Norvir Soft Gelatin Capsules

The following adverse reactions are discussed in greater detail in other sections of the labeling.

• Drug Interactions [see WARNINGS AND PRECAUTIONS]
• Hepatotoxicity [see WARNINGS AND PRECAUTIONS]
• Pancreatitis [see WARNINGS AND PRECAUTIONS]
• Allergic Reactions/Hypersensitivity [see WARNINGS AND PRECAUTIONS]

When co-administering NORVIR with other protease inhibitors, see the full prescribing information for that protease inhibitor including adverse reactions.

Clinical Trial Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in clinical practice.

Adverse Reactions In Adults

The safety of NORVIR alone and in combination with other antiretroviral agents was studied in 1,755 adult patients. Table 2 lists treatment-emergent Adverse Reactions (with possible or probable relationship to study drug) occurring in greater than or equal to 1% of adult patients receiving NORVIR in combined Phase II/IV studies.

The most frequently reported adverse drug reactions among patients receiving NORVIR alone or in combination with other antiretroviral drugs were gastrointestinal (including diarrhea, nausea, vomiting, abdominal pain (upper and lower)), neurological disturbances (including paresthesia and oral paresthesia), rash, and fatigue/asthenia.

Table 2. Treatment-Emergent Adverse Reactions (With Possible or Probable Relationship to Study Drug) Occurring in greater than or equal to 1% of Adult Patients Receiving NORVIR in Combined Phase II/IV Studies (N = 1,755)

Adverse Reactions	n	%
Eye disorders
Blurred vision	113	6.4
Gastrointestinal disorders
Abdominal Pain (upper and lower)*	464	26.4
Diarrhea including severe with electrolyte imbalance*	1,192	67.9
Dyspepsia	201	11.5
Flatulence	142	8.1
Gastrointestinal hemorrhage*	41	2.3
Gastroesophageal reflux disease (GERD)	19	1.1
Nausea	1,007	57.4
Vomiting*	559	31.9
General disorders and administration site conditions
Fatigue including asthenia*	811	46.2
Hepatobiliary disorders
Blood bilirubin increased (including jaundice)*	25	1.4
Hepatitis (including increased AST, ALT, GGT)*	153	8.7
Immune system disorders
Hypersensitivity including urticatria and face edema*	114	8.2
Metabolism and nutrition disorders
Edema and peripheral edema*	110	6.3
Gout*	24	1.4
Hypercholesterolemia*	52	3.0
Hypertriglyceridemia*	158	9.0
Lipodystrophy acquired*	51	2.9
Musculos keletal and connective tissue disorders
Arthralgia and back pain*	326	18.6
Myopathy/creatine phosphokinase increased*	66	3.8
Myalgia	156	8.9
Nervous system disorders
Dizziness*	274	15.6
Dysgeusia*	285	16.2
Paresthesia (including oral paresthesia)*	889	50.7
Peripheral neuropathy	178	10.1
Syncope*	58	3.3
Psychiatric disorders
Confusion*	52	3.0
Disturbance in attention	44	2.5
Renal and urinary disorders
Increased urination*	74	4.2
Respiratory, thoracic and mediastinal disorders
Coughing*	380	21.7
Oropharyngeal Pain*	279	15.9
Skin and subcutaneous tissue disorders
Acne*	67	3.8
Pruritus*	214	12.2
Rash (includes erythematous and maculopapular)*	475	27.1
Vascular disorders
Flushing, feeling hot*	232	13.2
Hypertension*	58	3.3
Hypotension including orthostatic hypotension*	30	1.7
Peripheral coldness*	21	1.2
* Represents a medical concept including several similar MedDRA PTs

Laboratory Abnormalities in Adults

Table 3 shows the percentage of adult patients who developed marked laboratory abnormalities.

