ritonavir and Intracranial-Hemorrhages

Tipranavir (TPV), a protease inhibitor, has box warnings for intracranial hemorrhage (ICH) and hepatotoxicity (including hepatic failure and death). A box warning is a labeling statement about serious adverse events leading to significant injury and/or death. A box warning is the most serious warning placed in the labeling of a prescription medication. As a result of the respective morbidity and mortality associated with ICH and hepatic failure, the Food and Drug Administration's (FDA's) Adverse Event Reporting System (AERS) was searched for reports of these adverse events in HIV-infected patients receiving a tipranavir/ritonavir (TPV/r)-based regimen. This search comprised part of the FDA's safety analysis for traditional approval. From July 2006 to March 2007, 10 cases of ICH were identified in AERS. From June 2005 to March 2007, 12 cases of liver-associated deaths were identified. One patient experienced liver failure and fatal ICH. Most patients with these events had additional risk factors. Among patients with liver-associated deaths, 3 had HIV-RNA less than 400 copies per milliliter at the time of hepatic failure. Among 10 patients who discontinued TPV/r when hepatic failure developed, median number of days post-TPV/r to death was 23 (range, 2-69 days). Review of AERS did not identify new safety concerns regarding ICH. Among most patients with liver-associated deaths, death appears to occur soon after hepatic failure develops. If considering TPV/r, careful assessment of risk/benefit is suggested for patients at risk for ICH and hepatic failure.

Topics: Adult; Adverse Drug Reaction Reporting Systems; Aged; Drug Therapy, Combination; Female; HIV Infections; HIV Protease Inhibitors; HIV-1; Humans; Intracranial Hemorrhages; Liver Failure; Male; Middle Aged; Pyridines; Pyrones; Ritonavir; Sulfonamides; United States; United States Food and Drug Administration

Topics: HIV Infections; HIV Protease Inhibitors; Humans; Intracranial Hemorrhages; Pyridines; Pyrones; Ritonavir; Sulfonamides

Topics: Drug Labeling; HIV Protease Inhibitors; Humans; Intracranial Hemorrhages; Pyridines; Pyrones; Ritonavir; Sulfonamides; United States; United States Food and Drug Administration