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Database of Antiretroviral Drug Interactions

All Interactions with Atazanavir (Reyataz)

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Acetaminophen
(others)(Tylenol)
1 gram BID on d 1-20300 mg atazanavir QD with 100 mg ritonavir QD on d 11-20-Atazanavir Cmin: increased 26%--

No dose adjustment necessary

Apixaban727
--Not studied; may increase levels of apixaban.-Potential for increased risk of bleedingInhibition of apixaban metabolism via CYP3A4.

Avoid coadministration. Consider alternative anticoagulant

Alternative Agents:
dabigatran

Atenolol
(others)
50 mg QD on days 7-11 and 19-23400 mg QD on days 1-11Atenolol AUC: increased 25%; Cmax: increased 34%; Cmin: no significant changeAtazanavir AUC: no significant change; Cmax: no significant change; Cmin: decreased 26%--

No dose adjustment necessary

Atovaquone487
(Mepron)
250 mg with 100 mg proguanil x 1300 mg with 100 mg ritonavir QDAtovaquone AUC: decreased 46%; Cmax: decreased 49%-Potentially compromised antimalarial activityIncreased atovaquone glucuronidation; induction of CYP450 3A4 by atazanavir/ritonavir

Dose adjustment not established

Boceprevir595
(Victrelis)
800 mg TID300 mg with 100 mg ritonavir QDBoceprevir Cmin: decreased 18%Atazanavir AUC: decreased 35%; Cmax: decreased 25%; Cmin: decreased 49%Decreased HIV treatment efficacy-

Do not coadminister

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Bosentan727, 699
---Expected decreased atazanavir levelsPossible loss of antiviral efficacy-

Do not coadminister bosentan with unboosted atazanavir

Cimetidine240
(Tagamet)(Tagamet)
----May decrease atazanavir effectsPossible decreased GI absorption

Unboosted atazanavir 400 mg: give atazanavir 2 hrs before or 10 hours after H2-blocker. Single doses of H2-blockers should not exceed 20 mg of famotidine (or equivalent). Additionally, if treatment naive, total daily dose of H2 blocker should not exceed 40 mg of famotidine (or equivalent). Atazanavir 300 mg boosted with ritonavir or cobicistat: Give boosted atazanavir at same time as H2 blocker or 10 hours or more after. Total doses of H2 blocker should not exceed the equivalent of 40 mg BID famotidine (treatment naive) or 20 mg BID for (treatment experienced patients). If using tenofovir disoproxil fumarate, atazanavir, and H2 blocker in treatment experienced patient, increase atazanavir dose to 400 mg in addition to boosting with ritonavir or cobicistat.

Cisapride
(Propulsid)
--Not studied; may increase cisapride levels-Increased cisapride effects (eg, cardiac arrhythmias)Inhibition of CYP450 3A4 by atazanavir

Do not coadminister

Alternative Agents:
Metoclopramide

Clarithromycin363
(Biaxin)
500 mg BID on days 7-11 and 18-21400 mg QD on days 1-10Clarithromycin AUC: increased 94%; Cmax: increased 50%; Cmin: decreased 62%; 14-hydroxyclarithromycin AUC: decreased 70%; Cmax: decreased 72%; Cmin: increased 164%Atazanavir AUC: increased 28%; Cmax: no significant change; Cmin: increased 91%Increased clarithromycin effects. May cause QTc prolongation.Inhibition of CYP450 3A4 by atazanavir

Reduce clarithromycin dose by 50%

Alternative Agents:
azithromycin

Colchicine727, 551
(Colcrys)
----Increased colchicine effectsnhibition of P450 3A4 by atazanavir/ritonavir

For treatment of gout, reduce colchicine dosage to 0.6 mg x 1 then 0.3 mg one hour later. Dose not to be repeated no earlier than 3 days. For prophylaxis of gout, reduce colchicine dosage to 0.3 mg QD if on 0.6 mg BID prior to PI therapy or reduce colchicine dose to 0.3 mg QOD if on 0.6 mg QD prior to PI therapy. For treatment of familial Mediterranean fever: Do not exceed colchicine 0.6 mg once daily or 0.3 mg BID. Do not coadminister in patients with hepatic or renal impairment

Dabigatran727
(Pradaxa)
--Not studied; may increase dabigatran levels - Potential for increased risk of bleeding Inhibition of dabigatran metabolism via CYP3A4

No dose adjustment if CrCL > 50 ml/min. Avoid concomitant use if CrCl < 50ml/min.

