ddI

didanosine (ddI, 2,3-dideoxyinosine)

Videx, Videx EC

Pharmacologic class: Nucleoside reverse transcriptase inhibitor

Therapeutic class: Antiretroviral, antiviral

Pregnancy risk category B

FDA Box Warning

• Pancreatitis has occurred when drug was used alone or in combination regimens in treatment-naive or treatment-experienced patients. Suspend therapy in patients with suspected pancreatitis; discontinue in patients with confirmed pancreatitis.

• Drug may cause lactic acidosis and severe hepatomegaly with steatosis when used alone or in combination with other antiretrovirals. Fatal lactic acidosis has occurred in pregnant women receiving didanosine-stavudine combination with other antiretrovirals. In pregnant patients, use this combination with caution and only if benefit clearly outweighs risk.

Action

Inhibits replication of human immunodeficiency virus (HIV) by disrupting synthesis of DNA polymerase, an enzyme crucial to DNA and RNA formation

Availability

Capsules (delayed-release): 125 mg, 200 mg, 250 mg, 400 mg

Powder for oral solution (pediatric): 2 g in 4-oz glass bottle, 4 g in 8-oz glass bottle

Indications and dosages

➣ HIV infection

Adults weighing 60 kg (132 lb) or more: 400 mg (capsules) P.O. once daily

Adults weighing less than 60 kg (132 lb): 250 mg (capsules) P.O. once daily

Children: 120 mg/m² (powder for oral solution, pediatric) P.O. q 12 hours

Dosage adjustment

• Renal impairment

Contraindications

• Hypersensitivity to drug

• Concurrent use of allopurinol or ribavirin

Precautions

Use cautiously in:

• renal or hepatic impairment, peripheral neuropathy, hyperuricemia

• elderly patients

• pregnant or breastfeeding patients

• children.

Administration

• Know that drug is usually given in conjunction with other antiretrovirals.

• Give on empty stomach 30 minutes before or 2 hours after a meal.

• Don't administer with fruit juice.

• Know that pharmacist must prepare pediatric powder for oral solution by diluting with water and antacid to a concentration of 10 mg/ml.

• Be aware that delayed-release capsules aren't intended for use in children.

Adverse reactions

CNS: dizziness, anxiety, abnormal thinking, hypoesthesia, agitation, confusion, hypertonia, asthenia, peripheral neuropathy, seizures, coma

CV: peripheral coldness, palpitations, hypotension, bradycardia, weak pulse, pseudoaneurysm, incomplete atrioventricular (AV) block, complete AV block, nodal arrhythmias, ventricular tachycardia, thrombophlebitis, embolism

EENT: diplopia, abnormal vision, ocular hypotony, iritis, retinal detachment

GI: nausea, vomiting, diarrhea, abdominal enlargement, dyspepsia, ileus, GI reflux, hematemesis, dysphagia, dry mouth, pancreatitis

GU: urinary retention, frequency, or incontinence; dysuria; cystalgia; prostatitis; renal dysfunction; nephrotoxicity

Hematologic: anemia, leukocytosis, thrombocytopenia, bleeding, neutropenia

Hepatic: hepatomegaly with steatosis, noncirrhotic portal hypertension

Metabolic: diabetes mellitus, hyperkalemia, lactic acidosis, noncirrhotic portal hypertension

Musculoskeletal: muscle contractions

Respiratory: pneumonia, crackles, rhonchi, bronchitis, pleurisy, dyspnea, wheezing, pleural effusion, pulmonary edema, pulmonary embolism, bronchospasm

Skin: diaphoresis, pallor, rash, urticaria, pruritus, bullous eruption, petechiae, cellulitis, abscess

Other: edema, development of human antichimeric antibodies

Interactions

Drug-drug. Allopurinol, ganciclovir (oral), ribavirin, tenofovir: increased didanosine blood level

Amprenavir, delavirdine, indinavir, ritonavir, saquinavir: altered didanosine pharmacokinetics

Antacids, other drugs that increase gastric pH: increased risk of didanosine toxicity

Co-trimoxazole, pentamidine: increased risk of pancreatic toxicity

Dapsone, fluoroquinolones, ketoconazole: decreased blood levels of these drugs

Itraconazole: decreased itraconazole blood level

Methadone: 50% decrease in didanosine blood level

Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, uric acid: increased levels

Granulocytes, hemoglobin, platelets, white blood cells: decreased values

Drug-food. Any food: decreased rate and extent of drug absorption

Patient monitoring

See Monitor patient for signs and symptoms of pancreatitis. Withhold drug in patients with signs or symptoms of pancreatitis and discontinue drug in patients with confirmed pancreatitis.

See Monitor patient for early signs and symptoms of portal hypertension (thrombocytopenia, splenomegaly). Discontinue drug in patients with evidence of noncirrhotic portal hypertension.

