
- by Colin Edward Egan
- on 21 Sep, 2025
TL;DR
- Indinavir is a protease inhibitor used to treat HIV‑1 infection.
- Typical adult dose is 800mg three times daily with food and plenty of water.
- Common side effects include kidney stones, high triglycerides, and nausea.
- Check for drug interactions-especially with certain antibiotics, antifungals, and cholesterol meds.
- Generic indinavir is cheaper, but insurance coverage varies; patient assistance programs exist.
What Is Indinavir?
Indinavir, marketed under the name Crixivan, belongs to the protease inhibitor class of antiretroviral drugs. It was one of the first oral HIV medicines approved by the FDA back in 1996. The drug works by blocking the HIV‑1 protease enzyme, which the virus needs to cut large protein pieces into smaller, functional components. Without those components, the virus can’t assemble new infectious particles.
Today, indinavir is less often prescribed as a first‑line option because newer protease inhibitors have fewer side effects and more convenient dosing. However, many patients still rely on it, especially when a doctor needs a specific resistance profile or when cost is a major concern.
How Indinavir Treats HIV
The virus’s life cycle includes a stage where the viral polyprotein is cleaved into functional pieces by the protease enzyme. Indinavir’s molecular structure mimics the natural substrate of the enzyme, binding tightly and preventing the cleavage. This halts the maturation of new virus particles, turning them into dead‑end, non‑infectious particles.
Because HIV can quickly develop resistance, indinavir is almost always prescribed as part of combination antiretroviral therapy (cART). Pairing it with two nucleoside reverse transcriptase inhibitors (NRTIs) or an integrase inhibitor keeps viral load suppressed and lowers the chance of resistance.
Clinical trials from the late 1990s showed that indinavir reduced viral loads by >1 log10 within 4 weeks when taken with two NRTIs. Long‑term studies confirmed that adherence to the three‑times‑daily schedule maintained viral suppression in most patients.

Who Should Take It and How to Use It
Indinavir is approved for adults and children over 2 years old who have HIV‑1 infection. Doctors consider it when:
- The patient’s virus is resistant to other protease inhibitors.
- Cost constraints make the generic version the most affordable choice.
- The patient tolerates the drug’s side‑effect profile better than alternatives.
Dosage guidelines (for most adults):
- Start with 800mg taken orally three times a day (total 2400mg per day).
- Take each dose with a full glass of water (at least 250ml) to reduce kidney‑stone risk.
- Always take with food; a light snack helps absorption and eases stomach upset.
- If the dose is missed, take it as soon as remembered-unless it’s less than 6hours before the next scheduled dose, then skip the missed pill.
Kidney function matters. Patients with a creatinine clearance below 30ml/min should avoid indinavir or use a reduced dose under strict monitoring.
Regular lab work is essential:
- Baseline and quarterly CD4 counts and viral loads.
- Lipid panel every 3-6 months because indinavir raises triglycerides.
- Kidney labs (serum creatinine, calcium) every 6 months.
Common Side Effects and What to Watch For
Indinavir’s side‑effect profile is unique among protease inhibitors. The most frequently reported adverse events include:
Side Effect | Incidence | Typical Onset |
---|---|---|
Kidney stones (nephrolithiasis) | 5-10% | Weeks‑months |
Elevated triglycerides | 30-40% | 1-3 months |
Nausea / vomiting | 20-30% | First weeks |
Diarrhea | 15-20% | First weeks |
Fatigue | 10-15% | Variable |
Kidney‑stone prevention is a big deal. Drink at least 2‑3 liters of water daily, avoid high‑oxalate foods (spinach, nuts) if you’ve had stones before, and alert your doctor if you feel flank pain or notice blood in the urine.
High triglycerides can increase cardiovascular risk. If labs show levels above 500mg/dL, doctors often add a fibrate or omega‑3 supplement. Lifestyle tweaks-cutting sugary drinks, increasing exercise-help too.
Other less common but serious events:
- Rhabdomyolysis (muscle breakdown) when combined with certain statins.
- Severe allergic reactions: rash, hives, swelling of face or throat.
- Insulin resistance leading to new‑onset diabetes.
If any of these happen, stop the drug and seek medical help immediately.

Cost, Access, and Frequently Asked Questions
Indinavir’s patent expired in 2010, so generic versions are widely available. Prices vary by pharmacy and insurance plan:
- Without insurance, a 30‑day supply of generic indinavir 800mg tablets can range from $200 to $350.
- With typical U.S. private insurance, co‑pays are usually $10‑$30 per month.
- Medicaid and Medicare Part D coverage differ by state; many states list indinavir as a preferred drug, lowering out‑of‑pocket costs.
Patient assistance programs (PAPs) from the manufacturer’s successor companies still operate for uninsured patients. Eligibility usually requires income below 200% of the federal poverty level.
Below are answers to the most common follow‑up questions people type after searching just “Indinavir”.
Question | Short Answer |
---|---|
Can I take indinavir with alcohol? | Yes, but heavy drinking can worsen liver enzymes and increase triglycerides. |
Is indinavir safe during pregnancy? | Animal studies show no major birth defects, but human data are limited; discuss risks with your OB‑GYN. |
Do I need to fast before taking indinavir? | No, take it with food and a full glass of water. |
Will indinavir cause weight gain? | Some patients gain a few pounds due to fluid retention; monitor diet and activity. |
Can I switch from another protease inhibitor to indinavir? | Yes, but a doctor should cross‑check resistance patterns and adjust the companion drugs. |
**Quick troubleshooting checklist**:
- Missed dose? Take it if >6h before next dose, otherwise skip.
- Kidney‑stone symptoms? Increase fluids, call doctor immediately.
- Triglycerides >500mg/dL? Discuss adding a lipid‑lowering agent.
- Rash or swelling? Discontinue and seek emergency care.
Remember, the best way to stay on track is open communication with your HIV care team. They can adjust doses, swap meds, and help you navigate insurance hurdles so you stay virus‑free without breaking the bank.