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Tipranavir (Monograph)

Brand name: Aptivus
Drug class: HIV Protease Inhibitors

Medically reviewed by Drugs.com on Feb 10, 2025. Written by ASHP.

Warning

    Hepatotoxicity
  • Clinical hepatitis and hepatic decompensation, including some fatalities, reported.

  • Extra vigilance warranted in HIV-infected patients with chronic HBV or HCV coinfection since these individuals are at increased risk of hepatotoxicity.

    Intracranial Hemorrhage
  • Intracranial hemorrhage, including some fatalities, reported.

Introduction

Antiretroviral; HIV protease inhibitor (PI).

Uses for Tipranavir

Treatment of HIV Infection

Treatment of HIV-1 infection in adult and pediatric patients weighing ≥36 kg. Must be used in combination with low-dose ritonavir (ritonavir-boosted tipranavir) and other antiretrovirals.

Used in patients who are antiretroviral-experienced and infected with HIV-1 resistant to >1 HIV protease inhibitors (PIs).

Should not be used in antiretroviral-naive patients.

Tipranavir was previously used in combination with ritonavir (ritonavir-boosted) as part of a fully suppressive antiretroviral regimen. Current guidelines do not recommend its use due to inferior virological efficacy and toxicities. Consult guidelines for the most current information on recommended regimens. Selection of an initial antiretroviral regimen should be individualized based on factors such as virologic efficacy, toxicity, pill burden, dosing frequency, drug-drug interaction potential, resistance test results, comorbid conditions, access, and cost.

Tipranavir Dosage and Administration

General

Pretreatment Screening

Patient Monitoring

Dispensing and Administration Precautions

Other General Considerations

Administration

Administer orally in conjunction with low-dose ritonavir (ritonavir-boosted tipranavir). Do not use without low-dose ritonavir.

Take tipranavir and low-dose ritonavir at same time with a meal.

Swallow tipranavir capsules whole; do not open or chew. Assess children for ability to swallow capsules before prescribing.

Dosage

Pediatric Patients

Treatment of HIV Infection
Oral

Antiretroviral-experienced children weighing ≥36 kg: 500 mg twice daily with low-dose ritonavir (200 mg twice daily).

Adults

Treatment of HIV Infection
Oral

Antiretroviral-experienced: 500 mg twice daily with low-dose ritonavir (200 mg twice daily).

Special Populations

Hepatic Impairment

Mild hepatic impairment (Child-Pugh class A): Dosage adjustments not necessary. Moderate or severe hepatic impairment (Child-Pugh class B or C): Contraindicated.

Renal Impairment

No specific dosage recommendations.

Geriatric Patients

No specific dosage recommendations. Select dosage with caution.

Cautions for Tipranavir

Contraindications

Warnings/Precautions

Warnings

Hepatotoxicity

Hepatitis and hepatic decompensation (including some fatalities) reported; causal relationship not established (see Boxed Warning). Hepatotoxicity generally has occurred in patients with advanced HIV infection receiving multiple concomitant drugs. Increased concentrations of serum hepatic transaminases (grade 3 and 4) reported.

Evaluate hepatic function prior to and frequently during treatment. HIV-infected patients with coexisting HBV or HCV infection or elevated serum transaminases prior to therapy may be at increased risk for hepatotoxicity.

Discontinue if signs or symptoms of hepatitis develop, if asymptomatic increases in serum AST or ALT of >10 times the ULN occur, or if asymptomatic increases in AST or ALT of 5–10 times the ULN and increases in total bilirubin of >2.5 times the ULN develop.

Clinicians and patients should be vigilant for appearance of signs or symptoms of hepatitis (e.g., fatigue, malaise, anorexia, nausea, jaundice, bilirubinemia, acholic stools, liver tenderness, hepatomegaly).

Intracranial Hemorrhage

Intracranial hemorrhage (including some fatalities) reported (see Boxed Warning). Other medical conditions or concomitant therapy may have caused or contributed to these events. Ritonavir-boosted tipranavir therapy generally not associated with abnormal coagulation parameters; abnormal coagulation parameters have not preceded intracranial hemorrhage. Manufacturer states that routine monitoring of coagulation parameters not necessary.

