What Telzir is and what it is used for
Telzir is used to treat HIV (human immunodeficiency virus) infection.
Telzir is a type of medicine known as an anti-retroviral. It is taken with low doses of another medicine, ritonavir, which boosts the level of Telzir in the blood. Telzir belongs to a group of anti-retroviral medicines called protease inhibitors. Protease is an enzyme produced by HIV which enables the virus to multiply in white blood cells (CD4 cells) in your blood. By stopping protease from working, Telzir stops HIV multiplying and infecting more CD4 cells.
Telzir with low doses of ritonavir is used in combination with other anti-retroviral medicines (‘combination therapy’) to treat adults, adolescents and children aged over 6 years infected with HIV.
HIV can become resistant to anti-HIV medicines. To avoid this happening, and to stop your illness getting worse, it is very important that you keep taking all your medicines exactly as prescribed.
Telzir will not stop you passing on HIV. HIV infection is spread by sexual contact with someone who’s got the infection, or by transfer of infected blood (for example by sharing needles).
Before you take Telzir
Telzir is to be taken in combination with low doses of ritonavir and other antiretroviral medicines. It is therefore important that you carefully read the package leaflet provided with these medicines. If you have any further questions about ritonavir or the other medicines prescribed, please ask your doctor or pharmacist.
Don’t take Telzir:
- if you are allergic (hypersensitive) to fosamprenavir, amprenavir or any of the other ingredients in Telzir , or to ritonavir.
- if you are taking any of these medicines:
- astemizole or terfenadine (commonly used to treat allergy symptoms – these medicines may be available without prescription)
- pimozide (used to treat schizophrenia)
- cisapride (used to relieve indigestion)
- ergot derivatives (used to treat headaches)
- rifampicin (used to treat tuberculosis)
- amiodarone, quinidine, flecainide and propafenone (heart medicines)
- bepridil (used to treat high blood pressure)
- oral midazolam or oral triazolam (used to treat anxiety)
- products containing St John’s wort (Hypericum perforatum).
- Tell your doctor if any of these applies to you.
Take special care with Telzir
Before you take Telzir your doctor needs to know:
- If you have a known allergy to medicines containing sulphonamide. You may also be allergic to Telzir.
- If you have liver disease. Your doctor may lower your dose of Telzir and ritonavir depending on the amount of liver damage. You will be monitored while you are taking Telzir. If your liver disease gets worse, you may need to stop taking Telzir for a while, or permanently. People with hepatitis B or C taking combination therapy are at increased risk of getting severe liver problems.
- If you have haemophilia. Increased bleeding may occur while taking protease inhibitors (such as Telzir). The reason for this is not known. You may need additional factor VIII to control any bleeding.
- If you have diabetes. In some patients taking antiretroviral medicines including protease inhibitors, there have been reports of increased sugar in the blood and diabetes getting worse. Also, some people have become diabetic while taking these medicines.
- If you are taking any other medicines. See section ‘Other medicines and Telzir’ below.
Tell your doctor if any of these applies to you. You will need extra check-ups, including blood tests, while you’re taking your medication.
Your doctor will monitor your blood glucose levels before and during treatment with Telzir.
Look out for important symptoms
Some people taking medicines for HIV infection develop other conditions, which can be serious. These include:
- Flare up of old infections
- Change in your body shape
- Problems with your bones.
You need to know about important signs and symptoms to look out for while you’re taking Telzir. Please read the information on ‘Other side effects of combination therapy for HIV in section 4 of this leaflet. If you have any questions about this information or the advice given: —»Talk to your doctor.
You may get a skin rash. However you can still continue to take Telzir. It can be treated with antihistamines. Rarely, the skin rash can be severe and serious {Stevens Johnson syndrome). If this happens, Telzir must be stopped immediately and you must never take it again.
Protect other people. Telzir will not stop you passing HIV infection on to other people, by having sex or by blood transfer. To protect other people from becoming infected with HIV:
Use a condom when you have oral or penetrative sex.
Don’t risk blood transfer for example, don’t share needles.
Other medicines and Telzir
Tell your doctor or pharmacist if you’re taking any other medicines, if you’ve taken any recently, or if you start taking new ones – these include herbal medicines or other medicines you bought without a prescription. Your doctor will decide if these medicines are suitable for you to take with Telzir and ritonavir. This is very important, as Telzir or ritonavir can strengthen or weaken the effects of other medicines. This can sometimes lead to serious medical conditions.