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Daclatasvir749
(Daklinza)
20 mg daily300 mg with ritonavir 100 mg AUC(tau) increased 110%No significant change-Inhibition of CYP3A4

Decrease daclatasvir dose to 30 mg daily when used with atazanavir/ritonavir. No dose adjustment necessary if used with unboosted atazanavir

Darunavir161
(DRV)(Prezista)
400 mg BID with ritonavir 100 mg BID300 mg QDNo significant changeAtazanavir Cmin: increased 52%--

No dose adjustment necessary

Didanosine
(ddI)(Videx)
200 mg (buffered tabs) x 1 dose400 mg x 1 dose (given simultaneously with stavudine and didanosine)No significant changeAtazanavir AUC: decreased 87%; Cmin: decreased 84%; Cmax: decreased 89%Decreased atazanavir effectsAltered gastric pH decreasing atazanavir absorption

Administer didanosine tablets on an empty stomach and 2 hours before or 1 hour after food or atazanavir

Didanosine
(ddI)(Videx)
200 mg (buffered tabs) x 1 dose400 mg QD x 1 (given 1 hour after stavudine and didanosine)Not studiedNo significant change--

No dose adjustment necessary

Didanosine124
(ddI)(Videx)
250 mg EC x 1 dose400 mg QD with foodDidanosine AUC: no significant change (AUC comparable to that of didanosine 400 mg QD without tenofovir)Atazanavir AUC: decreased 26%; Cmax: decreased 24%--

No dose adjustment necessary

Didanosine152,
(ddI)(Videx)
400 mg (enteric coated capsule) QD with food400 mg QD with foodDidanosine AUC: decreased 34%; Cmax: decreased 36%No significant changeDecreased didanosine effectsReduced didanosine absorption due to presence of food

Administer didanosine EC and atazanavir at different times

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Didanosine152,
(ddI)(Videx)
400 mg (enteric coated capsule) QD with food300 mg with ritonavir 100 mg QDDidanosine AUC: decreased 34%; Cmax: decreased 38%; Cmin: increased 25%Atazanavir AUC: no significant change; Cmax: no significant change; Ritonavir AUC: no significant change; Cmax: no significant changeDecreased didanosine effectsReduced didanosine absorption due to presence of food

Administer didanosine EC and atazanavir at different times

Didanosine122
(ddI)(Videx)
Also dosed with stavudine400 mg x 1 doseNot studiedAtazanavir Cmax: decreased 89%; AUC: decreased 87%Decreased atazanavir effects-

Dose adjustment not established

Diltiazem
(Dilacor, Tiazac, Cardizem)
180 mg QD on days 7-11 and 19-23400 mg QD on days 1-11Diltiazem AUC: increased 125%; Cmax: increased 198%; Cmin: decreased 59%No significant changeIncreased diltiazem effects (eg, hypotension, heart block)Inhibition of CYP450 3A4 by atazanavir

Reduce diltiazem dose by 50%. ECG monitoring is recommended.

Dolutegravir641
(Tivicay)
30 mg QD400 mg QDDolutegravir AUC: increased 91%; Cmin: increased 180% ---

No dose adjustment necessary

Dolutegravir641
(Tivicay)
30 mg QD300 mg QD with ritonavir 100 mg QDDolutegravir AUC increased 62%; Cmin: increased 121%---

No dose adjustment necessary

Efavirenz4, 727
(EFV)(Sustiva)
600 mg QD on days 7-20600 mg QD on days 7-20Not studiedAtazanavir (all values compared to atazanavir 400 mg QD) AUC: decreased 21%; Cmax: no significant change; Cmin: decreased 59%Decreased atazanavir effectsInduction of P450 3A4 by efavirenz

Do not coadminister efavirenz with unboosted atazanavir

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Efavirenz100
(EFV)(Sustiva)
600 mg QD on days 7-20400 mg QD on days 1-20No significant changeAtazanavir AUC: decreased 74%; Cmax: decreased 59%; Cmin: decreased 93%; half-life: decreased 27%Decreased atazanavir effectsInduction of CYP450 3A4 by efavirenz

Do not coadminister efavirenz with unboosted atazanavir.

