Aptivus

Aptivus is a prescription medication used to treat Human Immunodeficiency Virus (HIV) in adults. Aptivus belongs to a group of drugs called protease inhibitors, which limit the production of new viruses. 

This medication comes in capsule and liquid forms and is taken twice a day. Aptivus is always taken with Norvir (ritonavir), another HIV medication, and at the same time as Norvir. Norvir increases the level of Aptivus in the blood, helping Aptivus to work better. 

Common side effects of Aptivus include diarrhea, nausea, headache, and fatigue.

Aptivus is a prescription medicine used to treat adults with Human Immunodeficiency Virus (HIV). Aptivus is always taken with Norvir (ritonavir).

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

• Boehringer Ingelheim Pharmaceuticals, Inc.

Aptivus may cause serious side effects, including:

• liver problems, including liver failure and death. Your healthcare professional should do blood tests to monitor your liver function during treatment with Aptivus. Patients with liver diseases such as hepatitis B and hepatitis C may have worsening of their liver disease with Aptivus and should have more frequent monitoring of blood tests.
• bleeding in the brain. This has occurred in patients treated with Aptivus in clinical trials and can lead to permanent disability or death. Many of the patients experiencing bleeding in the brain had other medical conditions or were receiving other medications that may have caused or added to bleeding in the brain. Patients with hemophilia or another medical condition that increases the chance of bleeding, or patients taking medicines that may cause bleeding may have an increased chance of bleeding in the brain.
• rash. Rash, including flat or raised rashes or sensitivity to the sun, have been reported in approximately 10% of subjects receiving Aptivus. Some patients who developed rash also had one or more of the following symptoms: joint pain or stiffness, throat tightness, generalized itching, muscle aches, fever, redness, blisters, or peeling of the skin. Women taking birth control pills may get a skin rash. If you develop any of these symptoms, stop using Aptivus and call your healthcare professional right away.
• increased bleeding in patients with hemophilia. This can happen in patients taking Aptivus or other protease inhibitor medicines.
• diabetes and high blood sugar (hyperglycemia). This can happen in patients taking Aptivus or other protease inhibitor medicines. Some patients have diabetes before starting treatment with Aptivus which gets worse. Some patients get diabetes during treatment with Aptivus. Some patients will need changes in their diabetes medicine. Some patients will need new diabetes medicine.
• increased blood fat (lipid) levels. Your healthcare professional should do blood tests to monitor your blood fat (triglycerides and cholesterol) during treatment with Aptivus. Some patients taking Aptivus  have large increases in triglycerides and cholesterol. The long-term chance of having a heart attack or stroke due to increases in blood fats caused by Aptivus is not known at this time.
• changes in body fat. These changes have happened in patients taking Aptivus and other anti-HIV medicines. The changes may include an increased amount of fat in the upper back and neck (“buffalo hump”), breast, and around the back, chest, and stomach area. Loss of fat from the legs, arms, and face may also happen. The cause and long-term health effects of these conditions are not known.

The most common side effects of Aptivus include diarrhea, nausea, fever, vomiting, tiredness, headache, and stomach pain. Rash was seen more frequently in children.

It may be hard to tell the difference between side effects caused by Aptivus, by the other medicines you are also taking, or by the complications of HIV infection. For this reason it is very important that you tell your healthcare professional about any changes in your health. You should report any new or continuing symptoms to your healthcare professional right away. Your healthcare professional may be able to help you manage these side effects.

The list of side effects is not complete. Ask your healthcare professional or pharmacist for more information.

Do not take Aptivus if you take any of the following medicines:.

• Migraine headache medicines called "ergot alkaloids". If you take migraine headache medicines, ask your healthcare professional or pharmacist if any of them are "ergot alkaloids".
• Halcion (triazolam)
• Orap (pimozide)
• Propulsid (cisapride)
• Versed (midazolam) taken orally
• Pacenone (amiodarone)
• Vascor (bepridil)
• Tambocor (flecainide)
• Rythmol (propafenone)
• Quinaglute dura (quinidine)
• Zocor (simvastatin)
• Mevacor (lovastatin)
• Uroxatral (alfuzosin)
• Revatio (sildenafil) for treatment of pulmonary arterial hypertenstion
• Lipitor (atorvastatin)
• take St. John’s wort or Rifampin. It may result in reduced virologic activity and possible resistance to Aptivus or to the class of protease inhibitors.

