are younger than 18 years of age. Lopinavir 100 mg and ritonavir 25 mg tablets should be recommended only in those children who have reliably demonstrated the ability to swallow the intact tablet.

What are the Side Effects of Lopinavir Ritonavir:

The most common side effects observed with lopinavir-ritonavir tablets are as follows:

• Rash
• Diarrhea
• Nausea
• Asthenia
• Headache
• Vomiting
• Abdominal Pain
• Raised liver enzymes
• Hyperlipidemia (hypertriglyceridemia and hypercholesterolemia)

Interactions of Lopinavir and Ritonavir: 

Lopinavir and ritonavir tablets are anticipated to have varying degrees of interaction with other medications that are also CYP3A and/or P-gp substrates.
The fixed-dose combination of Lopinavir and Ritonavir should be used with caution in such patients who are with the preexisting conduction system abnormalities, structural heart disease, ischaemic heart disease, and cardiomyopathies.

Price of Lopinavir Ritonavir: 

The cost of Lopinavir and Ritonavir is quite decent. A respective patient can purchase this fixed-dose combination medication through any authorized and registered pharmaceutical company.

Note: The combination of lopinavir 200 mg and ritonavir 50 mg & lopinavir 100 mg and ritonavir 25 mg is not recommended during breastfeeding. For alternate options, talk to your healthcare provider.

Read:- Atazanavir sulfate uses and its side effects

How Oseltamivir Phosphate is Best Antiviral Medication

In the United States in 1999, the Oseltamivir was approved for medical use. This medication was the first neuraminidase inhibitor available by mouth. And also It is on the WHO's (World Health Organization's) List of Essential Medicines but was downgraded to "complementary" status in 2017.
In the very same year (2017), Oseltamivir became the 159th most commonly prescribed medication in the US (United States), with more than three million prescriptions.

Oseltamivir Phosphate and it's uses: 

Oseltamivir is recommended to use in order to prevent and also in the treatment of influenza caused by influenza A and B viruses. The drug is on the WHO's (World Health Organization's) List of Essential Medicines, the safest and most effective medicines needed in a health system. The World Health Organization supports its use for severe illness due to confirmed or suspected influenza virus infection in critically ill people who have been hospitalized. The risk-benefit ratio of Oseltamivir is controversial.

The CDC (US Centers for Disease Control and Prevention), ECDC (European Centre for Disease Prevention and Control), Public Health England and the American Academy of Pediatrics (AAP) recommend the use of oseltamivir for people who have complications or are at high risk for complications. The complications include people who are hospitalized, those over the age of 65, young children, those who are with other significant health problems, people with pregnancy, and Indigenous peoples of the Americas among others.

According to a review, that came in the year of 2014. The review was in the New England Journal of Medicine. They recommended that all people who are admitted to ICU (intensive care units) during the influenza outbreaks with a diagnosis of community-acquired pneumonia should receive the oseltamivir until the absence of influenza infection is established by PCR testing.

A systematic review that came in 2015 and also meta-analysis observed that the oseltamivir is effective in order to treat the symptoms of influenza, reducing the risk of otitis media and reducing the length of hospitalization.
According to the same review, the oseltamivir did not significantly increase the risk of adverse events.

In 2005, during the H5N1 avian influenza epidemic in Southeast Asia, Oseltamivir (Tamiflu) was used at a wide level. So in the perspective of the epidemic, various governments including those of the United Kingdom, Canada, Israel, United States, and Australia, stockpiled quantities of oseltamivir in preparation for a possible pandemic and due to this, there were worldwide shortages of the Oseltamivir, driven by the high demand for stockpiling.

Side Effects of Oseltamivir Phosphate: 

In the United States, it is prescribed for influenza infection while pregnancy. Oseltamivir has been received by a small number of pregnant women in absence of the signs and symptoms of problems. The dose adjustment might be needed in those who are struggling with kidney problems.
Common side effects include 

• Vomiting
• Diarrhea
• Headache
• Trouble sleeping.
• Psychiatric Symptoms
• Seizures

How Does Oseltamivir Work:

Oseltamivir phosphate is a neuraminidase inhibitor, which is a competitive inhibitor of influenza's neuraminidase enzyme. The enzyme cleaves the sialic acid which is mainly found on glycoproteins on the surface of human cells which helps new virions in order to exit the cell. In this way oseltamivir works by preventing the new viral particles from being released.

On the basis of some reports of Oseltamivir. It shows that the drug is able to reduce the disease severity and also the hospitalization time in patients with canine parvovirus infection.
The medication can limit the potential as well as ability of the virus in order to invade the crypt cells of the small intestine and decrease gastrointestinal bacterial colonization and toxin production.

Dosage and Administration: 

TAMIFLU (Oseltamivir) may be taken with or without food. When this medication is consumed with food, it's tolerability can be increased in some patients. Oseltamivir Capsules are comes as the following strengths:

• Oseltamivir 30 mg
• Oseltamivir 45 mg
• Oseltamivir 75 mg

The dose of Oseltamivir 75 mg, Oseltamivir 45 mg, and also 30 mg should be taken according to the prescription of your healthcare provider.

Read:- How Darunavir Ritonavir combination is useful in the treatment of HIV