Efavirenz727, 101
(EFV)(Sustiva)
600 mg QD with ritonavir 200 mg on days 15-28400 mg QD on days 1-28Not studiedAtazanavir AUC: increased 241%; Cmax: increased 124%; Cmin: increased 671%; half-life: increased 79%Increased atazanavir effects-

In ART-Naive Patients use standard dose efavirenz together with atazanavir 400 mg boosted with ritonavir 100 mg once daily. Do not coadminister efavirenz with ritonavir-boosted atazanavir in ART-experienced patients.

Efavirenz4, 727
(EFV)(Sustiva)
600 mg QD x days 7-20400 mg QD on days 1-6 then 300 mg with ritonavir 100 mg QD on days 7-20Not studiedAtazanavir (all values compared to atazanavir 400 mg QD) AUC: increased 39% ; Cmax: no significant change; Cmin: increased 48%Increased atazanavir effectsInhibition of P450 3A4 by ritonavir

In ART-Naive Patients use standard dose efavirenz together with atazanavir 400 mg boosted with ritonavir 100 mg once daily. Do not coadminister efavirenz with ritonavir-boosted atazanavir in ART-experienced patients.

Elbasvir/grazoprevir733, 727
(Zepatier)
Elbasvir 50 mg QD with grazoprevir 100 mg QD300 mg QDElbasvir AUC ↑ 4.8 fold Grazoprevir AUC ↑ 10.6 fold-May increase the risk of ALT elevations due to a significant increase in grazoprevir plasma concentrations caused by OATP1B1/3 inhibitionOATP1B1/3 inhibition by atazanavir

Contraindicated: Do not coadminister

Elvitegravir/cobicistat651, 645, 639
(Genvoya, Stribild)
Elvitegravir 85 mg QD with COBI 150 mg QD300 mg QDElvitegravir AUC: increased 17%; Cmax: decreased 16%; Cmin: increased 83%Atazanavir Cmax: decreased 24%; Cmin: decreased 20%Potentially decreased or increased elvitegravir, cobicistat and/or atazanavir effects-

Do not coadminister

Ergotamine
(Cafergot, Ergot derivatives)(Cafergot, others)
--Not studied; may increase ergotamine levels-Increased ergotamine effects (eg, ergotism)Inhibition of CYP450 3A4 by atazanavir

Do not coadminister

Alternative Agents:
5-HT agonists ("triptans")

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Esomeprazole240
(Nexium)
----Decreased atazanavir effectsDecreased GI absorption

Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients.

Alternative Agents:
H2 blockers

Ethinyl estradiol/norethindrone acetate4
(others)(Ortho-Novum)
1 tab QD (7/7/7)400 mg QD x 14 daysNorethindrone Cmax: increased 67%; AUC: increased 110%; Cmin: increased 262%; Ethinyl estradiol AUC: increased 48%; Cmax: no significant change; Cmin: increased 91%Not studiedIncreased norethindrone and ethinyl estradiol effectsInhibition of UGT 1A1 by atazanavir

Use oral contraceptive that contains no more than 30 mcg of ethinyl estradiol or recommend an alternative contraceptive method. Oral contraceptives containing less than 25mcg of ethinyl estradiol or progestins other than norethindrone or norgestimate have not been studied.

Alternative Agents:
Non hormonal contraceptive method, barrier devices, condoms

Ethinyl estradiol/norgestimate727
(others)(Ortho Tri-Cyclen)
-300 mg QD with 100 mg atazanavir QDEthinyl estradiol AUC: decreased 19%; Cmax: decreased 16%; Cmin: decreased 37% 17-deacetyl norgestimate AUC: increased 85%; Cmax: increased 68%; Cmin: increased 102%---

Use oral contraceptive containing at least 35 mcg of ethinyl estradiol. Oral contraceptives containing progestins other than norethindrone or norgestimate have not been studied.

Alternative Agents:
Non-hormonal contraceptives, barrier devices, condoms

Etravirine405
(ETR)(Intelence)
-400 mg QDEtravirine AUC: increased 50%; Cmax: increased 47%; Cmin: increased 58%Atazanavir AUC: decreased 17%; Cmin: decreased 47%Possibly increased etravirine effects; decreased atazanavir effectsInhibition of etravirine metabolism; induction of CYP450 3A4 by etravirine

Do not coadminister

Etravirine727, 405
(ETR)(Intelence)
-300 mg QD with 100 mg ritonavir QDEtravirine AUC: increased 30%; Cmax: increased 30%; Cmin: decreased 26%Atazanavir AUC: decreased 14%; Cmin: decreased 38%Possibly increased etravirine effects-

When using atazanavir 300 mg plus ritonavir 100 mg once daily use etravirine standard dose.

