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Telaprevir (Oral route)

Pronunciation:

tel-A-pre-vir

Brand Names:

  • Incivek

Dosage Forms:

  • Tablet

Warnings:

Oral route(Tablet)

Fatal and non-fatal serious skin reactions, including Stevens-Johnson syndrome (SJS), drug reaction with eosinophilia and systemic symptoms (DRESS), and toxic epidermal necrolysis (TEN), have been reported in patients who received telaprevir combination treatment. Fatal cases have been reported in patients with progressive rash and systemic symptoms who continued to receive telaprevir combination treatment after a serious skin reaction was identified. For serious skin reactions, including rash with systemic symptoms or a progressive severe rash, immediately discontinue telaprevir, peginterferon alfa, and ribavirin and promptly refer patients for urgent medical care .

Classifications:

Therapeutic—

Antiviral

Pharmacologic—

Protease Inhibitor

Uses of This Medicine:

Telaprevir is used in combination with injectable peginterferon alfa (Pegasys®, Pegintron®) and ribavirin (Copegus®, Rebetol®) to treat chronic hepatitis C infection. These medicines are used in patients with liver disease (including cirrhosis) who have not been treated before or who have received other medicines that did not work well. Telaprevir is an antiviral agent.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies have not been performed on the relationship of age to the effects of telaprevir in the pediatric population. Safety and efficacy have not been established.

Older adults—

Although appropriate studies on the relationship of age to the effects of telaprevir have not been performed in the geriatric population, no geriatric-specific problems have been documented to date. However, elderly patients are more likely to have age-related liver problems, which may require caution in patients receiving telaprevir.

Pregnancy—

Pregnancy CategoryExplanation
All TrimestersBAnimal studies have revealed no evidence of harm to the fetus, however, there are no adequate studies in pregnant women OR animal studies have shown an adverse effect, but adequate studies in pregnant women have failed to demonstrate a risk to the fetus.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.

  • Alfuzosin
  • Carbamazepine
  • Cisapride
  • Dabrafenib
  • Dihydroergotamine
  • Doxorubicin
  • Doxorubicin Hydrochloride Liposome
  • Eletriptan
  • Ergonovine
  • Ergotamine
  • Everolimus
  • Fentanyl
  • Fosphenytoin
  • Ibrutinib
  • Ivabradine
  • Lomitapide
  • Lovastatin
  • Lurasidone
  • Maraviroc
  • Methylergonovine
  • Midazolam
  • Nimodipine
  • Pazopanib
  • Phenobarbital
  • Phenytoin
  • Pimozide
  • Primidone
  • Quetiapine
  • Rifampin
  • Riociguat
  • Romidepsin
  • Sildenafil
  • Simvastatin
  • St John's Wort
  • Tadalafil
  • Trabectedin
  • Triazolam
  • Vemurafenib
  • Vilazodone
  • Vinflunine

Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Ado-Trastuzumab Emtansine
  • Afatinib
  • Alfentanil
  • Amiodarone
  • Amlodipine
  • Apixaban
  • Artemether
  • Atorvastatin
  • Avanafil
  • Axitinib
  • Bedaquiline
  • Bepridil
  • Bosutinib
  • Budesonide
  • Cabozantinib
  • Clarithromycin
  • Clozapine
  • Colchicine
  • Cyclophosphamide
  • Cyclosporine
  • Darunavir
  • Dexamethasone
  • Digoxin
  • Domperidone
  • Enzalutamide
  • Erythromycin
  • Eslicarbazepine Acetate
  • Flecainide
  • Fluticasone
  • Fosamprenavir
  • Ivacaftor
  • Levomilnacipran
  • Lidocaine
  • Lomitapide
  • Lopinavir
  • Lumefantrine
  • Macitentan
  • Methylprednisolone
  • Mifepristone
  • Mitotane
  • Nevirapine
  • Nilotinib
  • Piperaquine
  • Pixantrone
  • Pomalidomide
  • Ponatinib
  • Posaconazole
  • Prednisone
  • Propafenone
  • Quinidine
  • Regorafenib
  • Retapamulin
  • Rifabutin
  • Ruxolitinib
  • Salmeterol
  • Simeprevir
  • Sirolimus
  • Tacrolimus
  • Tamsulosin
  • Telithromycin
  • Tenofovir Disoproxil Fumarate
  • Tocophersolan
  • Vardenafil
  • Vilanterol
  • Vincristine
  • Vincristine Sulfate Liposome
  • Voriconazole

Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Alprazolam
  • Atazanavir
  • Cobicistat
  • Desogestrel
  • Dienogest
  • Drospirenone
  • Efavirenz
  • Escitalopram
  • Estradiol Cypionate
  • Estradiol Valerate
  • Ethinyl Estradiol
  • Ethynodiol Diacetate
  • Etonogestrel
  • Ketoconazole
  • Levonorgestrel
  • Medroxyprogesterone Acetate
  • Mestranol
  • Methadone
  • Norelgestromin
  • Norethindrone
  • Norgestimate
  • Norgestrel
  • Zolpidem

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Blood or bone marrow problems (e.g., anemia) or
  • Gout, history of or
  • Weakened immune system (e.g., HIV or AIDS)—Use with caution. May make these conditions worse.
  • Decompensated liver disease or
  • Liver disease, moderate to severe—Should not be used in patients with these conditions.
  • Hepatitis B or
  • Organ transplants (e.g., liver or kidney), history of—It is not known if this medicine will work in patients with these conditions.

