"The US Food and Drug Administration (FDA) has approved atazanavir and cobicistat (Evotaz, Bristol-Myers Squibb) for treatment of adults with human immunodeficiency virus (HIV-1) infection.
Atazanavir/cobicistat is a fixed-dos"...
There is limited experience of overdose with saquinavir.
No acute toxicities or sequelae were noted in 1 subject who ingested 8 grams of INVIRASE as a single dose. The subject was treated with induction of emesis within 2 to 4 hours after ingestion. A second subject ingested 2.4 grams of INVIRASE in combination with 600 mg of ritonavir and experienced pain in the throat that lasted for 6 hours and then resolved. In an exploratory Phase II study of oral dosing with INVIRASE at 7200 mg per day (1200 mg q4h), there were no serious toxicities reported through the first 25 weeks of treatment.
Treatment of overdose with saquinavir should consist of general supportive measures including monitoring of vital signs and ECG and observations of the patient's clinical status. Since saquinavir is highly protein bound, dialysis is unlikely to be beneficial in significant removal of the active substance.
QT interval prolongation and torsades de pointes have been reported rarely with INVIRASE/ritonavir use. Do not use in patients with congenital long QT syndrome, those with refractory hypokalemia or hypomagnesemia, and in combination with drugs that both increase saquinavir plasma concentrations and prolong the QT interval [see WARNINGS AND PRECAUTIONS and CLINICAL PHARMACOLOGY].
INVIRASE is contraindicated in patients with clinically significant hypersensitivity (e.g., anaphylactic reaction, Stevens-Johnson syndrome) to saquinavir, saquinavir mesylate, or any of its ingredients.
INVIRASE when administered with ritonavir is contraindicated in patients with severe hepatic impairment.
Coadministration of INVIRASE/ritonavir is contraindicated with drugs that are CYP3A substrates for which increased plasma levels may result in serious or life-threatening reactions. These drugs and potentially related adverse events are listed in Table 1.
Table 1 : Drugs That Are Contraindicated With
|Drug Class||Drugs Within Class That Are Contraindicated With INVIRASE/ritonavir||Clinical Comment|
|Alpha 1-adrenoreceptor antagonist||Alfuzosin||Potentially increased alfuzosin concentrations can resultin hypotension.|
|Antiarrhythmics||Amiodarone, bepridil, dofetilide, flecainide, lidocaine (systemic), propafenone, quinidine||Potential for serious and/or life-threatening cardiac arrhythmia.|
|Antidepressant||Trazodone||Increased trazodone concentrations can result in potentially life threatening cardiac arrhythmia.|
|Anti-infectives||Clarithromycin, erythromycin, halofantrine, pentamidine||Potential for serious and/or life-threatening cardiac arrhythmia.|
|Antimycobacterial Agents||Rifampin||Rifampin should not be administered in patients taking INVIRASE/ritonavir as part of an ART regimen due to the risk of severe hepatocellular toxicity.|
|Ergot Derivatives||Dihydroergotamine, ergonovine, ergotamine, methylergonovine||Potential for serious and life threatening reactions such as ergot toxicity characterized by peripheral vasospasm and ischemia of the extremities and other tissues.|
|GI Motility Agent||Cisapride||Potential for serious and/or life threatening reactions such as cardiac arrhythmias.|
|HIV-1 Protease Inhibitor||Atazanavir||Potential for serious and/or life-threatening cardiac arrhythmia.|
|HMG-CoA Reductase Inhibitors||Lovastatin, Simvastatin||Potential for myopathy including rhabdomyolysis.|
|Immunosuppressant||Tacrolimus||Potential for serious and/or life-threatening cardiac arrhythmia.|
|Neuroleptics||Pimozide Chlorpromazine Sertindole Clozapine Haloperidol Mesoridazine Phenothiazines Thioridazine Ziprasidone||Potential for serious and/or life threatening reactions such as cardiac arrhythmias.|
|PDE5 Inhibitors||Sildenafil (Revatio®)[for treatment of pulmonary arterial hypertension]||Increased potential for sildenafil-associated adverse events (which include visual disturbances, hypotension, prolonged erection, and syncope). A safe and effective dose has not been established when used with INVIRASE/ritonavir.|
|Sedative/Hypnotics||Triazolam, orally administered||Potential for serious and/or life threatening reactions|
|midazolam||such as prolonged or increased sedation or respiratory depression. Triazolam and orally administered midazolam are extensively metabolized by CYP3A4. Coadministrationof triazolam or orally administered midazolam with INVIRASE/ritonavir may cause large increases in the concentration of these benzodiazepines.|
|Other drugs that are CYP3A substrates||Dapsone Disopyramide Quinine||Potential for serious and/or life-threatening cardiac arrhythmia.|
Last reviewed on RxList: 12/28/2015
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