Famotidine240
(Pepcid)
----May decrease atazanavir effectsPossible decreased GI absorption

Unboosted atazanavir 400 mg: give atazanavir 2 hrs before or 10 hours after H2-blocker. Single doses of H2-blockers should not exceed 20 mg of famotidine (or equivalent). Additionally, if treatment naive, total daily dose of H2 blocker should not exceed 40 mg of famotidine (or equivalent). Atazanavir 300 mg boosted with ritonavir or cobicistat: Give boosted atazanavir at same time as H2 blocker or 10 hours or more after. Total doses of H2 blocker should not exceed the equivalent of 40 mg BID famotidine (treatment naive) or 20 mg BID for (treatment experienced patients). If using tenofovir disoproxil fumarate, atazanavir, and H2 blocker in treatment experienced patient, increase atazanavir dose to 400 mg in addition to boosting with ritonavir or cobicistat.

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Famotidine
(Pepcid)
20 mg BID on d 11-17300 mg QD with 100 mg ritonavir QD with tenofovir on d 11-17-Atazanavir AUC: decreased 41%Decreased atazanavir effects-

Unboosted atazanavir 400 mg: give atazanavir 2 hrs before or 10 hours after H2-blocker. Single doses of H2-blockers should not exceed 20 mg of famotidine (or equivalent). Additionally, if treatment naive, total daily dose of H2 blocker should not exceed 40 mg of famotidine (or equivalent). Atazanavir 300 mg boosted with ritonavir or cobicistat: Give boosted atazanavir at same time as H2 blocker or 10 hours or more after. Total doses of H2 blocker should not exceed the equivalent of 40 mg BID famotidine (treatment naive) or 20 mg BID for (treatment experienced patients). If using tenofovir disoproxil fumarate, atazanavir, and H2 blocker in treatment experienced patient, increase atazanavir dose to 400 mg in addition to boosting with ritonavir or cobicistat.

Famotidine
(Pepcid)
20 mg BID on d 11-17 (simultaneous administration with morning atazanavir/ritonavir)300 mg QD with 100 mg ritonavir-No significant change--

Unboosted atazanavir 400 mg: give atazanavir 2 hrs before or 10 hours after H2-blocker. Single doses of H2-blockers should not exceed 20 mg of famotidine (or equivalent). Additionally, if treatment naive, total daily dose of H2 blocker should not exceed 40 mg of famotidine (or equivalent). Atazanavir 300 mg boosted with ritonavir or cobicistat: Give boosted atazanavir at same time as H2 blocker or 10 hours or more after. Total doses of H2 blocker should not exceed the equivalent of 40 mg BID famotidine (treatment naive) or 20 mg BID for (treatment experienced patients). If using tenofovir disoproxil fumarate, atazanavir, and H2 blocker in treatment experienced patient, increase atazanavir dose to 400 mg in addition to boosting with ritonavir or cobicistat.

Famotidine239
(Pepcid)
40 mg BID on d 11-20300 mg QD with ritonavir 100 mg QD on d 1-20 (simultaneous administration)Not studiedAtazanavir AUC: decreased 18%; Cmax: no significant change; Cmin: decreased 28%Decreased atazanavir effectsInhibition of atazanavir absorption by famotidine

Unboosted atazanavir 400 mg: give atazanavir 2 hrs before or 10 hours after H2-blocker. Single doses of H2-blockers should not exceed 20 mg of famotidine (or equivalent). Additionally, if treatment naive, total daily dose of H2 blocker should not exceed 40 mg of famotidine (or equivalent). Atazanavir 300 mg boosted with ritonavir or cobicistat: Give boosted atazanavir at same time as H2 blocker or 10 hours or more after. Total doses of H2 blocker should not exceed the equivalent of 40 mg BID famotidine (treatment naive) or 20 mg BID for (treatment experienced patients). If using tenofovir disoproxil fumarate, atazanavir, and H2 blocker in treatment experienced patient, increase atazanavir dose to 400 mg in addition to boosting with ritonavir or cobicistat.

