Skip to main content

Fortovase Side Effects

Generic name: saquinavir

Medically reviewed by Drugs.com. Last updated on Nov 3, 2023.

Note: This document contains side effect information about saquinavir. Some dosage forms listed on this page may not apply to the brand name Fortovase.

Applies to saquinavir: oral tablet.

Serious side effects of Fortovase

Along with its needed effects, saquinavir (the active ingredient contained in Fortovase) may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur while taking saquinavir:

More common

Less common

Rare

Other side effects of Fortovase

Some side effects of saquinavir may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects.

Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

Less common

For Healthcare Professionals

Applies to saquinavir: oral capsule, oral tablet.

General

Nausea, vomiting, diarrhea, fatigue, flatulence, and abdominal pain have been reported the most frequently with this drug (plus ritonavir). Additional side effects have been reported during postmarketing experience that were similar to those observed in clinical trials with saquinavir (the active ingredient contained in Fortovase) mesylate and saquinavir soft gel capsules alone or in combination with ritonavir.[Ref]

Gastrointestinal

Very common (10% or more): Nausea, diarrhea

Common (1% to 10%): Vomiting, abdominal distension, abdominal pain, upper abdominal pain, constipation, dry mouth, dyspepsia, eructation, flatulence, lip dry, loose stools, increased blood amylase

Uncommon (0.1% to 1%): Pancreatitis

Frequency not reported: Abdominal discomfort, ascites, bucca mucosa ulceration, dysphagia, gastritis, gastrointestinal (GI) hemorrhage, intestinal obstruction, cheilitis, frequent bowel movements, discolored feces, bloodstained feces, gastralgia, GI inflammation, gingivitis, GI ulcer, glossitis, hemorrhoids, melena, painful defecation, parotid disorder, rectal hemorrhage, salivary gland disorder, stomatitis, tooth disorder, abdominal colic, esophageal ulceration, esophagitis, gastroesophageal reflux, infectious diarrhea, pruritus ani, pyrosis, stomach upset, toothache[Ref]

Metabolic

Diabetes mellitus/hyperglycemia was sometimes associated with ketoacidosis during postmarketing experience.

Redistribution/accumulation of body fat has been reported with antiretroviral therapy; causality has not been established.[Ref]

Very common (10% or more): Increased blood cholesterol, increased blood triglycerides, increased low-density lipoprotein

Common (1% to 10%): Diabetes mellitus/hyperglycemia, anorexia, increased appetite

Uncommon (0.1% to 1%): Decreased appetite

Frequency not reported: Dehydration, hypertriglyceridemia, increased alkaline phosphatase, increased LDH, hypoglycemia, hyperlipidemia, appetite disturbance, increased blood glucose, decreased blood glucose, hypercalcemia, hypocalcemia, hyperphosphatemia, hypophosphatemia, hyperkalemia, hypokalemia, hypernatremia, hyponatremia

Postmarketing reports: Ketoacidosis, metabolic abnormalities (e.g., hypertriglyceridemia, hypercholesterolemia, insulin resistance, hyperlactatemia)

Antiretroviral therapy:

-Frequency not reported: Redistribution/accumulation of body fat (including central obesity, dorsocervical fat enlargement, peripheral wasting, facial wasting, breast enlargement, "cushingoid appearance"), increased blood lipid levels, increased glucose levels

Protease inhibitor therapy:

-Postmarketing reports: New onset diabetes mellitus, exacerbation of preexisting diabetes mellitus, hyperglycemia, diabetic ketoacidosis[Ref]

Hematologic

Increased bleeding (including spontaneous skin hematomas and hemarthrosis) in patients with hemophilia type A and B has been associated with protease inhibitors. In many of the reported cases, treatment with protease inhibitors was continued or restarted and some patients required additional factor VIII. A causal relationship between protease inhibitor therapy and these episodes has not been established.[Ref]

Very common (10% or more): Decreased platelet count

Common (1% to 10%): Anemia, decreased hemoglobin, decreased lymphocyte count, decreased WBC count

Uncommon (0.1% to 1%): Neutropenia

Frequency not reported: Hemolytic anemia, leukopenia, lymphadenopathy, pancytopenia, thrombocytopenia, splenomegaly, dermal bleeding, microhemorrhages

Protease inhibitor therapy:

-Frequency not reported: Increased bleeding (including spontaneous skin hematomas, hemarthrosis) in hemophiliacs[Ref]

Hepatic

There have been reports of worsening liver disease in patients with underlying hepatitis B or C, cirrhosis, chronic alcoholism, and/or other underlying liver abnormalities.