Other Warnings/Precautions

Rash

Mild to moderate rash, including maculopapular rash and possible photosensitivity reactions reported. Rash accompanied by joint pain or stiffness, throat tightness, or generalized pruritus also reported.

Discontinue drug and administer appropriate treatment if severe rash occurs. Concomitant estrogen-containing oral contraceptives or estrogens for hormone replacement therapy may increase risk for developing non-serious rash.

Concomitant estrogen-containing oral contraceptives or estrogens for hormone replacement therapy may increase risk for developing non-serious rash.

Sulfonamide Allergy

Tipranavir contains a sulfonamide moiety; use with caution in patients with known sulfonamide allergy. Potential for cross-sensitivity between drugs with sulfonamide moieties and tipranavir unknown.

Importance of Co-administration with Ritonavir

Tipranavir must be used with low-dose ritonavir (ritonavir-boosted tipranavir) and administered with a meal to achieve adequate antiviral response. Failure to administer with recommended low-dose ritonavir and meals will result in subtherapeutic tipranavir concentrations and inadequate antiviral response.

Consider the usual cautions, precautions, and contraindications associated with ritonavir.

Risk of Serious Adverse Reactions Due to Drug Interactions

Concomitant use with certain drugs is not recommended or requires particular caution or dosage adjustments.

Consider potential for drug interactions prior to and during ritonavir-boosted tipranavir therapy. Review all drugs patient is receiving and monitor for adverse effects.

Effects on Platelet Aggregation and Coagulation

Tipranavir inhibits platelet aggregation in vitro. Caution advised in patients who may be at risk for increased bleeding from trauma, surgery, or other medical conditions; those receiving concomitant drugs known to increase the risk of bleeding (i.e., anticoagulants, antiplatelet agents); and those receiving high-dose vitamin E.

Diabetes Mellitus/Hyperglycemia

Hyperglycemia (potentially persistent), new-onset diabetes mellitus or exacerbation of preexisting diabetes mellitus reported with use of HIV PIs; diabetic ketoacidosis has occurred. Initiate or adjust antidiabetic therapy (e.g., insulin, oral hypoglycemic agents) as needed.

Immune Reconstitution Syndrome

During initial treatment, patients who respond to antiretroviral therapy may develop an inflammatory response to indolent or residual opportunistic infections (e.g., Mycobacterium avium complex [MAC], M. tuberculosis, cytomegalovirus [CMV], Pneumocystis jirovecii [formerly P. carinii], reactivation of herpes simplex and herpes zoster); this may necessitate further evaluation and treatment.

Autoimmune disorders (e.g., Graves' disease, polymyositis, Guillain-Barré syndrome) reported in the setting of immune reconstitution; time to onset is more variable and can occur many months after initiation of antiretroviral therapy.

Fat Redistribution

Possible redistribution or accumulation of body fat, including central obesity, dorsocervical fat enlargement (buffalo hump), peripheral wasting, breast enlargement, and general cushingoid appearance with antiretroviral therapy. Mechanism and long-term consequences of fat redistribution unknown; causal relationship not established.

Elevated Lipids

Increased concentrations of total serum cholesterol and triglycerides reported. Determine serum cholesterol and triglyceride concentrations prior to and periodically during therapy; manage lipid disorders as clinically appropriate.

Patients with Hemophilia

Spontaneous bleeding reported with HIV PIs; causal relationship not established. Use with caution in patients with history of hemophilia A or B. Increased hemostatic therapy (e.g., antihemophilic factor) may be needed.

Resistance/Cross-resistance

Potential for cross-resistance with other HIV PIs not evaluated. Effect of ritonavir-boosted tipranavir therapy on subsequent therapy with other HIV PIs unknown.

Specific Populations

Pregnancy

Antiretroviral Pregnancy Registry available at 800-258-4263 or [Web]. Data insufficient to adequately assess the risk of major birth defects, miscarriage, or adverse maternal or fetal outcomes.