Famotidine
(Pepcid)
40 mg BID on d 7-12400 mg QD on d 1-12 (simultaneous administration)-Atazanavir AUC: decreased 41%; Cmax: decreased 47%; Cmin: decreased 42%Decreased atazanavir effectsInhibition of atazanavir absorption by famotidine

Unboosted atazanavir 400 mg: give atazanavir 2 hrs before or 10 hours after H2-blocker. Single doses of H2-blockers should not exceed 20 mg of famotidine (or equivalent). Additionally, if treatment naive, total daily dose of H2 blocker should not exceed 40 mg of famotidine (or equivalent). Atazanavir 300 mg boosted with ritonavir or cobicistat: Give boosted atazanavir at same time as H2 blocker or 10 hours or more after. Total doses of H2 blocker should not exceed the equivalent of 40 mg BID famotidine (treatment naive) or 20 mg BID for (treatment experienced patients). If using tenofovir disoproxil fumarate, atazanavir, and H2 blocker in treatment experienced patient, increase atazanavir dose to 400 mg in addition to boosting with ritonavir or cobicistat.

Famotidine239
(Pepcid)
40 mg Q12H400 mg QDNot studiedAtazanavir AUC: decreased 38%; Cmax: decreased 42%; Cmin: decreased 40%Decreased atazanavir effectsInhibition of atazanavir absorption by famotidine

For treatment-naive patients, atazanavir 400 mg QD can be used if dosed 2 hrs before or 10 hours after the H2-blocker or atazanavir 300 mg with ritonavir 100 mg QD can be used.For treatment-experienced patients, atazanavir 300 mg with ritonavir 100 mg QD can be used if dosed at least 2 hs before and at least 10 hours after the H2-blocker.

Famotidine155
(Pepcid)
40 mg Q12H on d 11-20400 mg atazanavir with 100 mg ritonavir on d 11-20- Atazanavir AUC: no significant change; Cmax: no significant change; Cmin: decreased 14%(compared to 300 mg atazanavir with 100 mg ritonavir QD)- Inhibition of atazanavir absorption by famotidine

For treatment-naive patients, atazanavir 400 mg QD can be used if dosed 2 hrs before or 10 hours after the H2-blocker or atazanavir 300 mg with ritonavir 100 mg QD can be used. For treatment-experienced patients, atazanavir 300 mg with ritonavir 100 mg QD can be used if dosed at least 2 hs before and at least 10 hours after the H2-blocker.

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Famotidine
(Pepcid)
40 mg QD on d 7-12400 mg on d 1-6, d 7-12 (10 hr after, 2 hrs before famotidine)-Atazanavir Cmin: decreased 31%Decreased atazanavir effectsInhibition of atazanavir absorption by famotidine

Unboosted atazanavir 400 mg: give atazanavir 2 hrs before or 10 hours after H2-blocker. Single doses of H2-blockers should not exceed 20 mg of famotidine (or equivalent). Additionally, if treatment naive, total daily dose of H2 blocker should not exceed 40 mg of famotidine (or equivalent). Atazanavir 300 mg boosted with ritonavir or cobicistat: Give boosted atazanavir at same time as H2 blocker or 10 hours or more after. Total doses of H2 blocker should not exceed the equivalent of 40 mg BID famotidine (treatment naive) or 20 mg BID for (treatment experienced patients). If using tenofovir disoproxil fumarate, atazanavir, and H2 blocker in treatment experienced patient, increase atazanavir dose to 400 mg in addition to boosting with ritonavir or cobicistat.

Fluconazole268
(Diflucan)(Diflucan)
200 mg QD x 10 days300 mg QD with ritonavir 100 mg QD x 10 daysNo significant changeNo significant change--

No dose adjustment necessary

Fluticasone
(Advair, Flonase, Aerobid)
--Increased fluticasone concentrations-Decreased plasma cortisol concentrations (eg, Cushing's syndrome, adrenal suppression)-

Use with caution with atazanavir; use with atazanavir/ritonavir is not recommended unless the potential benefit outweighs the risk

Alternative Agents:
Beclomethasone

Fosamprenavir431
(FPV)(Lexiva)
1400 mg QD400 mg QDAmprenavir AUC: increased 97%; Cmax: increased 58%; Cmin: increased 297%Atazanavir AUC: decreased 33%; Cmax: decreased 27%; Cmin: decreased 60%Increased amprenavir effects; reduced atazanavir effectsPossible induction of CYP450 3A4 by fosamprenavir

Do not coadminister

Fosamprenavir163
(FPV)(Lexiva)
1400 mg QD x 14 days200 mg QD x 14 daysFosamprenavir AUC: increased 78%; Cmax: increased 36%; Cmin: increased 283%Atazanavir AUC: decreased 33%; Cmax: decreased 30%; Cmin: decreased 57%Increased amprenavir levelsInhibition of CYP450 3A4 by atazanavir

