Home Drug Guide Tipranavir

Drug Guide

Generic Name

Tipranavir

Brand Names Aptivus

Classification

Therapeutic: Antiretroviral, Protease Inhibitor

Pharmacological: Non-peptidic Protease Inhibitor

FDA Approved Indications

  • Treatment of HIV-1 infections in combination with other antiretroviral agents in patients with evidence of viral replication and HIV-1 resistance to multiple protease inhibitors

Mechanism of Action

Tipranavir inhibits the HIV-1 protease enzyme, which is necessary for the maturation of infectious viral particles. By blocking this enzyme, it prevents the cleavage of the Gag-Pol polyprotein, resulting in the production of immature, noninfectious viral particles.

Dosage and Administration

Adult: 600 mg twice daily in combination with ritonavir 200 mg twice daily.

Pediatric: Not indicated for pediatric use.

Geriatric: Use with caution; no specific dosage adjustments necessary, but renal and hepatic function should be considered.

Renal Impairment: Use with caution; specific dosage adjustments are not well established.

Hepatic Impairment: Use with caution; hepatic function should be monitored closely.

Pharmacokinetics

Absorption: Rapidly absorbed, with peak plasma concentrations occurring approximately 2 hours after dosing.

Distribution: Extensively bound to plasma proteins (~99%).

Metabolism: Metabolized primarily by the cytochrome P450 enzyme system, notably CYP3A4.

Excretion: Excreted mainly in feces (about 83%), minimal renal excretion.

Half Life: Approximately 4-6 hours.

Contraindications

  • Hypersensitivity to tipranavir or any component of the formulation.

Precautions

  • History of hypersensitivity reactions, such as rash or allergy; hepatic impairment; sulfa allergy risk; neurologic side effects; bleeding disorders; carefully monitor for hepatitis and liver-related adverse effects.

Adverse Reactions - Common

  • N/V, diarrhea (Common)
  • Rash (Common)
  • Elevated liver enzymes (Common)

Adverse Reactions - Serious

  • Hepatic decompensation, hepatic failure (Serious)
  • Intracranial hemorrhage (Serious)
  • Allergic reactions, including rash and hypersensitivity (Serious)

Drug-Drug Interactions

  • CYP3A4 inducers and inhibitors (e.g., rifampin, ketoconazole), other antiretrovirals, anticoagulants, statins.

Drug-Food Interactions

  • High-fat meals may decrease absorption; administration should be consistent with or without food.

Drug-Herb Interactions

  • St. John's Wort and other herbal products inducing CYP3A4 may reduce tipranavir levels.

Nursing Implications

Assessment: Monitor liver function tests, for signs of bleeding, neurologic symptoms, and hypersensitivity reactions.

Diagnoses:

  • Risk for hepatic injury
  • Risk for bleeding
  • Altered mental status

Implementation: Administer with ritonavir; monitor for allergic reactions and adverse effects; counsel on adherence.

Evaluation: Assess viral load and CD4 counts regularly; evaluate for adverse reactions and drug interactions.

Patient/Family Teaching

  • Take medication exactly as prescribed.
  • Report any signs of allergic reactions, bleeding, neurologic symptoms, or hepatic issues.
  • Maintain regular follow-up appointments and lab tests.
  • Use contraception if applicable, as medication may affect pregnancy.

Special Considerations

Black Box Warnings:

  • Hepatic adverse reactions, including hepatitis and hepatic failure.

Genetic Factors: Consider screening for HLA-B*5701 allele, although primarily associated with abacavir.

Lab Test Interference: May affect liver function tests.

Overdose Management

Signs/Symptoms: Nausea, vomiting, dizziness, hypotension, possible hepatic toxicity.

Treatment: Supportive care, gastric lavage if recent ingestion, monitor liver function, provide symptomatic treatment.

Storage and Handling

Storage: Store at 20°C to 25°C (68°F to 77°F), excursions permitted to 15°C to 30°C (59°F to 86°F).

Stability: Stable under recommended storage conditions for the duration specified in the package insert.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.