Monograph Details
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Infections & Infestations
> Viral infections
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REYATAZ |
| Manufacturer |
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Bristol-Myers Squibb |
| Legal Classification |
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Rx
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| Pharmacological Class |
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HIV-1 protease inhibitor. |
| Generic Name |
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Atazanavir (as sulfate) 100mg, 150mg, 200mg, 300mg; caps. |
| Indications |
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HIV-1 infection. |
| Children |
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Not recommended. |
| Adults |
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Take with food. Therapy-naive: 400mg once daily. Therapy-experienced: atazanavir 300mg + ritonavir 100mg; both once daily. Concomitant efavirenz (must also give ritonavir; not for therapy-experienced): atazanavir 300mg + efavirenz 600mg + ritonavir 100mg; all once daily. Concomitant tenofovir (must also give ritonavir): consider giving atazanavir 300mg + tenofovir 300mg + ritonavir 100mg; all as a single daily dose; see literature. Concomitant H2 blockers: see literature. Consider reducing diltiazem or clarithromycin dose by ½. Renal or severe hepatic impairment: not recommended; moderate hepatic impairment: 300mg once daily. |
| Contraindications |
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Drugs metabolized by CYP3A that may cause serious events if blood levels are elevated (eg, midazolam, triazolam, ergots, cisapride, pimozide). |
| Precautions |
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Cardiac conduction abnormalities. Hepatic impairment. Hepatitis. Consider alternative antivirals if jaundice, scleral icterus, or lactic acidosis occurs. Diabetes. Monitor for hyperglycemia, fat redistribution, and hemophiliacs for spontaneous bleeding. Elderly. Pregnancy (Cat.B). Nursing mothers: not recommended. |
| Interactions |
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Rifampin, irinotecan, lovastatin, simvastatin, indinavir, proton pump inhibitors, bepridil, St. John's wort: not recommended. Caution with drugs metabolized by UGT1A1 (eg, irinotecan) or CYP3A (eg, calcium channel blockers, statins, immunosuppressants, PDE5 inhibitors: reduce doses of these; max 25mg sildenafil in 48 hrs; max 10mg tadalafil in 72 hrs; max 2.5mg vardenafil in 72 hrs.), and CYP2C8. Potentiated by CYP3A inhibitors. Antagonized by CYP3A inducers (eg, rifampin). Use cautiously and monitor diltiazem, antiarrhythmics, others that affect conduction (esp. if metabolized by CYP3A). Plasma levels decreased by drugs that reduce gastric acidity (eg, H2 blockers). Give 2 hours before or 1 hour after buffered or enteric coated didanosine. Antagonized by tenofovir (see dose). Increased risk of hyperbilirubinemia with indinavir; lactic acidosis with nucleoside analogues. Potentiates saquinavir, oral contraceptives. Monitor warfarin, tricyclics, rifabutin, atorvastatin, immunosuppressants. Variable effects on clarithromycin; consider other drugs. |
| Adverse Reactions |
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GI upset, stomach pain, headache, rash, dizziness, depression, jaundice, scleral icterus, fever, insomnia, arthralgia, lab abnormalities, hyperglycemia, fat redistribution, peripheral neuropathy, hyperbilirubinemia. |
| Extra Text |
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Note: Register pregnant patients exposed to atazanavir by calling (800) 258-4263. See Norvir entry in this section for more information on ritonavir. |
| How Supplied |
100mg, 150mg, 200mg—60
300mg—30 |
| Additional Resources |
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• Related Prescribing Note |
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