Antiretroviral Agents: Protease Inhibitors

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atazanavir

Detailed Prescribing Information

October 2006

Atazanavir = Reyataz Approved June 20,2003
Dosing Forms	100, 150, 200, 300 mg caps
Dosing	Without boosting: 2 x 200 mg once a day with a light meal With boosting: 1 x 300 mg or 2 x 150 mg + ritonavir 100 mg, both once a day
Dosing	Hepatic impairment: dose reduction to 300 mg once a day should be considered for moderate hepatic insufficiency (Child Pugh Class B)
Food Dependence	Food enhances absorption and reduces pharmacokinetic variability
Adverse Effects	Mainly GI disturbance including nausea, abdominal pain, diarrhea Also perioral paresthesia, hepatitis, fat redistribution, hyperlipidemia, Type 2 diabetes
Contraindications	Concomitant lovastatin, simvastatin Concomitant St John's Wort Ergot derivatives, cisapride, pimozide, midazolam, triazolam Proton pump inhibitors Irinotecan, bepridil Indinavir should not be used due to combined and possibly severe hyperbilirubinemia.
Interactions	Atazanavir levels are decreased by tenofovir (use boosted atazanavir dosing) Atazanavir levels are decreased by efavirenz (use boosted atazanavir dosing) Atazanavir increases inhibits CYP3A pathway: therefore, drugs metabolized via this pathway may accumulate - sildenafil, calcium channel blockers, statins, immunosuppressants Levels of all erectile dysfunction drugs are increased: the lowest dose of these drugs must be used as a maximum and at intervals not be be decreased beyond every 48-72 hours. H2-inhibitor: decreases atazanavir absorption - recommend to take minimum dose separated from atazanavir dosing by 12 hours
Interactions	No data: lopinavir, nevirapine
Suggested laboratory evaluations	Liver profile and glucose monthly x 3 months, then every 3-4 months; lipid profile q3-4 months
Warnings	Warfarin therapy should be monitored closely. Antiarrythmic therapy should be monitored closely. Stagger H2-blockers by at least an hour from atazanavir (consider co-administration of acidic drink such as cola beverage or acidic citrus drink?)
Full Prescribing Information	http://www.reyataz.com

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Nucleoside & Nucleotide Reverse Transcriptase Inhibitors (NRTI)

AZT | ddC | ddI | d4T | 3TC | ABC | FTC | TDF | Combivir | Trizivir | Epzicom | Truvada | Atripla

Nonnucleoside Reverse Transcriptase Inhibitors (NNRTI)

efavirenz | nevirapine | delavirdine

Protease Inhibitors (PI) | Boosted Protease Inhibitors

Fusion Inhibitors

enfuvirtide

Quick Menu / Table of Contents
Introduction	Principles	Management	NRTI Info	NNRTI Info
PI Info	Fusion Inhibitors	Drug Summary	Investigational	Adherence
Lab Evaluation	Resistance Tests	PEP	Antiretroviral Tables	OI Prevention
Vaccinations	TB Therapy	Hepatitis Therapy	OI Diagnosis	OI Therapy
Bibliography		Links		Palliative Therapy

10.23.2006