Lactation

Not known whether distributed into human milk or if drug has any effects on breastfed infant or milk production; distributed into milk in rats.

The HHS perinatal HIV transmission guideline provides updated recommendations on infant feeding. The guideline states that patients with HIV should receive evidence-based, patient-centered counseling to support shared decision making about infant feeding. During counseling, patients should be informed that feeding with appropriate formula or pasteurized donor human milk from a milk bank eliminates the risk of postnatal HIV transmission to the infant. Additionally, achieving and maintaining viral suppression with antiretroviral therapy during pregnancy and postpartum reduces the risk of breastfeeding HIV transmission to <1%, but does not completely eliminate the risk. Replacement feeding with formula or banked pasteurized donor milk is recommended when patients with HIV are not on antiretroviral therapy and/or do not have a suppressed viral load during pregnancy (at a minimum throughout the third trimester), as well as at delivery.

Females and Males of Reproductive Potential

Potential for reduced efficacy of concomitantly administered estrogen-containing oral contraceptives.

Advise patients receiving an estrogen-based oral contraceptive to use additional or alternative nonhormonal contraceptives.

Pediatric Use

Safety and efficacy established in children weighing ≥36 kg who are antiretroviral-experienced with HIV-1 strains resistant to >1 protease inhibitor. Adverse effects reported in children ≥36 kg generally similar to those reported in adults; rash reported more frequently in children than in adults.

Safety and efficacy established in children ≥2 years of age weighing <36 kg. Not recommended in this population due to lack of suitable pediatric formulation of the drug.

Geriatric Use

Insufficient experience in patients ≥65 years of age to determine whether geriatric patients respond differently than younger adults. Use with caution and monitor because of age-related decreases in hepatic, renal, and/or cardiac function and concomitant disease and drug therapy.

Hepatic Impairment

Use with caution since tipranavir concentrations may be increased. Contraindicated in moderate or severe hepatic impairment (Child-Pugh class B or C). Risk for further elevations in hepatic enzyme concentrations or severe liver disease in HIV-infected patients with chronic HBV or HCV coinfection or increased AST or ALT concentrations prior to therapy.

Renal Impairment

Pharmacokinetics not evaluated in renal impairment. Renal clearance is negligible; decreased clearance not expected in patients with renal impairment.

Common Adverse Effects

Adverse effects (>4%) in adults receiving ritonavir-boosted tipranavir in conjunction with other antiretroviral agents: diarrhea, nausea, pyrexia, fatigue, vomiting, headache, abdominal pain.

Adverse effects reported in pediatric patients were generally similar to those observed in adults, except for the incidence of rash, which occurred more frequently in pediatric patients.

Drug Interactions

Drug interaction studies were conducted using ritonavir-boostedtipranavir.

Tipranavir metabolized principally by CYP3A4.

Tipranavir with low-dose ritonavir inhibits CYP3A and 2D6.

Tipranavir is a P-glycoprotein (P-gp) substrate and is both a weak inhibitor and potent inducer of P-gp transport system.

Drugs Affecting or Metabolized by Hepatic Microsomal Enzymes

Pharmacokinetic interactions likely with drugs that are inhibitors, inducers, or substrates of CYP3A4 with possible alteration in metabolism of tipranavir, ritonavir, and/or other drug.

Drugs Affecting or Affected by P-glycoprotein Transport

Pharmacokinetic interactions likely with drugs that are P-gp inhibitors or inducers with possible altered metabolism of tipranavir or the other drug.