Severe hepatocellular toxicity (which presented as increased hepatic transaminases) occurred in healthy subjects exposed to this drug (plus ritonavir) and rifampin. Transaminases increased up to more than 20-fold the upper limit of normal in some patients and were associated with GI symptoms (including abdominal pain, gastritis, nausea, vomiting). Clinical symptoms resolved and hepatic transaminases returned to normal after all 3 drugs were stopped.[Ref]

Very common (10% or more): Elevated ALT, elevated AST

Common (1% to 10%): Increased blood bilirubin

Uncommon (0.1% to 1%): Hepatitis, jaundice

Frequency not reported: Chronic active hepatitis, hepatomegaly, hyperbilirubinemia, portal hypertension, elevated GGT, hepatosplenomegaly, severe cutaneous reaction associated with increased liver function tests, increased transaminase levels, exacerbation of chronic liver disease with grade 4 elevated liver function tests, worsening liver disease, severe hepatocellular toxicity (presenting as increased hepatic transaminases), sclerosing cholangitis, cholelithiasis, liver enzyme disorder[Ref]

Cardiovascular

Rare (less than 0.1%): Second or third degree atrioventricular block

Frequency not reported: QT interval prolongation, PR interval prolongation, heart murmur, hypertension, hypotension, thrombophlebitis, vasoconstriction/peripheral vasoconstriction, cyanosis, heart rate disorder, heart valve disorder, vein distension

Postmarketing reports: Torsades de pointes (rarely)[Ref]

This drug (plus ritonavir) showed a dose-dependent prolongation of the QT and PR intervals.[Ref]

Other

Common (1% to 10%): Fatigue, fever/pyrexia, asthenia/weakness, increased fat tissue, malaise

Uncommon (0.1% to 1%): Mucosal ulceration

Frequency not reported: Chest pain, edema, wasting syndrome, intoxication, increased weight, mucosal damage, retrosternal pain, shivering, generalized weakness, earache, ear pressure, otitis, abscess, bacterial infection, candidiasis, herpes simplex, herpes zoster, mycotic infection, staphylococcal infections, decreased weight, external parasites, cellulitis, molluscum contagiosum, moniliasis

Antiretroviral therapy:

-Frequency not reported: Increased weight[Ref]

Respiratory

Common (1% to 10%): Pneumonia, bronchitis, influenza, sinusitis, dyspnea

Frequency not reported: Cough, epistaxis, hemoptysis, laryngitis, pharyngitis, respiratory disorder, rhinitis, upper respiratory tract infection, angina tonsillaris, pulmonary disease[Ref]

Dermatologic

Common (1% to 10%): Acquired lipodystrophy, rash, pruritus, dry skin, eczema, alopecia, lipoatrophy

Uncommon (0.1% to 1%): Stevens-Johnson syndrome, bullous dermatitis

Frequency not reported: Acne, drug eruption, erythema, severe cutaneous reaction associated with increased liver function tests, increased sweating, urticaria, dermatitis, bullous dermatitis skin eruption (including with polyarthritis), folliculitis, furunculosis, hair changes, hot flushes, maculopapular rash, photosensitivity reaction, seborrheic dermatitis, skin disorder, skin nodule, skin pigment changes, skin ulceration, verruca, xeroderma, exanthema, nail disorders, night sweats, psoriasis

Postmarketing reports: Lipodystrophy (including loss of peripheral and facial subcutaneous fat, increased intraabdominal and visceral fat, breast hypertrophy, dorsocervical fat accumulation [buffalo hump])[Ref]

Nervous system

Common (1% to 10%): Headache, paresthesia, peripheral neuropathy, dizziness, dysgeusia/taste alteration

