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NORVIR (Ritonavir) Label

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NORVIR (Ritonavir) Label HIGHLIGHTS OF PRESCRIBING INFORMATION CONTRAINDICATIONS These highlights do not include all the information needed to use • NORVIR is contraindicated in patients with known hypersensitivity to NORVIR safely and effectively. See full prescribing information for ritonavir (e.g., toxic epidermal necrolysis, Stevens-Johnson syndrome) or NORVIR. any of its ingredients (4) • Co-administration with drugs highly dependent on CYP3A for clearance NORVIR (ritonavir) tablet, for oral use and for which elevated plasma concentrations may be associated with NORVIR (ritonavir) oral solution serious and/or life-threatening events (4) NORVIR (ritonavir) oral powder • Co-administration with drugs that significantly reduce ritonavir (4) Initial U.S. Approval: 1996 WARNINGS AND PRECAUTIONS WARNING: DRUG-DRUG INTERACTIONS LEADING TO The following have been observed in patients receiving NORVIR: POTENTIALLY SERIOUS AND/OR LIFE THREATENING • The concomitant use of NORVIR and certain other drugs may result in REACTIONS known or potentially significant drug interactions. Consult the full See full prescribing information for complete boxed warning prescribing information prior to and during treatment for potential drug Co-administration of NORVIR with several classes of drugs including interactions. (5.1, 7.2) sedative hypnotics, antiarrhythmics, or ergot alkaloid preparations may • Toxicity in preterm neonates: NORVIR oral solution should not be used in result in potentially serious and/or life-threatening adverse events due to preterm neonates in the immediate postnatal period because of possible possible effects of NORVIR on the hepatic metabolism of certain drugs. toxicities. A safe and effective dose of NORVIR oral solution in this patient Review medications taken by patients prior to prescribing NORVIR or population has not been established (2.2, 5.2) when prescribing other medications to patients already taking NORVIR. • Hepatotoxicity: Fatalities have occurred. Monitor liver function before and (4, 5.1) during therapy, especially in patients with underlying hepatic disease, including hepatitis B and hepatitis C, or marked transaminase elevations (5.3, 8.6) RECENT MAJOR CHANGES • Pancreatitis: Fatalities have occurred; suspend therapy as clinically Indications and Usage (1) 6/2017 appropriate (5.4) Dosage and Administration (2) 6/2017 • Allergic Reactions/Hypersensitivity: Allergic reactions have been reported General Dosing and Administration Recommendations (2.1) 6/2017 and include anaphylaxis, toxic epidermal necrolysis, Stevens-Johnson syndrome, bronchospasm and angioedema. Discontinue treatment if severe Recommended Adult Dosage (2.2) 6/2017 reactions develop (5.5, 6.2) Recommended Pediatric Dosage (2.3) 6/2017 • PR interval prolongation may occur in some patients. Cases of second and Preparation of Norvir Oral Powder (2.4) 6/2017 third degree heart block have been reported. Use with caution with patients Dose Modification due to Drug Interaction (2.5) 6/2017 with preexisting conduction system disease, ischemic heart disease, Contraindications (4) 11/2016 cardiomyopathy, underlying structural heart disease or when administering Warnings and Precautions with other drugs that may prolong the PR interval (5.6, 12.3) Diabetes Mellitus/Hyperglycemia (5.8) 11/2016 • Total cholesterol and triglycerides elevations: Monitor prior to therapy and periodically thereafter (5.7) • Patients may develop new onset or exacerbations of diabetes mellitus, INDICATIONS AND USAGE hyperglycemia (5.8) NORVIR tablets and oral solution are HIV protease inhibitors indicated in • Patients may develop immune reconstitution syndrome (5.9) combination with other antiretroviral agents for the treatment of HIV-1 infection (1) • Patients may develop redistribution/accumulation of body fat (5.10) NORVIR oral powder is indicated in combination with other antiretroviral • Hemophilia: Spontaneous bleeding may occur, and additional factor VIII agents for the treatment of pediatric patients with HIV-1 infection (1) may be required (5.11) DOSAGE AND ADMINISTRATION ADVERSE REACTIONS • Dose modification for NORVIR is necessary when used with other protease The most frequently reported adverse drug reactions among patients receiving inhibitors (2) NORVIR alone or in combination with other antiretroviral drugs were • Adult patients: 600 mg twice-day with meals (2.2) gastrointestinal (including diarrhea, nausea, vomiting, abdominal pain (upper and lower), neurological disturbances (including paresthesia and oral • Pediatrics patients: The recommended twice daily dose for children greater paresthesia), rash, and fatigue/asthenia (6.1) than one month of age is based on body surface area and should not exceed 600 mg twice daily