What is a common side effect of the medication indinavir?

Indinavir, a protease inhibitor used in the treatment of HIV, has a well-known side effect profile, and one of the most significant concerns is the potential for crystal-induced nephropathy. This occurs due to the precipitation of indinavir crystals in the renal tubules, which can lead to renal impairment or obstruction. Patients taking indinavir are at risk for nephrolithiasis (kidney stones), which can manifest as flank pain, hematuria, or urinary obstruction, potentially resulting in Acute Kidney Injury.

The mechanism behind this side effect involves the drug's solubility profile; indinavir has low solubility in urine, especially when patients become dehydrated, which increases the concentration of the drug and facilitates crystal formation. Proper hydration is often recommended to mitigate this risk in patients taking indinavir.

By understanding this side effect, healthcare providers can better counsel patients on the importance of maintaining adequate fluid intake while on indinavir therapy to minimize the risk of nephropathy.