<2 years: not recommended. Use soln if unable to swallow caps. Calculate dose based on body wt. (kg) or BSA (m2). 2–18 years: Tipranavir 14mg/kg + ritonavir 6mg/kg (or 375mg/m2 + ritonavir 150mg/m2) twice daily; max tipranavir 500mg + ritonavir 200mg twice daily. May consider reducing dose to tipranavir 12mg/kg + ritonavir 5mg/kg (or 290mg/m2 + ritonavir 115mg/m2) twice daily if intolerance or toxicity occurs provided their virus is not resistant to multiple PIs.
Moderate to severe hepatic insufficiency (Child-Pugh B–C). Concomitant potent CYP3A inducers or substrates (eg, alfuzosin, amiodarone, bepridil, flecainide, propafenone, quinidine, rifampin, ergots, cisapride, St. John's wort, lovastatin, simvastatin, pimozide, sildenafil, oral midazolam, triazolam).
Not for use in treatment-naive patients. Sulfa allergy. Mild hepatic impairment (Child-Pugh A). Hepatitis. Monitor lipids, liver function (baseline and periodically); discontinue if asymptomatic increase in AST/ALT >10xULN, or AST/ALT 5–10xULN and total bilirubin >2.5xULN. Diabetes. Risk of increased bleeding. Hemophilia: monitor for spontaneous bleeding. Pregnancy (Cat.C). Nursing mothers: not recommended.
See Contraindications. Concomitant salmeterol, fluticasone, fosamprenavir, lopinavir, saquinavir, atazanavir, or fluconazole, ketoconazole, itraconazole ≥200mg/day: not recommended. Caps: avoid metronidazole, disulfiram. May be synergistic with enfuvirtide. Potentiates PDE5 inhibitors (eg, sildenafil, tadalafil, vardenafil), trazodone, desipramine; reduce dose: see literature. Avoid concomitant colchicine if renal or hepatic impairment; otherwise: reduce dose: see literature. Reduce rifabutin dose by 75%. Antagonizes estrogens (use non-hormonal contraceptives), methadone, valproic acid, omeprazole. Antagonized by carbamazepine, phenobarbital, phenytoin. Potentiates atorvastatin, rosuvastatin: avoid coadministration. Monitor hypoglycemics, immunosuppressants, tricyclics, SSRIs, warfarin, drugs that affect or are affected by CYP3A4 (eg, azole antifungals, calcium channel blockers, clarithromycin, raltegravir, NRTIs, PIs, statins). Increased risk of bleeding with concomitant anticoagulants, antiplatelet agents, high-dose Vit.E. Separate dosing of didanosine, antacids. Bosentan: adjust dose (see literature). Oral soln: avoid high-dose Vit.E supplements.
GI upset, abdominal pain, pyrexia, fatigue, headache, rash (discontinue if severe), fat redistribution, severe liver disease, hepatitis (discontinue if symptomatic), hypertriglyceridemia, hyperlipidemia, hyperglycemia, immune reconstitution syndrome, intracranial hemorrhage (may be fatal), others; children: also cough.
Register pregnant patients exposed to tipranavir by calling (800) 258-4263.