When using a combination of ritonavir observed hepatitis, caused by the use of drugs (eg, acute hepatitis, cytolytic hepatitis). Hepatitis was observed in 0.5% of patients receiving combination therapy with ritonavir. In patients with impaired hepatic function, including with chronic active hepatitis B or C, have an increased risk of severe side effects from the liver.
It is necessary to monitor the relevant laboratory parameters before the appointment of combination therapy methenolone enanthate side effects ritonavir and during treatment. Consideration should be given control of increasing the activity of in patients with chronic hepatitis, cirrhosis, or in patients who have had increased activity of transaminases at baseline and especially during the first few months of combined therapy ritonavir.
In the case of violations of functions liver or deterioration in their severity (including clinically significant increase in the activity of “liver” enzymes and / or symptoms such as fatigue, anorexia, nausea, jaundice, dark urine, liver tenderness, hepatomegaly) should consider interruption or discontinuation ritonavir.
Patients with kidney disease
The kidneys play a minor role in the clearance of darunavir and therefore patients with kidney disease almost total clearance of darunavir has not diminished. Darunavir and ritonavir are highly plasma protein binding, and therefore hemodialysis or peritoneal dialysis does not play a significant role in the removal of these products from the body.
There have been reports of increased bleeding, including spontaneous skin hematomas and hemarthrosis, in patients with hemophilia type A and B treated with protease inhibitors. Some of these patients had received blood coagulation factor VIII. More than half of the reported cases of treatment of protease inhibitors was continued without interruption or resumed after a temporary suspension. It was suggested a causal relationship between protease inhibitor therapy and increased bleeding in hemophiliacs, but such a connection mechanism is not installed. Hemophilia patients receiving the combination ofmethenolone enanthate side effects ritonavir should be informed about the possibility of increased bleeding.
in patients receiving antiretroviral therapy, including protease inhibitors, described in new cases of diabetes, hyperglycemia or worsening of pre-existing diabetes mellitus. Some of these patients hyperglycaemia was severe and in some cases accompanied by ketoacidosis. Many patients had concomitant diseases, some of which required treatment with drugs that contribute to the development of diabetes or hyperglycemia.
Fat redistribution and metabolic disorders
Combination antiretroviral therapy may cause in HIV-infected patients, fat redistribution (lipodystrophy). There is currently no data on the long-term consequences of this phenomenon and its mechanism is not clear in many ways. A hypothesis about the connection between visceral lipomatosis and protease inhibitors, as well as between lipoatrophy and nucleoside reverse transcriptase inhibitors. Increased risk of lipodystrophy is associated with factors such as older age, and with long-term treatment with antiretroviral drugs and attendant metabolic disorders. In clinical surveys of HIV-infected patients receiving antiretroviral drugs, it is necessary to pay attention to physical signs of fat redistribution. It is recommended to measure the content of serum lipids and blood glucose. Disorders of lipid metabolism should be treated with appropriate drugs.
Immune reactivation syndrome
In HIV-infected patients with severe immune deficiency at the start of combination antiretroviral therapy may cause an inflammatory reaction to asymptomatic or residual opportunistic infections that can lead to severe clinical complications or worsening of symptoms. Typically, such reactions are observed within the first weeks or months of combination antiretroviral therapy. In Examples cytomegalovirus retinitis, generalized and / or local mycobacterial infections and pneumonia caused by Pneumocystis carinii. It is necessary to determine the severity of any symptoms of inflammation and implement appropriate therapy.
Cases of osteonecrosis, especially with conventional risk factors for patients with HIV infection at a late stage or under long-term antiretroviral combination therapy. The frequency of osteonecrosis is unknown. Interactions with other drugs darunavir and ritonavir are inhibitors of isoenzyme. The simultaneous use of a combination of methenolone enanthate side effects ritonavir and other drugs that are metabolized primarily of isoenzyme, can lead to increased concentrations of these drugs in the plasma, so that may increase or lengthen their therapeutic and side effects. Darunavir is metabolised of isoenzyme. Simultaneous administration of drugs, the activity of inducing, darunavir clearance may increase, resulting in decrease in the plasma concentration of darunavir. Simultaneous treatment with darunavir with inhibitors of methenolone enanthate side effects may decrease the clearance of darunavir, resulting in increased plasma concentration of darunavir in.