There are some medicines that must not be taken with Telzir. You must check the list of medicines under ‘Don’t take Telzir’ at the beginning of section 2 of this leaflet.
These medicines are not recommended with Telzir/ritonavir:
- doses of ketoconazole and itraconazole greater than 200 mg per day (used to treat fungal infections)
- doses of rifabutin greater than 150 mg every other day (an antibiotic)
- lidocaine given by injection (an anaesthetic)
- halofantrine (used to treat malaria)
- sildenafil and vardenafil (used to treat erectile dysfunction)
- lovastatin, simvastatin and doses of atorvastatin greater than 20 mg per day (used to lower cholesterol)
- fluticasone propionate and similar medicines used to treat asthma, unless considered essential. In this case close monitoring is required.
- lopinavir/ritonavir combination (used to treat HIV infection)
You will be closely monitored if you are taking these medicines with Telzir/ritonavir:
- atorvastatin up to 20 mg per day (used to lower cholesterol)
- carbamazepine, phenobarbital (used to treat epilepsy)
- cyclosporin, rapamycin, tacrolimus (used to suppress the immune system)
- desipramine,nortriptyline, paroxetine and similar medicines (used to treat depression)
- warfarin and other medicines that stop blood clotting
- injectable midazolam (used to treat anxiety).
Your dose of Telzir may need to be changed if you are taking etravirine (used to treat HIV infection)
Hormonal contraception
Taking Telzir and ritonavir while taking the contraceptive pill may harm your liver and may stop the contraceptive from working properly.
Use an alternative non-hormonal type of contraception such as a condom.
No studies have been done on the use of Telzir/ritonavir with other hormonal therapies, such as hormone replacement therapy (HRT).
Pregnancy and breast feeding
If you are pregnant, if you become pregnant, or if you are planning to become pregnant: Talk to your doctor about the risks and benefits of taking Telzir.
Women who are HIV-positive must not breast feed because HIV infection can be passed on to the baby in breast milk. If you’re breast feeding, or thinking about breast feeding: Talk to your doctor.
Driving and using machines
Telzir can make you feel dizzy and have other side effects that make you less alert. —» Don’t drive or operate machinery unless you’re feeling well.
Stay in regular contact with your doctor
Telzir helps to control your condition, but it is not a cure for HIV infection. You need to keep taking it every day to stop your illness getting worse. You may still develop other infections and illnesses linked to HIV infection. —» Keep in touch with your doctor, and don’t stop taking Telzir without your doctor’s advice.
How to take Telzir
Always take Telzir exactly as your doctor has told you. It is very important that you take the full daily dose of Telzir and ritonavir as prescribed by your doctor. Do not take more than the recommended dose. Check with your doctor or pharmacist if you are not sure.
Swallow the tablets whole, with some water or another drink. Telzir tablets can be taken with or without food. Telzir is also available as a liquid (oral suspension) for people who are unable to swallow tablets. (Read the package leaflet of Telzir oral suspension for guidance on whether to take it with or without food.)
How much to take Adults
The recommended dose is one 700 mg Telzir tablet twice daily with 100 mg ritonavir twice daily.
Children from 6 years of age and weighing at least 39 kg
Children can take the adult tablet dose of one 700 mg Telzir tablet twice daily with ritonavir 100 mg twice daily if they can swallow the tablets whole.
Children from 6 years of age and weighing less than 39 kg
Use Telzir oral suspension.
Adults with liver disease
If you have mild liver disease, the dose is one Telzir tablet (700 mg) twice daily with 100 mg ritonavir only once daily. If you have moderate or severe liver disease the dose of Telzir has to be lowered. This dose adjustment can not be made with Telzir tablets. You must take Telzir oral suspension.
If you take too much Telzir
If you have taken more than the prescribed dose of Telzir: Contact your doctor or pharmacist immediately for advice.
If you forget to take Telzir
If you forget to take a dose of Telzir, take it as soon as you remember and then continue your treatment as before. Don’t take a double dose to make up for a missed dose.
Don’t stop Telzir without advice
Take Telzir for as long as your doctor recommends. Don’t stop unless your doctor advises you to.
Possible side effects
Like all medicines, Telzir can cause side effects, but not everyone gets them. When treating HIV, it can be hard to tell whether side effects are caused by Telzir, by other medicines taken at the same time or by the HIV disease itself. For this reason, it is very important to talk to your doctor about any changes in your health.
