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Norvir Price Increase: comparison of HIV drug prices
 
 
  Abbott Labs sent out this chart that lists the daily costs of many of the widely used antiretrovirals. In December Abbott announced they were raising the cost of Norvir several hundred percent. Norvir was one of the first protease inhibitors approved for treating HIV along with Crixivan (indinavir) back in 1996. These were the two main protease inhibitors that were the foundation of a triple drug HAART regimen back then. The Norvir dose was 600 mg twice daily. Norvir was also researched to be used in combination with 400 mg saquinavir in a potent double PI regimen, used with or without nucleosides. Norvir significantly raised the blood levels of saquinavir making this double PI regimen very potent and providing flexibility regarding dosing timing due to the high blood levels achieved by "boosting" saquinavir levels. The side effects of ritonavir were difficult for many patients. Afollowup research found 400 mg Norvir plus 400mg saquinavir was very potent but had less side effects, and this regimen became a popular one at that time. Since then, research established that either 100 mg or 200 mg of ritonavir was an effective way to use protease inhibitors. The small dose of ritonavir "boosted" the blood levels of the accompanying PI and thus establishing a major advance in treating HIV: boosted PI levels accomplished by adding small dose ritonavir was very potent and was more forgiving in terms of dosing timing and thus adherence. These developments created a very popular new concept, a mainstay, in treating HIV: ritonavir boosted protease inhibitors. Today, low dose ritonavir is used to boost all other protease inhibitors except Viracept, including Abbott's Kaletra, Bristol-Myers Squibb's Reyataz, GlaxoSmithKline's Fosamprenavir, and a new PI in development, tipranavir, used for patients with resistance to currently available protease inhibitors.
 
EXPLANATION OF TABLE
 
This table compares prices for single drugs, as well as for combinations of 2 drugs. For example, Combivir is one pill containing two drugs (AZT and 3TC). Kaletra contains two protease inihibitors (lopinavir and ritonavir). Trizivir is one pill containing three drugs (AZT, 3TC and abacavir-also known as Ziagen). The dose listed in the table is mostly for a daily dose. But Norvir is usually dosed at 100 mg twice a day. This information can be helpful to you in figuring and comparing the costs of these drugs.
 
In the table below, Norvir cost is for one 100 mg capsule. Most protease inhibitor regimens that use Norvir to boost the PI are dosed twice a day, so two 100 mg Norvir capsules are used daily. Saquinavir is now dosed as 1000 mg (Invirase) twice daily along with 100 mg of ritonavir twice daily. Crixivan is generally taken as 800 mg twice daily along with a boost by 100 mg ritonavir taken twice daily. Combivir is one pill taken twice a day and combines two nucleoside drugs in the one pill (AZT, 3TC). Combivir is taken along with a PI or a NNRTI. Sustiva (efavirenz) is an NNRTI and is taken as 600 mg once daily; it is not boosted by Norvir. Although not listed in the chart, Viramune is an NNRTI and is also not boosted by Norvir.
 
Kaletra is 400 mg of lopinavir plus 100 mg of ritonavir in one capsule taken twice daily. Reyataz is taken one of two ways: two 150 mg capsules taken once daily along with one 100 mg capsule of ritonavir also taken once daily; or, 400 mg Reyataz taken once daily without any ritonavir boost.
 
Trizivir is a regimen in and of itself. It consists of 3 drugs in one pill taken twice daily (AZT, 3TC, abacavir). Lexiva is the new version of amprenavir (Agenerase), called fosamprenavir. There is no reason to take the old version of amprenavir any longer. Fosamprenavir has a reduced pill burden. It is now made in 700 mg pills while the old version was 150 mg pills. In addition, the severe GI upset associated with the old version of amprenavir is no longer a side effect with fosamprenavir. Lexiva can be taken once daily or twice daily for treatment-na•ve patients or twice daily for treatment-experienced patients. When taken twice daily the dose is 700 mg twice a day along with 100 mg of ritonavir twice a day. When taken as once daily the dose is 1400 mg once a day along with 200 mg of ritonavir taken once daily. Although Lexiva can be taken as 1400 mg twice a day without any ritonavir boost, use of Lexiva is expected to be mostly with the regimen using ritonavir boosting. The cost of Lexiva in the chart reflects using Lexiva when dosed as 1400 mg twice daily without the ritonavir boost. If taking 1400 mg once daily or 700 mg twice daily, along with ritonavir boosting, the Lexiva cost is half of that listed in the chart, since the chart lists the cost of taking Lexiva 1400 mg twice a day.
 
Abbott sent a Dear Doctor....
 
http://www.retroconference.org/2004/home.htm
 
Here is the link to an article in The Wall Street Journal on the controversy:
 
http://www.natap.org/2003/dec/123103_2.htm
 
 
 
   
 
   
 
 
 
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