See Assess carefully for signs and symptoms of lactic acidosis, such as dizziness, light-headedness, and bradycardia.

• Monitor for signs and symptoms of peripheral neuropathy.

• In patients with renal impairment, watch for drug toxicity and hypermagnesemia (suggested by muscle weakness and confusion).

Patient teaching

• Tell patient to take drug on empty stomach.

• Advise patient using buffered powder to mix it with water, not juice, and to let powder dissolve for several minutes before taking.

See Instruct patient to immediately report abdominal pain, nausea, vomiting, tiredness, fast or irregular heartbeats, easy bruising, difficulty breathing, yellowing of skin or eyes, or dark urine.

• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, and foods mentioned above.

DDI

ddI

(dē′dē-ī′)n. An antiviral drug, C₁₀H₁₂N₄O₃, that is a nucleoside reverse transcriptase inhibitor and is used in combination with other drugs for the treatment of HIV infection. Also called didanosine.

ddI

2',3'-dideoxyinosine, Videx AIDS An anti-HIV nucleoside analogue Adverse effects Neuropathy of hands and feet, pancreatic damage, pancreatitis, diarrhea. See AIDS, Didanosine.

DDI

Acronym	Definition
DDI➣Didanosine (aka Videx; antiretroviral drug)
DDI➣Data Documentation Initiative
DDI➣Development Dimensions International, Inc.
DDI➣Direction et Développement Informatique (French: Management and Software Development)
DDI➣Dideoxyinosine
DDI➣Dedicated Display Interface
DDI➣Display Driver Interface
DDI➣Disk Doubler Image
DDI➣Digital Data Interchange
DDI➣Direct Data Interface
DDI➣Distributed Data Interface
DDI➣Direct Draw Interface
DDI➣Data Distribution Initiative
DDI➣Disk Dupe Image
DDI➣Device Driver Interface
DDI➣Déclaration des Droits de l'Internaute (French: Declaration of Internet Rights)
DDI➣Direct Dialing In
DDI➣Drug-Drug Interaction
DDI➣Diplôme de Docteur Ingénieur (French: Doctorate of Engineering; various universities)
DDI➣Data Design Interactive (video game developer; UK)
DDI➣Dansk Døve-Idrætsforbund
DDI➣Design Driven Innovation (networking blog)
DDI➣Direct Debit Instruction (UK finance & banking term)
DDI➣Development, Design and Implementation (various organizations)
DDI➣Deputy Director of Intelligence (US CIA)
DDI➣Don't Do It
DDI➣Développement et Distribution Informatique (French: Information Distribution and Development; Belgium)
DDI➣Duke Digital Initiative (Duke University)
DDI➣Direct Debit Instruction
DDI➣Discado Directo Internacional (Spanish: international direct dial)
DDI➣Discagem Direta Internacional (Brazilian Portuguese: direct international dialing)
DDI➣Dynamic Desktop Initiative (software; CItrix)
DDI➣Distressed Debt Investors
DDI➣Device Dependent Interface
DDI➣Digital Display Indicator
DDI➣Design, Develop, and Implement
DDI➣Douai Distribution Industrielle (French distribution company)
DDI➣Dairy Development International, LLC
DDI➣Data Directions Inc. (Virginia)
DDI➣Diagnostic Digital Imaging
DDI➣Deutsches Derivate Institut (German: German Derivatives Institute)
DDI➣Data and Dimensions Interface
DDI➣Director of Defense Information
DDI➣Dartmouth Debate Institute
DDI➣Downwelling Diffuse Irradiance (clouds)
DDI➣Día de Independencia (Spanish: Independence Day)
DDI➣Direct Deposit Indicator
DDI➣Digital Data Interpreter
DDI➣Distilled De-Ionized (water)
DDI➣Digital Data Indicator
DDI➣Depth Deviation Indicator
DDI➣Duty Director for Intelligence
DDI➣Discrete Data Input (NASA)
DDI➣Database Data Interchange
DDI➣Dedicated Display Indicator (NASA)
DDI➣Director Defense Information
DDI➣Discrete Digital Input
DDI➣Dummy, Drill and Inert (training ammunition)
DDI➣Document Data Index (configuration management)
DDI➣Decoy-DECM Integration
DDI➣Dynamic Dies, Inc. (est. 1971)
DDI➣Dynamic Data Interchange
DDI➣Dental Digital Imaging (dentistry)
DDI➣Database Designing Incorporated
DDI➣Diamond Design, Inc.
DDI➣Demand Display Index
DDI➣Direct Dial Information
DDI➣Daini-Denden Planning Company (Japan, now KDDI)
DDI➣Drivers Display Interface
DDI➣Digital Design Initiative

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