Dose adjustment not established

Fosamprenavir159
(FPV)(Lexiva)
700 mg BID with 100 mg ritonavir BID on days 1-10300 mg with 100 mg ritonavir QD on days 1-10, in crossover 300 mg QD when combined with FPV/r 700 mg/100 mg BIDAmprenavir AUC: no significant change; Cmax: no significant change; Cmin: no significant changeRitonavir AUC: increased 93%; Cmax: increased 96%; Cmin: increased 37% (when ATV 300 mg QD added to FPV/r 700 mg/100 mg BID)Atazanavir AUC: decreased 22%; Cmax: decreased 24%; Cmin: no significant changePossibly increased ritonavir effectsInhibition of CYP450 3A4 by atazanavir and fosamprenavir

No dose adjustment necessary

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Ketoconazole283,
(Nizoral)
200 mg QD on days 7-13400 mg QD on days 1-13Not studiedNo significant change--

No dose adjustment necessary

Lamivudine106,
(3TC)(Epivir)
150 mg BID with zidovudine 300 mg BID x 6 days400 mg QD x 6 daysNo significant changeNot studied--

No dose adjustment necessary

Lamotrigine727
(Lamictal)
-atazanavir 300 mg with 100 mg ritonavir AUC decreased 32%---

Monitor clinically and adjust dose as necessary. Consider therapeutic drug monitoring or use of alternative agent.

Lansoprazole727, 390
(Prevacid)
60 mg QD x 2 doses400 mg QD-Atazanavir AUC: decreased 94%; Cmax: decreased 91%; half-life: no significant changeDecreased atazanavir effectsDecreased GI absorption of atazanavir due to reduced acidity

Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients.

Alternative Agents:
H2 receptor antagonists

Ledipasvir/sofosbuvir743, 713
90/400 mg300 mg with ritonavir 100 mg daily given simultaenously for 10 daysLedipasvir AUC(tau) increased 96%; Cmax increased 68%.Atazanavir AUC increased 27%; Cmin increased 63%Potentially increased ledipasvir adverse effects. Potentially increased tenofovir disoproxil fumarate adverse effects if co-administered with protease inhibitor and ledipasvir.-

No dose adjustment necessary. Monitor for tenofovir disoproxil fumarate toxicity if used in the regimen.

Ledipasvir/sofosbuvir743, 713
90/400 mg300 mg with 100 mg ritonavir x 10 days given staggered from Harvoni by 12 hoursLedipasvir AUC(tau) increased 134%; Cmax increased 75%Atazanavir AUC(tau) increased 43%Potentially increased ledipasvir adverse effects. Potentially increased tenofovir disoproxil fumarate adverse effects if co-administered with protease inhibitor and ledipasvir.-

No dose adjustment necessary. Monitor for tenofovir disoproxil fumarate toxicity if used in the regimen.

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Lopinavir/ritonavir160
(LPV/r)(Kaletra)
400 mg/100 mg BID on d 11-24300 mg QD on d 11-24No significant changeAtazanavir AUC: no significant change; Cmin: increased 45%; Cmax: no significant change (compared to 300 mg atazanavir with 100 mg ritonavir QD)Increased atazanavir effectsInhibition of CYP450 3A4 by ritonavir, lopinavir and atazanavir

No dose adjustment necessary

Lopinavir/ritonavir160
(LPV/r)(Kaletra)
400 mg/100 mg BID on d 25-34300 mg with 100 mg QD ritonavir on d 25-34-Atazanavir AUC: no significant change; Cmin: increased 64% (compared to 300 mg atazanavir with 100 mg ritonavir QD)-Inhibition of CYP450 3A4 by ritonavir, lopinavir and atazanavir

No dose adjustment necessary

Lovastatin
(Mevacor)(Mevacor)
--Not studied; may increase lovastatin levels-Increased lovastatin effects (eg, myopathy, rhabdomyolysis)Inhibition of CYP450 3A4 by atazanavir

Do not coadminister

Alternative Agents:
Atorvastatin (low dose); Pravastatin

Maraviroc2
(MVC)(Selzentry)
300 mg BID400 mg QDMaraviroc AUC: increased 257%; Cmax: increased 109%; Cmin: increased 319%- Increased maraviroc effectsInhibition of CYP450 3A4 by atazanavir