Very common side effects
These may affect more than 1 in 10 people:
- Diarrhoea
- Increase in cholesterol (a type of blood fat). Your doctor will monitor your blood fat levels before and during treatment with Telzir.
Common side effects
These may affect up to 1 in 10 people:
- Increases in triglycerides (a type of blood fat). Your doctor will monitor your blood fat levels before and during treatment with Telzir.
- Feeling sick or being sick {nausea or vomiting), pain in the stomach, loose stools
- Skin rashes (red, raised or itchy) – if the skin rash is severe, you may have to stop taking this medicine
- Headache, feeling dizzy
- Feeling tired
- Increases in enzymes produced by the liver called transaminases, increases of an enzyme produced by the pancreas called lipase.
- Tingling or numbness around the lips and mouth.
Uncommon side effects
These may affect up to 1 in 100 people:
- Swelling of the face, lips and tongue (angioedema).
Rare side effects
These may affect up to 1 in 1000 people:
- A severe or life-threatening skin reaction {Stevens Johnson syndrome).
You may experience muscle problems
There have been reports of muscle pain, tenderness or weakness, particularly with antiretroviral therapy including protease inhibitors and nucleoside analogues. On rare occasions, these muscle disorders have been serious {rhabdomyolysis). If you notice any muscle problems: —»Tell your doctor.
Haemophiliacs may bleed more
In patients with haemophilia type A and B, there have been reports of increased bleeding while taking protease inhibitors.
If this happens to you:
Talk to your doctor immediately.
If you get side effects
Tell your doctor or pharmacist if any of the side effects gets severe or troublesome, or if you notice any side effects not listed in this leaflet.
Other side effects of combination therapy for HIV
Old infections may flare up
People with advanced HIV infection (AIDS) have weak immune systems and are more likely to develop serious infections (opportunistic infections). When these people start treatment, they may find that old, hidden infections flare up, causing signs and symptoms of inflammation. These symptoms are probably caused by the body’s immune system becoming stronger, so that the body starts to fight these infections.
If you get any symptoms of infection or signs of inflammation while you’re taking Telzir: —»Tell your doctor immediately. Don’t take other medicines for the infection without your doctor’s advice.
Your body shape may change
People taking combination therapy may find that their body shape changes, because of changes in fat distribution:
Fat may be lost from the legs, arms or face
Extra fat may build up around the tummy (abdomen) or the breasts or internal organs
Fatty lumps (sometimes called a buffalo hump) may appear on the back of the neck.
It is not yet known what causes these changes, or whether they have any long-term effects on your health. If you notice changes in your body shape: —»Tell your doctor.
You may have problems with your bones
Some people taking combination therapy for HIV develop a condition called osteonecrosis. With this condition, parts of the bone tissue die because of reduced blood supply to the bone.
People may be more likely to get this condition:
- if they have been taking combination therapy for a long time
- if they are also taking anti-inflammatory medicines called corticosteroids
- if they drink alcohol
- if their immune systems are very weak
- if they are overweight. Signs to look out for include:
- stiffness in the joints
- aches and pains (especially in the hip, knee or shoulder)
- difficulty moving.
If you notice any of these symptoms: Tell your doctor.
Other effects may show up in tests
Combination therapy for HIV can also cause:
- increased levels of lactic acid in the blood
- increased levels of sugar or fats in the blood
- resistance to insulin (so if you’re diabetic, you may have to change your insulin dose to control your blood sugar).
How to store Telzir
Keep out of the reach and sight of children.
Do not use Telzir after the expiry date shown on the bottle and the carton.
Telzir does not require any special storage conditions.
If you have any unwanted Telzir tablets, don’t dispose of them in your waste water or your household waste. Take them back to your pharmacist who will dispose of them in a way that won’t harm the environment.
Further information
What Telzir contains
The active substance is fosamprenavir. Each tablet contains 700 mg of fosamprenavir as fosamprenavir calcium (equivalent to approximately 600 mg amprenavir).
The other ingredients are: microcrystalline cellulose, croscarmellose sodium, povidone K30, magnesium stearate, colloidal anhydrous silica, hypromellose, titanium dioxide (E171), glycerol triacetate, iron oxide red (E172).
What Telzir looks like and contents of the pack
Telzir is supplied in plastic bottles containing 60 film-coated tablets. The tablets are capsule shaped, biconvex, pink coloured and marked with ‘GXLL7’ on one side.
Telzir is also available as an oral suspension for those patients unable to swallow the tablets.