(tel a' pre vir)
[Posted 3/1/2012]ISSUE:FDA notified healthcare professionals of updates to the prescribing information concerning interactions between protease inhibitors and certain statin drugs. Protease inhibitors and statins taken together may raise the blood levels of statins and increase the risk for muscle injury (myopathy). The most serious form of myopathy, called rhabdomyolysis, can damage the kidneys and lead to kidney failure, which can be fatal.
BACKGROUND:Statins are a class of prescription drugs used together with diet and exercise to reduce blood levels of low-density lipoprotein (LDL) cholesterol (''bad cholesterol''). HIV protease inhibitors are a class of prescription anti-viral drugs used to treat HIV. HCV protease inhibitors are a class of prescription anti-viral drugs used to treat hepatitis C infection.
RECOMMENDATION:Healthcare professionals should follow the recommendations in the prescribing information (drug labels) when prescribing HIV or HCV protease inhibitors with statins. See the FDA Drug Safety Communication for additional information, including a data summary. For more information visit the FDA website at: Web Siteand Web Site.
WHY is this medicine prescribed?
Telaprevir is used along with two other medications (ribavirin [Copegus, Rebetol] and peginterferon alfa [Pegasys]) to treat chronic hepatitis C (an ongoing viral infection that damages the liver) in people who have not yet been treated for this condition or whose condition could not successfully be treated with ribavirin and peginterferon alfa alone. Telaprevir is in a class of medications called protease inhibitors. It works by decreasing the amount of hepatitis C virus (HCV) in the body. Telaprevir may not prevent the spread of hepatitis C to other people.
HOW should this medicine be used?
Telaprevir comes as a tablet to take by mouth. It is usually taken three times a day (every 7 to 9 hours). You must eat a meal or snack that contains about 20 grams of fat within 30 minutes before you take telaprevir. Ask your doctor for examples of foods that contain 20 grams of fat that you can eat when you take telaprevir. Do not take telaprevir without food. Take telaprevir at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take telaprevir exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.
Continue to take telaprevir even if you feel well. Telaprevir must be taken in combination with peginterferon alfa and ribavirin, usually for 12 weeks. Peginterferon alfa and ribavirin are usually continued after treatment with telaprevir is finished. Do not stop taking telaprevir, peginterferon alfa, or ribavirin, unless told to do so by your doctor.
Your doctor or pharmacist will give you the manufacturer's patient information sheet (Medication Guide) when you begin treatment with telaprevir and each time you refill your prescription. Read the information carefully and ask your doctor or pharmacist if you have any questions. You can also visit the Food and Drug Administration (FDA) website ( Web Site) or the manufacturer's website to obtain the Medication Guide.
Are there OTHER USES for this medicine?
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.
What SPECIAL PRECAUTIONS should I follow?
Before taking telaprevir,
- tell your doctor and pharmacist if you are allergic to telaprevir, any other medications, or any of the ingredients in telaprevir tablets. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
- tell your doctor if you are taking any of the following medications or herbal products: alfuzosin (Uroxatral); atorvastatin (Lipitor, in Caduet); ergot medications such as dihydroergotamine (D.H.E. 45, Migranal), ergotamine (Ergomar, in Cafergot, in Migergot), ergonovine, and methylergonovine (Methergine); cisapride (Propulsid); lovastatin (Mevacor, in Advicor); midazolam (Versed) taken by mouth; pimozide (Orap); rifampin (Rifadin, Rimactane, in IsonaRif, in Rifamate, in Rifater); sildenafil (only Revatio brand used for lung disease); simvastatin (in Simcor, in Vytorin, Zocor); St. John's wort; triazolam (Halcion); and tadalafil (only Adcirca brand used for lung disease). Your doctor will probably tell you not to take telaprevir if you are taking one or more of these medications.
- tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, and nutritional supplements you are taking or plan to take. Be sure to mention any of the following: alprazolam (Xanax); anticoagulants ('blood thinners') such as warfarin (Coumadin); antifungal medications such as itraconazole (Sporanox), ketoconazole (Nizoral), posaconazole (Noxafil), or voriconazole (Vfend); bosentan ( Tracleer); budesonide (Pulmicort, Rhinocort); calcium channel blockers such as amlodipine (Norvasc), diltiazem (Cardizem, Dilacor, Tiazac, others), felodipine (Plendil), nicardipine (Cardene), nifedipine (Adalat, Procardia), nisoldipine (Sular), and verapamil (Calan, Isoptin, Verelan); clarithromycin (Biaxin); colchicine (Colcrys); desipramine (Norpramin); digoxin (Lanoxin); efavirenz (Sustiva, in Atripla); erythromycin (E.E.S., E-Mycin, others); escitalopram (Lexapro); fluticasone (Advair, Flonase, Flovent); hormone replacement therapy (HRT); immunosuppressants such as cyclosporine (Gengraf, Neoral, Sandimmune), sirolimus (Rapamune), or tacrolimus (Prograf); medications for erectile dysfunction (ED) such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra, Staxyn); medications for irregular heartbeat such as amiodarone (Cordarone, Pacerone), bepridil (Vascor) (not available in the U.S.), flecainide (Tambocor), lidocaine (Lidoderm, Lidopen, Xylocaine), propafenone (Rhythmol), or quinidine; certain medications for seizures such as carbamazepine (Tegretol), phenobarbital, and phenytoin (Dilantin); methadone (Dolophine); midazolam injection (Versed); oral contraceptives ('birth control pills'); oral steroids such as dexamethasone (Decadron, Dexpak), methylprednisolone (Medrol), and prednisone (Sterapred); rifabutin (Mycobutin); ritonavir (Norvir) used in combination with other HIV protease inhibitors such as atazanavir (Reyataz), darunavir (Preszista), fosamprenavir (Lexiva), and lopinavir (in Kaletra); salmeterol (Serevent, in Advair); telithromycin (Ketek); tenofovir (Viread, in Truvada and Atripta); trazodone; and zolpidem (Ambien). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with telaprevir, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
- tell your doctor if you have ever had an organ transplant and if you have or have ever had anemia (not enough red blood cells in the blood to carry oxygen to the rest of the body), gout (attacks of joint pain caused by high levels of uric acid in the blood), human immunodeficiency virus (HIV), problems with your immune system, hepatitis B (HBV) or liver disease other than hepatitis C, or kidney disease.
- if you are having surgery, including dental surgery, tell your doctor or dentist that you are taking telaprevir.
- tell your doctor if you are pregnant, plan to become pregnant, or can possibly become pregnant. If you are male, tell your doctor if your partner is pregnant, plans to become pregnant, or can possibly become pregnant. Telaprevir must be taken with ribavirin which can harm the fetus. You must use two methods of birth control to prevent pregnancy in you or your partner during your treatment with these medications and for 6 months after your treatment. Talk to your doctor about which methods you should use; hormonal contraceptives (birth control pills, patches, implants, rings, or injections) may not work well in women who are taking these medications. You or your partner must be tested for pregnancy every month during your treatment and for 6 months after your treatment. If you or your partner become pregnant while taking these medications, call your doctor immediately.
- tell your doctor if you are breast-feeding.
What SPECIAL DIETARY instructions should I follow?
Unless your doctor tells you otherwise, continue your normal diet.
What should I do IF I FORGET to take a dose?
If you remember the missed dose within 4 hours of the time you were scheduled to take it, take the missed dose with a snack or meal (containing about 20 grams of fat) right away. However, if it is more than 4 hours since you were to take the dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one.
What SIDE EFFECTS can this medicine cause?
Telaprevir may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:
- change in ability to taste
- discomfort, burning or itching around the anus
Some side effects can be serious. If you experience any of these symptoms, call your doctor immediately:
- rash (with or without itching)
- yellowing of the skin or eyes
- blisters in the mouth or throat
- red, swollen eyes
- swelling of the face
- decreased urination
- pale skin
- shortness of breath
Telaprevir may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at Web Site] or by phone [1-800-332-1088].
What should I know about STORAGE and DISPOSAL of this medication?
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). After a bottle of telaprevir is first opened, the medication must be used within 28 days. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.
What should I do in case of OVERDOSE?
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Symptoms of overdose may include:
- loss of appetite
- changes in taste
What OTHER INFORMATION should I know?
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to telaprevir.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.
It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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