with meals (2.3) To report SUSPECTED ADVERSE REACTIONS, contact AbbVie Inc. • NORVIR oral solution should not be administered to neonates before a at 1-800-633-9110 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. postmenstrual age (first day of the mother’s last menstrual period to birth plus the time elapsed after birth) of 44 weeks has been attained (2.3, 5.2) DRUG INTERACTIONS • NORVIR oral powder can only be used for dosing increments of 100 mg • Co-administration of NORVIR can alter the concentrations of other drugs. (2.3) The potential for drug-drug interactions must be considered prior to and • Instructions for Use should be followed for preparation and administration during therapy (4, 5.1, 7, 12.3) of NORVIR oral powder (2.4) USE IN SPECIFIC POPULATIONS DOSAGE FORMS AND STRENGTHS • Lactation: Women infected with HIV should be instructed not to breastfeed • Tablet: 100 mg (3) due to the potential for HIV transmission (8.2). • Oral Solution: 80 mg per milliliter (3) • Oral Powder: 100 mg per packet (3) See 17 for PATIENT COUNSELING INFORMATION and FDA- approved patient labeling. Revised: 6/2017 FULL PRESCRIBING INFORMATION: CONTENTS* 2.1 General Dosing and Administration Recommendations WARNING: DRUG-DRUG INTERACTIONS LEADING TO 2.2 Recommended Adult Dosage POTENTIALLY SERIOUS AND/OR LIFE THREATENING 2.3 Recommended Pediatric Dosage REACTIONS 2.4 Preparation of Norvir Oral Powder 1 INDICATIONS AND USAGE 2.5 Dose Modification due to Drug Interaction 2 DOSAGE AND ADMINISTRATION 3 DOSAGE FORMS AND STRENGTHS Reference ID: 4108617 4 CONTRAINDICATIONS 8.2 Lactation 5 WARNINGS AND PRECAUTIONS 8.3 Females and Males of Reproductive Potential 5.1 Risk of Serious Adverse Reactions Due to Drug Interactions 8.4 Pediatric Use 5.2 Toxicity in Preterm Neonates 8.5 Geriatric Use 5.3 Hepatotoxicity 8.6 Hepatic Impairment 5.4 Pancreatitis 10 OVERDOSAGE 5.5 Allergic Reactions/Hypersensitivity 11 DESCRIPTION 5.6 PR Interval Prolongation 12 CLINICAL PHARMACOLOGY 5.7 Lipid Disorders 12.1 Mechanism of Action 5.8 Diabetes Mellitus/Hyperglycemia 12.3 Pharmacokinetics 5.9 Immune Reconstitution Syndrome 12.4 Microbiology 5.10 Fat Redistribution 13 NONCLINICAL TOXICOLOGY 5.11 Patients with Hemophilia 13.1 Carcinogenesis, Mutagenesis, Impairment of Fertility 5.12 Resistance/Cross-resistance 14 CLINICAL STUDIES 5.13 Laboratory Tests 14.1 Advanced Patients with Prior Antiretroviral Therapy 6 ADVERSE REACTIONS 14.2 Patients without Prior Antiretroviral Therapy 6.1 Clinical Trial Experience 15 REFERENCES 6.2 Postmarketing Experience 16 HOW SUPPLIED/STORAGE AND HANDLING 7 DRUG INTERACTIONS 17 PATIENT COUNSELING INFORMATION 7.1 Potential for NORVIR to Affect Other Drugs 7.2 Established and Other Potentially Significant Drug Interactions *Sections or subsections omitted from the full prescribing information are not 8 USE IN SPECIFIC POPULATIONS listed. 8.1 Pregnancy Reference ID: 4108617 FULL PRESCRIBING INFORMATION WARNING: DRUG-DRUG INTERACTIONS LEADING TO POTENTIALLY SERIOUS AND/OR LIFE THREATENING REACTIONS Co-administration of NORVIR with several classes of drugs including sedative hypnotics, antiarrhythmics, or ergot alkaloid preparations may result in potentially serious and/or life-threatening adverse events due to possible effects of NORVIR on the hepatic metabolism of certain drugs. Review medications taken by patients prior to prescribing NORVIR or when prescribing other medications to patients already taking NORVIR [see Contraindications (4), Warnings and Precautions (5.1)]. 1 INDICATIONS AND USAGE NORVIR tablets and oral solution are indicated in combination with other antiretroviral agents for the treatment of HIV-1 infection. NORVIR oral powder is indicated in combination with other antiretroviral agents for the treatment of pediatric patients with HIV-1 infection. 2 DOSAGE AND ADMINISTRATION 2.1 General Dosing and Administration Recommendations • NORVIR must be used in combination with other antiretroviral agents. • NORVIR is administered orally. NORVIR tablets should be swallowed whole, and not chewed, broken or crushed. Take NORVIR with meals. • Patients may improve the taste of NORVIR oral solution by mixing with chocolate milk, Ensure®, or Advera® within one hour of dosing. • NORVIR oral powder should be mixed with soft food such as apple sauce or vanilla pudding, or mixed with liquid such as water, chocolate milk, or infant formula [see Dosage and Administration (2.4) and Instructions for Use]. The bitter aftertaste of NORVIR oral powder may be lessened if administered with food. General Dosing Guidelines Patients who take the 600 mg twice daily soft gel capsule NORVIR dose may experience more gastrointestinal side effects such as nausea, vomiting, abdominal pain or diarrhea when switching from the soft gel capsule to the tablet formulation because of greater maximum
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