Uncommon (0.1% to 1%): Somnolence, convulsions

Frequency not reported: Abnormal coordination, hypoesthesia, intracranial hemorrhage (sometimes leading to death), tremor, loss of consciousness, syncope, tinnitus, dysarthria, dysesthesia, ataxia, extremity numbness, face numbness, facial pain, hyperesthesia, hyperreflexia, hyporeflexia, lethargy, lightheadedness, paresis, poliomyelitis, progressive multifocal leukoencephalopathy, seizures, spasms, decreased hearing, stroke, myelopolyradiculoneuritis, prickly sensation[Ref]

Psychiatric

Common (1% to 10%): Decreased libido, sleep disorder

Frequency not reported: Anxiety/anxiety attack, confusion/confusional state, depression, insomnia, libido disorder, psychotic disorder/psychosis, suicide attempt, agitation, amnesia, euphoria, excessive dreaming, hallucination, irritability, overdose effect, psychic disorders, reduced intellectual ability, speech disorder[Ref]

Musculoskeletal

Common (1% to 10%): Back pain, muscle spasms

Frequency not reported: Arthralgia, myalgia, polyarthritis, elevated blood creatine phosphokinase, arthritis, muscle cramps, musculoskeletal pain, musculoskeletal disorders, stiffness, tissue changes, trauma, leg cramps

Combination antiretroviral therapy:

-Frequency not reported: Osteonecrosis

Protease inhibitor therapy:

-Rare (less than 0.1%): Rhabdomyolysis

-Frequency not reported: Increased creatine phosphokinase, myalgia, myositis[Ref]

Hypersensitivity

Common (1% to 10%): Hypersensitivity

Frequency not reported: Allergic reaction, drug fever[Ref]

Renal

Common (1% to 10%): Increased blood creatinine

Uncommon (0.1% to 1%): Renal impairment

Frequency not reported: Nephrolithiasis, acute renal insufficiency[Ref]

Ocular

Uncommon (0.1% to 1%): Visual impairment

Frequency not reported: Blepharitis, dry eye syndrome, eye irritation, visual disturbance, xerophthalmia, chalazion, cytomegalovirus retinitis[Ref]

Immunologic

Frequency not reported: Immune reconstitution/reactivation syndrome, autoimmune disorders in the setting of immune reconstitution (e.g., Graves' disease, polymyositis, Guillain-Barre syndrome)[Ref]

Genitourinary

Frequency not reported: Enlarged prostate, pelvic pain, vaginal discharge, micturition disorder, urinary tract infection, epididymitis, impotence, menstrual disorder, menstrual irregularity, nocturia, penis disorder, renal calculus, renal colic, urinary tract bleeding[Ref]

Oncologic

Frequency not reported: Acute myeloid leukemia, papillomatosis, skin papilloma, tumor[Ref]

Endocrine

Frequency not reported: Hyperprolactinemia, increased thyroid stimulating hormone[Ref]

More about Fortovase (saquinavir)

Patient resources

Other brands

Invirase

Professional resources

Other brands

Invirase

Related treatment guides

References

1. Product Information. Invirase (saquinavir). Roche Laboratories. 2001;PROD.

2. Cerner Multum, Inc. UK Summary of Product Characteristics.

3. Kakuda TN, Falcon RW. Effect of Food and Ranitidine on Saquinavir Pharmacokinetics and Gastric pH in Healthy Volunteers. Pharmacotherapy. 2006;26:1060-8.

4. Modjtahedi BS, Modjtahedi SP, Maibach HI. Gender: a possible determinant in dosing of dermatologic drugs--an overview. Cutan Ocul Toxicol. 2006;25:195-210.

5. Ribera E, Azuaje C, Lopez RM, et al. Pharmacokinetic interaction between rifampicin and the once-daily combination of saquinavir and low-dose ritonavir in HIV-infected patients with tuberculosis. J Antimicrob Chemother. 2007;59:690-7.

6. EMEA. European Medicines Agency. EPARs. European Union Public Assessment Reports. http://www.ema.europa.eu/ema/index.jsp?curl=pages/includes/medicines/medicines_landingpage.jsp&mid 2007.