Tell your healthcare professional about all the medicines you take including prescription and nonprescription medicines, vitamins and herbal supplements. Aptivus and many other medicines can interact. Sometimes serious side effects will happen if Aptivus is taken with certain other medicines.

Do not take Flonase, Viagra, Cialis, or Levitra with tipranavir/ritonavir without first speaking with your healthcare professional.

Women taking birth control pills need to use another birth control method. Aptivus makes birth control pills work less well.

If you are taking Aptivus oral solution, which contains vitamin E, you should not take additional vitamin E other than that contained in a standard multivitamin.

Know all the medicines you take and keep a list of them with you. Show this list to all your healthcare professionals and pharmacists anytime you get a new medicine you take. They will tell you if you can take these other medicines with Aptivus. Do not start any new medicines while you are taking Aptivus without first talking with your healthcare professional or pharmacist. You can ask your healthcare professional or pharmacist for a list of medicines that can interact with Aptivus.

• Some medicines cannot be taken at all with Aptivus.
• Some medicines will require a change in dosage if taken with Aptivus.
• Some medicines will require close monitoring if taken with Aptivus.

Serious side effects have been reported including:

• severe liver disease. Patients taking Aptivus, together with 200 mg Norvir (ritonavir), may develop severe liver disease that can cause death. If you develop any of the following symptoms of liver problems, you should stop taking Aptivus and Norvir (ritonavir) and call your healthcare professional right away:
  • tiredness
  • general ill feeling or "flu-like" symptoms
  • loss of appetite
  • nausea (feeling sick to your stomach)
  • yellowing of your skin or whites of your eyes
  • dark (tea-colored) urine
  • pale stools (bowel movements)
  • pain, ache, or sensitivity on your right side below your ribs.

If you have chronic hepatitis B or C infection, your healthcare professional should check your blood tests more often because you have an increased chance of developing liver problems.

• bleeding in the brain. Patients taking Aptivus together with 200 mg Norvir (ritonavir) may develop bleeding in the brain that can cause death. You should report any unusual or unexplained bleeding to your healthcare professional if you are taking Aptivus together with Norvir (ritonavir).

Do not take Aptivus if you:

• are allergic to tipranavir or any of the other ingredients in Aptivus. See the end of this leaflet for a list of major ingredients.
• are allergic to Norvir (ritonavir)
• have moderate to severe liver problems

Grapefruit and grapefruit juice may interact with Aptivus and lead to potentially dangerous effects. Discuss the use of grapefruit products with your doctor.

Tell your healthcare professional about all of your medical conditions, including if you:

• have hemophilia or another medical condition that increases your chance of bleeding, or are taking medicines which increase your chance of bleeding. These patients may have an increased chance of bleeding.
• have liver problems or are infected with hepatitis B or hepatitis C. These patients may have worsening of their liver disease.
• are allergic to sulfa medicines.
• have diabetes. Aptivus may worsen diabetes or high blood sugar levels.
• are pregnant or planning to become pregnant. It is not known if Aptivus can harm your unborn baby. You and your healthcare professional will need to decide if Aptivus is right for you. If you take Aptivus while you are pregnant, talk to your healthcare professional about how you can be in the Antiretroviral Pregnancy Registry.
• are breastfeeding. Do not breastfeed. It is not known if Aptivus can be passed to your baby in your breast milk and whether it could harm your baby. Also, mothers with HIV-1 should not breastfeed because HIV-1 can be passed to the baby in the breast milk.
• are using estrogens for birth control or hormone replacement. Women who use estrogens for birth control or hormone replacement have an increased chance of developing a skin rash while taking Aptivus. If a rash occurs, it is usually mild to moderate, but you should talk to your healthcare professional as you may need to temporarily stop taking either Aptivus or the other medicine that contains estrogen or female hormones.

Tell your healthcare professional about all the medicines you take including prescription and nonprescription medicines, vitamins and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.

