atelet count (103/μL)
Grade 2 50 - 99.999 3% 5%
Grade 3 25 - 49.999 1% <1%
Grade 4 <25 1% <1%
Blood chemistry
Fasting (non-random) serum glucose test (mg/dL)
Grade 2 126 - 250 10% 7%
Grade 3 251 - 500 3% 1%
Grade 4 >500 0% 0%
Total serum bilirubin
Grade 2 1.6 - 2.5 x ULN 6% 3%
Grade 3 2.6 - 5.0 x ULN 3% 3%
Grade 4 >5.0 x ULN 1% 0%
Serum aspartate aminotransferase
Grade 2 2.6 - 5.0 x ULN 9% 7%
Grade 3 5.1 - 10.0 x ULN 4% 3%
Grade 4 >10.0 x ULN 1% 1%
Serum alanine aminotransferase
Grade 2 2.6 - 5.0 x ULN 9% 9%
Grade 3 5.1 - 10.0 x ULN 4% 2%
Grade 4 >10.0 x ULN 1% 2%
Serum alkaline phosphatase
Grade 2 2.6 - 5.0 x ULN 2% <1%
Grade 3 5.1 - 10.0 x ULN <1% 1%
Grade 4 >10.0 x ULN 1% <1%
Serum pancreatic amylase test
Grade 2 1.6 - 2.0 x ULN 2% 1%
Grade 3 2.1 - 5.0 x ULN 4% 3%
Grade 4 >5.0 x ULN <1% <1%
Serum lipase test
Grade 2 1.6 - 3.0 x ULN 5% 4%
Grade 3 3.1 - 5.0 x ULN 2% 1%
Grade 4 >5.0 x ULN 0% 0%
Serum creatine kinase
Grade 2 6.0 - 9.9 x ULN 2% 2%
Grade 3 10.0 - 19.9 x ULN 4% 3%
Grade 4 ≥20.0 x ULN 3% 1%
The following adverse reactions have been identified during postapproval use of ISENTRESS. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Blood and Lymphatic System Disorders: thrombocytopenia
Gastrointestinal Disorders: diarrhea
Musculoskeletal and Connective Tissue Disorders: rhabdomyolysis
Psychiatric Disorders: anxiety, paranoia
Skin and Subcutaneous Tissue Disorders: rash, Stevens-Johnson syndrome
Raltegravir does not inhibit (IC>100 µM) CYP1A2, CYP2B6, CYP2C8, CYP2C9, CYP2C19, CYP2D6 or CYP3A in vitro. Moreover, in vitro, raltegravir did not induce CYP1A2, CYP2B6 or CYP3A4. A midazolam drug interaction study confirmed the low propensity of raltegravir to alter the pharmacokinetics of agents metabolized by CYP3A4 in vivo by demonstrating a lack of effect of raltegravir on the pharmacokinetics of midazolam, a sensitive CYP3A4 substrate. Similarly, raltegravir is not an inhibitor (IC>50 µM) of the UDP-glucuronosyltransferases (UGT) tested (UGT1A1, UGT2B7), and raltegravir does not inhibit P-glycoprotein-mediated transport. Based on these data, ISENTRESS is not expected to affect the pharmacokinetics of drugs that are substrates of these enzymes or P-glycoprotein (e.g., protease inhibitors, NNRTIs, opioid analgesics, statins, azole antifungals, proton pump inhibitors and anti-erectile dysfunction agents).
In drug interaction studies, raltegravir did not have a clinically meaningful effect on the pharmacokinetics of the following: hormonal contraceptives, methadone, lamivudine, tenofovir, etravirine, darunavir/ritonavir.
Raltegravir is not a substrate of cytochrome P450 (CYP) enzymes. Based on in vivo and in vitro studies, raltegravir is eliminated mainly by metabolism via a UGT1A1-mediated glucuronidation pathway.
Rifampin, a strong inducer of UGT1A1, reduces plasma concentrations of ISENTRESS. Therefore, the dose of ISENTRESS should be increased during coadministration with rifampin [see Dosage and Administration (2)]. The impact of other inducers of drug metabolizing enzymes, such as phenytoin and phenobarbital, on UGT1A1 is unknown.
Coadministration of ISENTRESS with drugs that inhibit UGT1A1 may increa
