An older HIV medicine (a protease inhibitor)
Indinavir
An older HIV protease inhibitor used in combination therapy, well known for causing kidney stones if fluids are not kept up.
What is Indinavir?
Indinavir is an older HIV medicine called a protease inhibitor. It was used as part of combination therapy, always with other HIV medicines and never on its own, usually boosted with a small amount of ritonavir to help it work. It is well known for causing kidney stones and crystals in the urine, so drinking plenty of fluids is very important. It can also raise a blood pigment called bilirubin, which can cause harmless yellowing. It is now rarely used, as newer protease inhibitors and other HIV medicines are preferred.
Education and reference only. This is a plain-language guide to Indinavir — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Indinavir is an antiretroviral medicine used to treat HIV. It belongs to a group called protease inhibitors. Like all HIV medicines, it is only ever used as part of combination therapy, alongside other antiretrovirals and never on its own, because a single HIV medicine used alone lets the virus become resistant. It is usually given boosted with a small amount of another medicine, ritonavir, which raises its levels so it works better. It is taken by mouth. It is now rarely used in the UK, having largely been replaced by newer, more convenient protease inhibitors and other options.
How it works
HIV uses an enzyme called protease to assemble new, working copies of the virus. Indinavir blocks this enzyme, so the virus produces only faulty particles that cannot infect new cells, helping keep the amount of virus down. Because HIV can become resistant to any single medicine, indinavir works as part of a combination that attacks the virus in different ways at once. It is usually boosted with ritonavir, which slows its breakdown so its levels stay higher and steadier. Some of indinavir breaks down into crystals that can form kidney stones, which is why drinking plenty of fluids is important.
Company & origin
Originated / developed by: Specialist manufacturer.
An older HIV medicine used in the UK as part of combination therapy; now rarely used, with newer protease inhibitors and other options preferred.
Practical use
How to take Indinavir
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Take it by mouth exactly as prescribed, always together with the other HIV medicines in your combination, never on its own.
- Drink plenty of fluids throughout the day to reduce the risk of kidney stones.
- Take it consistently and on time, as missing doses can let the virus become resistant.
- Report pain in your back or side, or blood in your urine, promptly.
- Give your specialist a full list of your other medicines, as indinavir interacts with many of them.
Weighing it up
Advantages & disadvantages of Indinavir
Advantages
- An effective HIV protease inhibitor in its time, helping suppress the virus as part of combination therapy.
- Taken by mouth, and made more reliable when boosted with ritonavir.
- Played an important role in the move to effective combination HIV treatment.
Disadvantages
- Can cause kidney stones and crystals in the urine, so plenty of fluids are needed.
- Can raise bilirubin (causing harmless yellowing) and affect blood fats and blood sugar.
- Interacts with many medicines and is now rarely used, as newer options are preferred.
Practical use
Good to know
The most important thing to know about indinavir is that it can cause kidney stones and crystals in the urine, so it is essential to drink plenty of fluids throughout the day to flush the kidneys. Signs such as pain in the back or side, or blood in the urine, should be reported promptly. It can also raise a blood pigment called bilirubin, which may cause a harmless yellow tinge to the skin or eyes that does not usually mean a problem with the liver. Like other protease inhibitors, it can affect blood fats and blood sugar and interacts with many other medicines. It is usually boosted with ritonavir and must always be taken as part of a combination, consistently and on time. HIV care is provided by a specialist team.
Who should not take it / use with caution
- People who have had a serious allergic reaction to indinavir should not take it.
- It is used with caution in people with kidney problems or a history of kidney stones, and in liver problems.
- It must not be combined with certain medicines that interact dangerously, and is used under specialist care as part of a combination.
Monitoring
- Regular blood tests including the amount of virus (viral load), immune cells (CD4 count) and liver function.
- Watching for kidney stones, and checking kidney function and bilirubin.
- Reviewing blood fats and blood sugar, and the overall HIV combination.
Side effects
- Kidney stones or crystals in the urine, with pain in the back or side or blood in the urine.
- A harmless rise in bilirubin causing yellowing of the skin or eyes.
- Changes in blood fats and blood sugar, and changes in body fat over time.
- Nausea, headache or a metallic taste in some people.
Key interactions
- It interacts with many medicines, raising or lowering their levels, so a full medicines list is essential.
- It must not be combined with certain medicines that can cause dangerous effects, which your specialist will check.
- It is usually given with ritonavir, which boosts its levels, and the combination is chosen carefully to avoid harmful overlaps.
Available as: Capsules taken by mouth, usually boosted with ritonavir.
Answers
Indinavir: frequently asked questions
What is indinavir used for?
It is an older HIV protease inhibitor used as part of combination therapy to help keep the virus suppressed; it is always used with other HIV medicines, never alone.
Why must I drink plenty of fluids?
Indinavir can form crystals that cause kidney stones, so drinking plenty of fluids throughout the day helps flush the kidneys and lower this risk.
Why have my eyes gone slightly yellow?
Indinavir can raise a blood pigment called bilirubin, which can cause a harmless yellow tinge that does not usually mean a liver problem; still mention it to your team.
Why is it boosted with ritonavir?
A small amount of ritonavir slows the breakdown of indinavir so its levels stay higher and steadier, helping it work better.
Can it be taken on its own?
No. Like all HIV medicines it must be part of a combination, because using one HIV medicine alone lets the virus become resistant.
The wider class
About Antiretroviral (protease inhibitor) for HIV
Indinavir belongs to the antiretroviral (protease inhibitor) for hiv class. For how the class as a whole works, its shared safety principles and monitoring, see the full guide.
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Authoritative sources
- BNF
- NICE CKS
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