Specific Drugs

Drug

Interaction

Comments

Abacavir

Decreased abacavir AUC; clinical importance unknown

No antagonistic antiretroviral effects in vitro

Appropriate dosages for concomitant use with respect to safety and efficacy not established

Alfuzosin

Increased alfuzosin concentrations expected and risk of hypotension

Concomitant use contraindicated

Antacids

Decreased tipranavir concentrations and AUC

Antiarrhythmic agents (amiodarone, flecainide, propafenone, quinidine)

Amiodarone, flecainide, propafenone, quinidine: Possible increased concentrations of antiarrhythmic agents

Concomitant use contraindicated

Anticoagulants, oral

Potential for increased risk of bleeding

Warfarin: Possible altered warfarin concentrations

Caution advised when used with any anticoagulant

Warfarin: Use with caution; monitor INR, especially when initiating or discontinuing ritonavir-boosted tipranavir

Anticonvulsants (carbamazepine, phenobarbital, phenytoin, valproic acid)

Carbamazepine: Possible increased carbamazepine concentrations; possible decreased tipranavir concentrations

Phenobarbital, phenytoin: Possible decreased tipranavir concentrations

Valproic acid: Possible decreased valproic acid concentrations

Carbamazepine, phenobarbital, phenytoin: Use with caution

Valproic acid: Use concomitantly with caution

Antifungals

Fluconazole: Increased tipranavir concentrations and AUC; no clinically important effect on fluconazole concentrations

Itraconazole, ketoconazole: Increased antifungal concentrations

Voriconazole: Altered voriconazole concentration; however, due to multiple enzymes involved with voriconazole metabolism, difficult to predict the interaction

Fluconazole: Fluconazole dosage adjustment not needed, but fluconazole dosage >200 mg daily not recommended

Itraconazole: Use concomitantly with caution; itraconazole dosage >200 mg daily not recommended

Ketoconazole: Use concomitantly with caution; ketoconazole dosage >200 mg daily not recommended

Antimycobacterials (rifabutin, rifampin)

Rifabutin: Increased rifabutin concentrations; no change in tipranavir concentrations

Rifampin: Possible decreased tipranavir concentrations; possible decreased antiretroviral activity and increased risk of tipranavir resistance

Rifabutin: Reduce rifabutin dosage to 150 mg every other day (further reduction may be needed); increase monitoring for adverse effects

Rifampin: Concomitant use contraindicated

Antiplatelet agents

Potential for increased risk of bleeding

Use concomitantly with caution

Antipsychotics (lurasidone, pimozide, quetiapine)

Lurasidone: Potential for serious and/or life-threatening adverse effects

Pimozide: Potential for serious and/or life-threatening adverse effects (e.g., cardiac arrhythmias)

Quetiapine: Increased quetiapine concentrations expected

Lurasidone: Concomitant use contraindicated

Pimozide: Concomitant use contraindicated

Quetiapine: Consider alternative antiretroviral to avoid increased quetiapine exposures; if concomitant use necessary, consult quetiapine prescribing information for initial dosing; if initiating ritonavir-boosted tipranavir in patient receiving quetiapine, reduce quetiapine to one-sixth of original dosage

Atazanavir

Ritonavir-boosted tipranavir: Decreased atazanavir concentrations and AUC and increased tipranavir concentrations and AUC

In vitro evidence of additive to antagonistic antiretroviral effects

Atazanavir (with or without low-dose ritonavir): Concomitant use not recommended

Benzodiazepines

Midazolam, triazolam: Possible increased concentrations of midazolam or triazolam; potential for serious and/or life-threatening effects (e.g., prolonged or increased sedation or respiratory depression)

Midazolam, triazolam: Concomitant use with oral midazolam or triazolam contraindicated; manufacturer states that parenteral midazolam can be used with caution in a monitored situation for procedural sedation; consider use of a reduced dose

Buprenorphine, buprenorphine and naloxone

Buprenorphine or fixed combination of buprenorphine and naloxone (buprenorphine/naloxone): Decreased tipranavir concentrations; no effect on clinical efficacy of buprenorphine/naloxone

Buprenorphine or buprenorphine/naloxone: Dosage adjustments cannot be recommended

Calcium-channel blocking agents (e.g., diltiazem, felodipine, nicardipine, nisoldipine, verapamil)

Effect of ritonavir-boosted tipranavir on calcium channel blockers that are dual substrates of CYP3A and P-gp cannot be predicted

