Tipranavir

It inhibit HIV protease in viruses that are resistant to the other protease inhibitors. Tipranavir is well absorbed when taken with food. The half-life is 6 hours, and it must be administered twice daily in combination with ritonavir. Tipranavir has unique actions both as a CYP450 inducer and a substrate that is different from the other protease inhibitors. Side effects are similar to those of the other protease inhibitors with the exception of two U.S. Food and Drug Administration black box warnings for severe and fatal hepatitis and rare cases of fatal and nonfatal intracranial hemorrhages. Most patients experiencing these severe side effects had underlying comorbidities. Tipranavir is useful in “salvage” regimens in patients with multidrug resistance.The drug is a substrate and inducer of CYP3A4 and also induces P-glycoprotein transporters, possibly altering GI absorption of other drugs. For example, increased blood levels of the HMG-CoA reductase inhibitors (eg, lovastatin) may occur, thus increasing the risk for myopathy and rhabdomyolysis. GI adverse effects, rash, and liver toxicity have been reported.