Table 3. Percentage of Adult Patients, by Study and Treatment Group, with Chemistry and Hematology Abnormalities Occurring in greater than 3% of Patients Receiving NORVIR

Variable	Limit	Study 245 Naive Patients			Study 247 Advanced Patients		Study 462 PI-Naive Patients
		NORVIR plus ZDV	NORVIR	ZDV	NORVIR	Placebo	NORVIR plus Saquinavir
Chemistry	High
Cholesterol	> 240 mg/dL	30.7	44.8	9.3	36.5	8.0	65.2
CPK	> 1000 IU/L	9.6	12.1	11.0	9.1	6.3	9.9
GGT	> 300 IU/L	1.8	5.2	1.7	19.6	11.3	9.2
SGOT (AST)	> 180 IU/L	5.3	9.5	2.5	6.4	7.0	7.8
SGPT (ALT)	> 215 IU/L	5.3	7.8	3.4	8.5	4.4	9.2
Triglycerides	> 800 mg/dL	9.6	17.2	3.4	33.6	9.4	23.4
Triglycerides	> 1500 mg/dL	1.8	2.6	-	12.6	0.4	11.3
Triglycerides Fasting	> 1500 mg/dL	1.5	1.3	-	9.9	0.3	-
Uric Acid	> 12 mg/dL	-	-	-	3.8	0.2	1.4
Hematology	Low
Hematocrit	< 30%	2.6	-	0.8	17.3	22.0	0.7
Hemoglobin	< 8.0 g/dL	0.9	-	-	3.8	3.9	-
Neutrophils	≤ 0.5 x 109 /L	-	-	-	6.0	8.3	-
RBC	< 3.0 x 1012 /L	1.8	-	5.9	18.6	24.4	-
WBC	< 2.5 x 109 /L	-	0.9	6.8	36.9	59.4	3.5
- Indicates no events reported.

Adverse Reactions In Pediatric Patients

NORVIR has been studied in 265 pediatric patients greater than 1 month to 21 years of age. The adverse event profile observed during pediatric clinical trials was similar to that for adult patients.

Vomiting, diarrhea, and skin rash/allergy were the only drug-related clinical adverse events of moderate to severe intensity observed in greater than or equal to 2% of pediatric patients enrolled in NORVIR clinical trials.

Laboratory Abnormalities in Pediatric Patients

The following Grade 3-4 laboratory abnormalities occurred in greater than 3% of pediatric patients who received treatment with NORVIR either alone or in combination with reverse transcriptase inhibitors: neutropenia (9%), hyperamylasemia (7%), thrombocytopenia (5%), anemia (4%), and elevated AST (3%).

Postmarketing Experience

The following adverse events have been reported during post-marketing use of NORVIR. Because these reactions are reported voluntarily from a population of unknown size, it is not possible to reliably estimate their frequency or establish a causal relationship to NORVIR exposure.

Body As A Whole

Dehydration, usually associated with gastrointestinal symptoms, and sometimes resulting in hypotension, syncope, or renal insufficiency has been reported. Syncope, orthostatic hypotension, and renal insufficiency have also been reported without known dehydration.

Co-administration of ritonavir with ergotamine or dihydroergotamine has been associated with acute ergot toxicity characterized by vasospasm and ischemia of the extremities and other tissues including the central nervous system.

Cardiovascular System

First-degree AV block, second-degree AV block, third-degree AV block, right bundle branch block have been reported [see WARNINGS AND PRECAUTIONS].

Cardiac and neurologic events have been reported when ritonavir has been co-administered with disopyramide, mexiletine, nefazodone, fluoxetine, and beta blockers. The possibility of drug interaction cannot be excluded.

Endocrine System

Cushing’s syndrome and adrenal suppression have been reported when ritonavir has been coadministered with fluticasone propionate or budesonide.

Nervous System

There have been postmarketing reports of seizure. Also, see Cardiovascular System.

Skin And subcutaneous Tissue Disorders

Toxic epidermal necrolysis (TEN) has been reported.

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