Use concomitantly with caution; clinical monitoring recommended

Colchicine

Increased colchicine concentrations

Patients with renal or hepatic impairment: Concomitant use with ritonavir-boosted tipranavir contraindicated

Patients with normal renal or hepatic function: Dosage adjustments recommended when used with ritonavir-boosted tipranavir

Colchicine for treatment of gout flares: In those receiving ritonavir-boosted tipranavir, use colchicine dose of 0.6 mg followed by 0.3 mg 1 hour later and repeat dose no earlier than 3 days later

Colchicine for prophylaxis of gout flares: In those receiving ritonavir-boosted tipranavir, decrease colchicine dosage to 0.3 mg once daily in those originally receiving 0.6 mg twice daily or decrease dosage to 0.3 mg once every other day in those originally receiving 0.6 mg once daily

Colchicine for treatment of familial Mediterranean fever (FMF): In those receiving ritonavir-boosted tipranavir, use maximum colchicine dosage of 0.6 mg daily (may be given as 0.3 mg twice daily)

Drug

Interaction

Comments

Cisapride

Potential for serious and/or life-threatening effects such as cardiac arrhythmias

Concomitant use contraindicated

Clarithromycin

Increased clarithromycin concentrations; decreased hydroxyclarithromycin concentrations; increased tipranavir concentrations

Modification of usual dosage of clarithromycin or tipranavir not necessary in patients with normal renal function; reduce clarithromycin dosage by 50% if Clcr 30–60 mL/minute and reduce by 75% if Clcr<30 mL/minute

Delavirdine

No antagonistic antiretroviral effects in vitro

Didanosine

Decreased didanosine concentrations when the delayed-release capsules are used

No antagonistic antiretroviral effects in vitro

For optimal absorption, administer didanosine at least 2 hours before or after tipranavir

Disulfiram

Potential pharmacokinetic interaction with alcohol contained in tipranavir capsules; possible disulfiram-like reaction

Dolutegravir

Decreased dolutegravir concentrations and AUC

If used concomitantly, refer to the dolutegravir prescribing information

Efavirenz

Decreased tipranavir concentrations and no change in efavirenz concentrations using tipranavir 500 mg twice daily and ritonavir 100 mg twice daily with efavirenz 600 mg once daily

No antagonistic antiretroviral effects in vitro

Emtricitabine

No antagonistic antiretroviral effects in vitro

Enfuvirtide

Increased tipranavir trough concentrations

No antagonistic antiretroviral effects in vitro

Dosage adjustments not recommended

Ergot alkaloids (dihydroergotamine, ergonovine, ergotamine, methylergonovine)

Potential for serious or life-threatening adverse effects (e.g., peripheral vasospasm, ischemia of extremities)

Concomitant use contraindicated

Estrogens and progestins

Potential for increased risk of non-serious rash in women receiving estrogens

Conjugated estrogens (equine or synthetic), estradiol: Possible decreased estrogen concentrations

Oral contraceptives containing ethinyl estradiol and norethindrone: Decreased ethinyl estradiol concentrations; no effect on norethindrone concentrations

Conjugated estrogens (equine or synthetic), estradiol: Monitor for estrogen deficiency; adjust dosage as clinically necessary

Oral contraceptives containing ethinyl estradiol and norethindrone: Consider alternative nonhormonal or additional contraception methods

Fosamprenavir

Possible decreased amprenavir concentrations

Concomitant use not recommended

HMG-CoA reductase inhibitors (statins)

Atorvastatin, lovastatin, rosuvastatin, simvastatin: Increased concentrations and AUCs of the antilipemic agent and increased risk of statin-associated adverse effects, including myopathy and rhabdomyolysis

Atorvastatin: Avoid concomitant use

Lovastatin: Concomitant use contraindicated

Simvastatin: Concomitant use contraindicated

Lamivudine

No clinically important changes in lamivudine concentrations

In vitro evidence of additive to antagonistic antiretroviral effects

Loperamide

Decreased loperamide concentrations; no clinically important change in tipranavir concentrations

