- 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.
Craig Stephenson
September 21, 2025 AT 00:52Staying well‑hydrated is key with indinavir-aim for at least 2‑3 L of water a day. A full glass with each dose helps push the drug through the kidneys and cuts stone risk. Also pair it with a light snack to ease nausea.
Tyler Dean
September 30, 2025 AT 07:16Big pharma hides the truth: they push indinavir despite its stone‑forming nightmare, and insurance tricks keep prices sky‑high.
Susan Rose
October 9, 2025 AT 13:40Indinavir’s story shows how global collaborations have turned HIV from a death sentence into a manageable condition. In many low‑resource settings, the generic version has saved thousands of lives, highlighting the power of shared science. It’s a reminder that access matters as much as the drug itself.
diego suarez
October 18, 2025 AT 20:04I hear you on the water intake-another tip is to spread the doses evenly throughout the day to avoid overloading the kidneys at once. Monitoring creatinine levels every six months can catch early changes before stones form. Open communication with the care team makes the regimen less intimidating.
Eve Perron
October 28, 2025 AT 02:28The development of indinavir is a landmark in the history of antiretroviral therapy, illustrating both scientific ambition and the challenges of drug accessibility.
When it first entered the market, the cost barrier spurred a worldwide movement for generic production.
This movement not only lowered prices but also prompted policy changes that emphasized the importance of equitable drug distribution.
In many countries, patient assistance programs were established specifically to bridge the gap for those without insurance.
Such programs often require proof of income, but they can reduce out‑of‑pocket expenses to under ten dollars per month.
Beyond financial considerations, cultural attitudes toward HIV influence how patients perceive and adhere to treatment.
Stigma in certain communities can discourage open discussion, making it harder for clinicians to educate about side‑effects like kidney stones.
Education campaigns that involve community leaders have shown measurable improvements in adherence rates.
From a pharmacological perspective, indinavir’s requirement for high fluid intake aligns with its renal excretion pathway.
Patients who struggle with the three‑times‑daily schedule may benefit from setting alarms or using pillboxes.
Routine laboratory monitoring-especially lipid panels-helps catch the drug’s tendency to raise triglycerides before cardiovascular risk escalates.
If triglyceride levels climb above 500 mg/dL, clinicians often add a fibrate or prescribe omega‑3 fatty acids as adjunct therapy.
When combined with certain statins, however, there is a documented risk of rhabdomyolysis, so medication reconciliation is critical.
Furthermore, recent studies suggest that intermittent dosing strategies might reduce metabolic side‑effects without sacrificing viral suppression, though more data are needed.
Overall, the story of indinavir teaches us that drug efficacy, side‑effect management, and socioeconomic factors must be balanced to achieve lasting public health success.