PREZISTA Dosing

Indication

PREZISTA^®, co-administered with 100 mg ritonavir (PREZISTA/rtv), and with other antiretroviral agents, is indicated for the treatment of human immunodeficiency virus (HIV-1) infection.

This indication is based on analyses of plasma HIV RNA levels and CD4+ cell counts from 2 controlled Phase 3 trials of 48 weeks duration in antiretroviral treatment-naïve and treatment-experienced patients and 2 controlled Phase 2 trials of 96 weeks duration in clinically advanced, treatment-experienced patients.

In treatment-experienced patients, the following points should be considered when initiating therapy with PREZISTA/rtv:

• Treatment history and, when available, genotypic or phenotypic testing, should guide the use of PREZISTA/rtv.
• The use of other active agents with PREZISTA/rtv is associated with a greater likelihood of treatment response.

The risks and benefits of PREZISTA/rtv have not been established in pediatric patients.

No clinical studies have demonstrated the effect of PREZISTA/rtv on clinical progression of HIV-1.

Important Safety Information

Drug Interactions

• Coadministration of PREZISTA ^® is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events (eg, dihydroergotamine, ergonovine, ergotamine, methylergonovine, cisapride, pimozide, oral midazolam, triazolam, lovastatin, or simvastatin)
• Coadministration of PREZISTA ^® is also contraindicated with rifampin and products containing St. John's Wort (Hypericum perforatum) because this may cause significant decrease in plasma concentration of darunavir, resulting in loss of therapeutic effect and development of resistance
• Coadministration is not recommended with indinavir, lopinavir/ritonavir, saquinavir, and pravastatin
• Caution should be used when prescribing agents such as sildenafil, vardenafil, tadalafil, or other substrates, inhibitors, or inducers of CYP3A in patients receiving PREZISTA ^® . This list of potential drug interactions is not complete

Additional Important Safety Information

• PREZISTA must be co-administered with 100 mg ritonavir and food to achieve the desired antiviral effect. Failure to administer PREZISTA with ritonavir and food may result in a loss of efficacy of darunavir. Please refer to ritonavir prescribing information for additional information on precautionary measures
• Drug-induced hepatitis (eg, acute hepatitis, cytolytic hepatitis) has been reported with PREZISTA ^® . During the clinical development program (N=3063), hepatitis has been reported in 0.5% of patients receiving combination therapy with PREZISTA ^® . Patients with pre-existing liver dysfunction, including chronic active hepatitis B or C, have an increased risk for liver function abnormalities, including severe hepatic adverse events
  
  Post-marketing cases of liver injury, including some fatalities, have been reported. A causal relationship with PREZISTA ^® therapy has not been established
  
  Appropriate laboratory testing should be conducted prior to initiating therapy with PREZISTA ^® and patients should be monitored during treatment. Increased AST/ALT monitoring should be considered in patients with underlying chronic hepatitis, cirrhosis, or in patients who have pre-treatment elevations of transaminases, especially during the first several months of PREZISTA ^® treatment. Evidence of new or worsening liver dysfunction (including clinically significant elevation of liver enzymes and/or symptoms such as fatigue, anorexia, nausea, jaundice, dark urine, liver tenderness, hepatomegaly) in patients on PREZISTA ^® should prompt consideration of interruption or discontinuation of treatment
• Cases of severe skin rashes (0.4%) and Stevens-Johnson syndrome (<0.1%) have been reported in subjects receiving PREZISTA. In clinical trials (n=3063), rash (all grades, generally mild-to-moderate, regardless of causality) occurred in 10.3% of subjects treated with PREZISTA. Discontinuation due to rash was 0.5%. PREZISTA should be discontinued if severe rash develops.
• PREZISTA should be used with caution in patients with known sulfonamide allergy
• New-onset or exacerbations of pre-existing diabetes mellitus, hyperglycemia, and increased bleeding in hemophiliacs have been reported in patients receiving protease inhibitors. Initiation or dose adjustments of insulin or oral hypoglycemic agents may be required. A causal relationship between protease inhibitors and these events has not been established
• Redistribution and/or accumulation of body fat have been observed in patients receiving ARV therapy. The causal relationship, mechanism, and long-term consequences of these events have not been established
• Immune reconstitution syndrome has been reported in patients treated with ARV therapy
• The potential for HIV cross-resistance among protease inhibitors has not been fully explored in PREZISTA ^® treated patients
• PREZISTA ^® is not recommended for use in patients with severe hepatic impairment. There are no pharmacokinetic or safety data available in patients with severe hepatic impairment
• PREZISTA should be used during pregnancy only if the potential benefit justifies the potential risk. No adequate and well-controlled studies have been conducted in pregnant women
• In treatment-naïve adult patients, the most common adverse drug reactions (2%) reported of at least moderate intensity (Grade 2) in the PREZISTA ^® arm were diarrhea (6%), headache (5%), abdominal pain (4%), nausea (3%), vomiting (2%), and rash (2%)
• In treatment-experienced adult patients, the most common adverse drug reactions (2%) reported of at least moderate intensity (Grade 2) in the PREZISTA ^® arm were diarrhea (12%), nausea (7%), rash (6%), abdominal pain (5%), vomiting (4%), asthenia (3%), headache (2%), abdominal distension (2%), and dyspepsia (2%)

This is not a complete list of all adverse drug reactions reported with the use of PREZISTA ^®

Please see the full Prescribing Information in PDF format for more details.