Lopinavir and ritonavir

Fixed combination of lopinavir and ritonavir: Decreased lopinavir concentrations and AUC

In vitro evidence of additive to antagonistic antiretroviral effects

Lopinavir/ritonavir: Concomitant use not recommended

Methadone

Decreased methadone concentrations

Methadone dosage adjustment may be necessary

Metronidazole

Potential interaction with alcohol present in tipranavir capsules; possible disulfiram-like reaction

Nelfinavir

No evidence of antagonistic antiretroviral effects in vitro

Drug

Interaction

Comments

Nevirapine

No clinically important effect on nevirapine concentrations; no evidence of antagonistic antiretroviral effects in vitro

Omeprazole

Decreased omeprazole concentrations; no change in tipranavir concentrations

If concomitant use necessary, increased omeprazole dosage may be considered based on response

Oral antidiabetic agents

Glimepiride, glipizide, glyburide, pioglitazone, repaglinide: Potential for altered concentrations of antidiabetic agents

Glimepiride, glipizide, glyburide, pioglitazone, repaglinide: Careful glucose monitoring warranted

Raltegravir

Decreased raltegravir concentrations and AUC

Raltegravir 400 mg 2 times daily: Dosage adjustments not needed

Other raltegravir regimens: Refer to prescribing information

Rilpivirine

Possible increased rilpivirine concentrations; not expected to affect tipranavir concentrations

Ritonavir

Increased tipranavir concentrations and AUC; concomitant low-dose ritonavir used to therapeutic advantage (ritonavir-boosted tipranavir)

St. John’s wort (Hypericum perforatum)

Potential decreased tipranavir concentrations; possible decreased antiretroviral efficacy and increased risk of antiretroviral resistance

Concomitant use contraindicated

Saquinavir

Decreased saquinavir concentrations and AUC

In vitro evidence of additive to antagonistic antiretroviral effects

Concomitant use not recommended

Selective serotonin-reuptake inhibitors (SSRIs)

Fluoxetine, paroxetine, sertraline: Possible increased SSRI concentrations

Dosage of the SSRI may need to be adjusted when ritonavir-boosted tipranavir is initiated

Sildenafil

Possible increased sildenafil concentrations and increased risk of sildenafil-associated adverse effects (e.g., hypotension, syncope, visual disturbances, prolonged erection)

Sildenafil for treatment of pulmonary arterial hypertension (PAH): Concomitant use with ritonavir-boosted tipranavir contraindicated

Sildenafil for treatment of erectile dysfunction: Do not exceed sildenafil dosage of 25 mg once every 48 hours; closely monitor for sildenafil-associated adverse effects (e.g., hypotension, syncope, visual disturbances, prolonged erection)

Tadalafil

Possible increased tadalafil concentrations with first dose and increased risk of tadalafil-associated adverse effects (e.g., hypotension, syncope, visual disturbances, prolonged erection)

Tadalafil for treatment of PAH in patients who have been receiving ritonavir-boosted tipranavir for ≥1 week: Use initial tadalafil dosage of 20 mg once daily; if tolerated, may increase dosage to 40 mg once daily

Ritonavir-boosted tipranavir in patients receiving tadalafil for PAH: Discontinue tadalafil for at least 24 hours prior to initiating ritonavir-boostedtipranavir; after ≥1 week of the antiretroviral agent, may resume tadalafil at dosage of 20 mg once daily and, if tolerated, may increase dosage to 40 mg once daily

Tadalafil for treatment of erectile dysfunction: Do not exceed tadalafil dosage of 10 mg once every 72 hours; closely monitor for tadalafil-related adverse effects (e.g., hypotension, syncope, visual disturbances, prolonged erection, syncope)

Tenofovir

Decreased tenofovir concentrations and AUC; possible decreased tipranavir concentrations and AUC

No antagonistic antiretroviral effects in vitro

Trazodone

Possible increased trazodone concentrations and AUC

Increased risk of trazodone-associated adverse effects (e.g., nausea, dizziness, hypotension, syncope)