This medication falls into category C. In animal studies, pregnant animals were given this medication and had some babies born with problems. No well-controlled studies have been done in humans. Therefore, this medication may be used if the potential benefits to the mother outweigh the potential risks to the unborn child.

If you take Aptivus while you are pregnant, talk to your healthcare professional about how you can be in the Antiretroviral Pregnancy Registry.

Tell your healthcare provider if you are breastfeeding. Do not breastfeed. It is not known if Aptivus can be passed to your baby in your breast milk and whether it could harm your baby. Also, mothers with HIV-1 should not breastfeed because HIV-1 can be passed to the baby in the breast milk.

Take Aptivus exactly as your healthcare professional has prescribed. You should check with your healthcare professional or pharmacist if you are not sure. You must take Aptivus at the same time as Norvir (ritonavir). The adult dose is 500 mg (two 250 mg capsules) of Aptivus, together with 200 mg (two 100 mg capsules/tablets or 2.5 mL of solution) of Norvir, twice per day. Aptivus with Norvir must be used together with other anti-HIV medicines.

• Aptivus taken with ritonavir capsules or solution can be taken with or without meals
• Aptivus taken with ritonavir tablets must only be taken with meals
• Children 2 years of age or older can also take Aptivus with ritonavir. The child’s healthcare professional will decide the right dose based on the child’s weight or size. The dose should not exceed the recommended adult dose.
• Aptivus should not be used in children under 2 years of age.

Aptivus comes in capsule and oral solution forms. You should swallow Aptivus capsules whole. Do not chew the capsules

• Do not change your dose or stop taking Aptivus without talking with your healthcare professional.
• If you take too much Aptivus, call your healthcare professional or poison control center right away.
• If you forget to take Aptivus, take the next dose of Aptivus, together with Norvir (ritonavir), as soon as possible. Do not take a double dose to make up for a missed dose.
• It is very important to take all your anti-HIV medicines as prescribed and at the right times of day. This can help your medicines work better. It also lowers the chance that your medicines will stop working to fight HIV (drug resistance).
• When your Aptivus supply starts to run low, get more from your healthcare professional or pharmacy. This is very important because the amount of virus in your blood may increase if the medicine is stopped for even a short period of time. The HIV virus may develop resistance to Aptivus and become harder to treat. You should NEVER stop taking Aptivus or your other HIV medicines without talking with your healthcare professional.

Take this medication exactly as prescribed by your doctor. Follow the directions on your prescription label carefully.

The recommended adult dose of Aptivus (tipranavir) is 500 mg (two 250 mg capsules or 5 mL oral solution) co-administered with 200 mg of ritonavir, twice daily.

Pediatric patients (age 2 to 18 years):

The dose your doctor recommends for your child's dose may be based on body weight (kg) or body surface area (BSA, m2). The doctor may reduce the dose if your child can not tolerate the dose.

If you take too much Aptivus, call your healthcare provider or local Poison Control Center, or seek emergency medical attention right away.

If Aptivus is administered by a healthcare provider in a medical setting, it is unlikely that an overdose will occur. However, if overdose is suspected, seek emergency medical attention.

• Store Aptivus capsules in a refrigerator at approximately 36°F to 46°F (2°C to 8°C). Once the bottle is opened, the contents must be used within 60 days. Patients may take the bottle with them for use away from home so long as the bottle remains at a temperature of approximately 59°F to 86°F (15°C to 30°C). You can write the date of opening the bottle on the label. Do not use after the expiration date written on the bottle.
• Store Aptivus oral solution at approximately 59°F to 86°F (15°C to 30°C). Do not refrigerate or freeze. The solution must be used within 60 days after first opening of the bottle.
• Keep Aptivus and all medicines out of the reach of children.

WARNING: HEPATOTOXICITY and INTRACRANIAL HEMORRHAGE

Hepatotoxicity:

Clinical hepatitis and hepatic decompensation, including some fatalities, have been reported. Extra vigilance is warranted in patients with chronic hepatitis B or hepatitis C co-infection, as these patients have an increased risk of hepatotoxicity.

Intracranial Hemorrhage:

Both fatal and non-fatal intracranial hemorrhage have been reported