7. Warnke D, Barreto J, Temesgen Z. Antiretroviral drugs. J Clin Pharmacol. 2007;47:1570-9.

8. Cerner Multum, Inc. Australian Product Information.

9. Drugs for HIV infection. Treat Guidel Med Lett. 2009;7:11-22.

10. Gill MJ. Safety profile of soft gelatin formulation of saquinavir in combination with nucleosides in a broad patient population. AIDS. 1998;12:1400-2.

11. Figgitt DP, Plosker GL. Saquinavir soft-gel capsule - An updated review of its use in the management of HIV infection. Drugs. 2000;60:481-516.

12. Product Information. Fortovase (saquinavir). Roche Laboratories. 2001;PROD.

13. Anderson PL. Pharmacologic perspectives for once-daily antiretroviral therapy. Ann Pharmacother. 2004;38:1969-70.

14. von Hentig N, Muller A, Rottmann C, et al. Pharmacokinetics of saquinavir, atazanavir and ritonavir in a boosted double-protease inhibitor twice-daily regimen. Antimicrob Agents Chemother. 2007;51:1431-9.

15. Panel on Antiretroviral Guidelines for Adults and Adolescents. Guidelines for the use of antiretroviral agents in HIV-1-infected adults and adolescents. Department of Health and Human Services. https://aidsinfo.nih.gov/contentfiles/lvguidelines/adultandadolescentgl.pdf 2015.

16. Melbourne: Therapeutic Guidelines Limited. eTG complete [Online] http://online.tg.org.au/complete/desktop/tgc.htm 2015.

17. AIDSinfo. NIH. National Institutes of Health. Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. https://aidsinfo.nih.gov/contentfiles/lvguidelines/pediatricguidelines.pdf 2016.

18. Carr A. HIV protease inhibitor-related lipodystrophy syndrome. Clin Infect Dis. 2000;30:s135-42.

19. Lotsch J, Harder S, Geisslinger G, et al. Association of saquinavir plasma concentrations with side effects but not with antiretroviral outcome in patients infected with protease inhibitor susceptible HIV-1. Antimicrob Agents Chemother. 2007;51:3264-72.

20. Cameron DW, Becker S, King MS, et al. Exploratory study comparing the metabolic toxicities of a lopinavir/ritonavir plus saquinavir dual protease inhibitor regimen versus a lopinavir/ritonavir plus zidovudine/lamivudine nucleoside regimen. J Antimicrob Chemother. 2007;59:957-63.

21. Zorrilla CD, Van Dyke R, Bardeguez A, et al. Clinical response and tolerability to and safety of saquinavir with low-dose ritonavir in human immunodeficiency virus type 1-infected mothers and their infants. Antimicrob Agents Chemother. 2007;51:2208-10.

22. FDA. U.S. Food and Drug Administration. FDA drug safety communication: Ongoing safety review of Invirase (saquinavir) and possible association with abnormal heart rhythms. http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInformationforPatientsandProviders/ucm201221.htm 2010.

23. Biondi L. Health Canada endorsed important safety information on Invirase (saquinavir mesylate). http://hc-sc.gc.ca/dhp-mps/alt_formats/pdf/medeff/advisories-avis/prof/2010/invirase_hpc-cps-eng.pdf 2010.

24. Silva M, Skolnik PR, Gorbach SL, Spiegelman D, Wilson IB, FernandezDiFranco MG, Knox TA. The effect of protease inhibitors on weight and body composition in HIV-infected patients. AIDS. 1998;12:1645-51.

25. Martinez E, Mocroft A, GarciaViejo MA, PerezCuevas JB, Blanco JL, Mallolas J, Bianchi L, Conget I, Blanch J, Phillips A, Gatell. Risk of lipodystrophy in HIV-1-infected patients treated with protease inhibitors: a prospective cohort study. Lancet. 2001;357:592-8.

26. GarciaSilva J, Almagro M, Juega J, Pena C, LopezCalvo S, delPozo J, Fonseca E. Protease inhibitor-related paronychia, ingrown toenails, desquamative cheilitis and cutaneous xerosis. Aids. 2000;14:1289-91.

27. Roling J, Schmid H, Fischereder M, Draenert R, Goebel FD. HIV-Associated Renal Diseases and Highly Active Antiretroviral Therapy-Induced Nephropathy. Clin Infect Dis. 2006;42:1488-95.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Some side effects may not be reported. You may report them to the FDA.