Proper Use of This Medicine:

To help clear up your infection completely, telaprevir must be taken together with peginterferon alfa and ribavirin for the full time of treatment, even if you begin to feel better after a few days. Also, it is important to keep the amount of medicine in your body at a steady level. To help keep the amount constant, telaprevir must be used on a regular schedule.

Telaprevir should be taken within 30 minutes after eating a high-fat meal or snack (containing about 20 grams of fat). Ask your doctor about examples of food that you can eat that contain 20 grams of fat.

This medicine should come with a Medication Guide. Read and follow the information carefully. Ask your doctor if you have any questions. Ask your pharmacist for the Medication Guide if you do not have one.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage form (tablet):
    • For hepatitis C virus infection, in combination with peginterferon alfa and ribavirin:
      • Adults—750 milligrams (mg) (two 375-mg tablets) three times a day with food. Each dose should be taken 7 to 9 hours apart.
      • Children—Use and dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

If you miss a dose or forget to take your medicine and it is less than 4 hours from the time your regular dose was scheduled, take the tablet as soon as you can. If you miss a dose and it is more than 4 hours from the time your regular dose was scheduled, skip the missed dose and take your next dose at the regular time. Call your doctor if you have questions about this.

Storage—

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Precautions While Using This Medicine:

It is very important that your doctor check your progress at regular visits to make sure this medicine is working properly. Blood tests may be needed to check for unwanted effects.

Using this medicine together with ribavirin while you are pregnant can harm your unborn baby. These medicines may also cause birth defects if the father is using it when his sexual partner becomes pregnant. If a pregnancy occurs while you are using these medicines, tell your doctor right away.

To make sure you are not pregnant, your doctor may ask you to have a pregnancy test before you start using this medicine. You must have a negative pregnancy test before you will be allowed to use this medicine with ribavirin. Two forms of birth control must be used during treatment and for 6 months after treatment ends. You should test for pregnancy every month while you are using this medicine, and for 6 months after your treatment ends.

Do not use the following medicines while you are using this medicine: alfuzosin (Uroxatral®), cisapride (Propulsid®), oral midazolam (Versed®), pimozide (Orap®), rifampin (Rifadin®, Rimactane®), sildenafil (Revatio®), St. John's wort, tadalafil (Adcirca®), triazolam (Halcion®), certain medicines to lower cholesterol (such as lovastatin, simvastatin, Mevacor®, Zocor®), or ergot medicines (such as dihydroergotamine, ergonovine, ergotamine, methylergonovine, Cafergot®, Ergomar®, Wigraine®). Using telaprevir with any of these medicines can cause very serious medical problems.

Serious skin reactions can occur with this medicine. Check with your doctor right away if you have a severe skin rash, blistering, peeling, or loosening of the skin, fever or chills, hives or welts, red skin lesions, acne, sores or ulcers on the skin, or yellowing of the skin or the whites of your eyes.

Check with your doctor right away if you have back, leg, or stomach pains, bleeding gums, chills, dark urine, difficulty with breathing, fever, general body swelling, headache, loss of appetite, nausea or vomiting, nosebleeds, pale skin, sore throat, unusual tiredness or weakness, or yellowing of the eyes or skin. These could be symptoms of a blood disorder called anemia.

Birth control pills may not work while you are using this medicine. To keep from getting pregnant, use two other forms of birth control. Other forms of birth control include condoms, diaphragms, or contraceptive foams or jellies.

Using this medicine with peginterferon alfa can temporarily lower the number of white blood cells in your blood, increasing the chance of getting an infection. It can also lower the number of platelets in the blood, which are necessary for proper blood clotting. If this occurs, there are certain precautions you can take, especially when your blood count is low, to reduce the risk of infection or bleeding:

  • If you can, avoid people with infections. Check with your doctor immediately if you think you are getting an infection or if you get a fever or chills, cough or hoarseness, lower back or side pain, or painful or difficult urination.
  • Check with your doctor immediately if you notice any unusual bleeding or bruising, black, tarry stools, blood in the urine or stools, or pinpoint red spots on your skin.
  • Be careful when using a regular toothbrush, dental floss, or toothpick. Your medical doctor, dentist, or nurse may recommend other ways to clean your teeth and gums. Check with your medical doctor before having any dental work done.
  • Do not touch your eyes or the inside of your nose unless you have just washed your hands and have not touched anything else in the meantime.
  • Be careful not to cut yourself when you are using sharp objects such as a safety razor or fingernail or toenail cutters.
  • Avoid contact sports or other situations where bruising or injury could occur.

Do not change or suddenly stop using this medicine without checking first with your doctor.

This medicine will not keep you from giving hepatitis C to other people. Follow your doctor's instructions about how to prevent the spread of this infection.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
Black, tarry stools
bleeding gums
blood in the urine or stools
chills
cough
fever
joint pain, stiffness, or swelling
lower back, side, or stomach pain
painful or difficult urination
pale skin
pinpoint red spots on the skin
rash
shortness of breath
sore throat
swelling of the feet or lower legs
troubled breathing with exertion
ulcers, sores, or white spots in the mouth
unusual bleeding or bruising
unusual tiredness or weakness
Rare
Blistering, peeling, or loosening of the skin
cloudy urine
dark urine
diarrhea
difficulty with breathing
drowsiness
general tiredness and weakness
headache
itching
joint or muscle pain
light-colored stools
nausea or vomiting
red skin lesions, often with a purple center
red, irritated eyes
swelling or puffiness of the face
unusual weight gain
upper right abdominal or stomach pain
yellow eyes and skin

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose
Change in taste
decreased appetite
loss of taste

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
Bleeding after defecation
uncomfortable swelling around the anus

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


Last Updated: 4/4/2014

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