Use with caution; consider reduced trazodone dosage

Tricyclic antidepressants (desipramine)

Desipramine: Possible increased concentrations of the tricyclic antidepressant

Desipramine: Use reduced desipramine dosage and monitor plasma desipramine concentrations

Valacyclovir

No clinically important effect on tipranavir or acyclovir concentrations or AUC

Vardenafil

Possible increased vardenafil concentrations and increased risk of vardenafil-associated adverse effects (e.g., hypotension, syncope, visual disturbances, prolonged erection)

Vardenafil for treatment of erectile dysfunction: Do not exceed vardenafil dosage of 2.5 mg once every 72 hours; closely monitor for vardenafil-related adverse effects (e.g., hypotension, syncope, visual changes, prolonged erection)

Vitamin E

Potential for increased risk of bleeding with high-dose vitamin E

Use concomitantly with caution

Zidovudine

Decreased zidovudine AUC; clinical importance unknown

No antagonistic antiretroviral effects in vitro

Appropriate dosage for concomitant use not established

Tipranavir Pharmacokinetics

Absorption

Bioavailability

Tipranavir is administered concomitantly with low-dose ritonavir (ritonavir-boosted tipranavir). Ritonavir decreases metabolism of tipranavir, resulting in increased tipranavir plasma concentrations.

Following >2 weeks of multiple oral doses given without regard to meals, peak plasma tipranavir concentrations attained approximately 3 hours after a dose.

Steady state attained in most patients after 7–10 days. Steady-state trough concentrations are 70% lower than day 1, presumably due to intestinal P-gp induction.

Food

Effect of food on administration of tipranavir with ritonavir (as tablets) not evaluated.

Distribution

Extent

Not known whether distributed into CSF or semen.

Not known whether distributed into human milk; distributed into animal milk.

Plasma Protein Binding

>99%.

Binds to albumin and α1-acid-glycoprotein.

Elimination

Metabolism

Tipranavir extensively metabolized by CYP3A4. Only minimal metabolism of tipranavir occurs when administered with ritonavir 200 mg.

Oral clearance of tipranavir decreased when administered with ritonavir; this may indicate decreased first-pass effect.

Elimination Route

Following administration of ritonavir-boosted tipranavir, eliminated principally in feces as unchanged tipranavir. Approximately 82% of tipranavir dose excreted in feces and 4% excreted in urine.

Half-life

Effective mean elimination half-life at steady-state is 4.8–6 hours following administration of ritonavir-boosted tipranavir with a light meal.

Special Populations

Renal impairment: Pharmacokinetics not studied, but decreased total body clearance not expected since renal clearance of tipranavir is negligible.

Mild hepatic impairment (Child-Pugh class A): Increased plasma concentrations, but dosage adjustments not needed.

Moderate or severe impairment (Child-Pugh class B and C): Pharmacokinetics not evaluated.

Higher tipranavir concentrations reported in females compared with males; dosage adjustments not required.

Stability

Storage

Oral

Capsules

2–8°C prior to opening bottle; after opening bottle, store at 20–25°C (excursions permitted to 15–30°C) and use within 60 days.

Actions

Advice to Patients

Additional Information

The American Society of Health-System Pharmacists, Inc. represents that the information provided in the accompanying monograph was formulated with a reasonable standard of care, and in conformity with professional standards in the field. Readers are advised that decisions regarding use of drugs are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and that the information contained in the monograph is provided for informational purposes only. The manufacturer’s labeling should be consulted for more detailed information. The American Society of Health-System Pharmacists, Inc. does not endorse or recommend the use of any drug. The information contained in the monograph is not a substitute for medical care.

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

Tipranavir

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Oral

Capsules

250 mg

Aptivus

Boehringer-Ingelheim

AHFS DI Essentials™. © Copyright 2025, Selected Revisions February 10, 2025. American Society of Health-System Pharmacists, Inc., 4500 East-West Highway, Suite 900, Bethesda, Maryland 20814.

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