Decrease maraviroc dose to 150 mg BID

Maraviroc2
(MVC)(Selzentry)
300 mg BID300 mg QD with 100 mg ritonavir QDMaraviroc AUC: increased 388%; Cmax: increased 167%; Cmin: increased 567%-Increased maraviroc effectsInhibition of CYP450 3A4 by atazanavir/ritonavir

Decrease maraviroc dose to 150 mg BID

Methadone
(Dolophine)(Dolophine)
stable dose on d 1-15400 mg QD on d 2-15Total methadone Cmax: decresed 15%---

No dose adjustment necessary

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Midazolam
(Versed)
--Not studied; may increase midazolam levels-Increased midazolam effects (eg, increased sedation, confusion, respiratory depression)Inhibition of CYP450 3A4 by atazanavir

Parenteral midazolam can be used with caution when given as a single dose in a monitored situation for procedural sedation; chronic midazolam administration (oral or intravenous) should be avoided

Alternative Agents:
Lorazepam

Nelfinavir157
(NFV)(Viracept)
1250 mg BID x 14 d400 mg QD x 7 dNelfinavir Cmin: increased 57%; M8 AUC: increased 30%; Cmax: increased 24%; Cmin: increased 124%No significant change-Inhibition of CYP450 3A4 by atazanavir

No dose adjustment necessary

Nevirapine
(NVP)(Viramune)
200 mg BID300 mg atazanavir QD with 100 mg ritonavir QDNevirapine AUC: increased 25%; Cmax: increased 17%; Cmin: increased 32%Atazanavir AUC: decreased 42%; Cmax: decreased 28%; Cmin: decreased 72%Decreased atazanavir effectsInduction of CYP4450 3A4 by nevirapine

Do not coadminister

Nevirapine
(NVP)(Viramune)
200 mg BID400 mg atazanavir QD with 100 mg ritonavir QDNevirapine AUC: increased 26%; Cmax: increased 21%; Cmin: increased 35%Atazanavir AUC: decreased 19%; Cmax: no significant change; Cmin: decreased 59%Decreased atazanavir effectsInduction of CYP450 3A4 by nevirapine

Do not coadminister

Omeprazole
(Prilosec)
20 mg QD on d 17-23300 mg QPM with 100 mg ritonavir QPM on d 7-16, 17-23-Atazanavir AUC: decreased 42%; Cmax: decreased 39%, Cmin: decreased 46%Possibly decreased atazanavir effectsDecreased GI absorption of atazanavir due to reduced acidity

Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients.

Alternative Agents:
H2 receptor antagonists

Omeprazole
(Prilosec)
20 mg QD on d 17-23300 mg QD with 100 mg ritonavir QD on d 7-16 then 400 mg atazanavir QD with 100 mg ritonavir QD on d 17-23-Atazanavir AUC: decreased 30%; Cmin: decreased 31%; Cmax: decreased 31%Possibly decreased atazanavir effectsDecreased GI absorption of atazanavir due to reduced acidity

Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients.

Alternative Agents:
H2 receptor antagonists

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Omeprazole240, 247
(Prilosec)
40 mg QD x 10 d300 mg with ritonavir 100 mg QD with 8 oz cola x 20 d-Atazanavir AUC: decreased 70%; Cmax: decreased 66%; Cmin: decreased 76%Decreased atazanavir effectsDecreased GI absorption of atazanavir due to reduced acidity

Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients.

Alternative Agents:
H2 receptor antagonists

Omeprazole240, 248
(Prilosec)
40 mg QD x 10 d400 mg QD with ritonavir 100 mg QD x 20 d-Atazanavir AUC: decreased 61%; Cmax: decreased 56%; Cmin: decreased 66%Decreased atazanavir effectsDecreased GI absorption of atazanavir due to reduced acidity

Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients.

Alternative Agents:
H2 receptor antagonists

Omeprazole248, 240
(Prilosec)
40 mg QD x 10 d300 mg QD with ritonavir 100 mg QD x 20 d-Atazanavir AUC: decreased 76%; Cmax: decreased 72%; Cmin: decreased 78%Decreased atazanavir effectsDecreased GI absorption of atazanavir due to reduced acidity

Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients.

Alternative Agents:
H2 receptor antagonists

Omeprazole
(Prilosec)
40 mg QD x 5 d400 mg QD x 12 d-Atazanavir AUC: decreased 94%; Cmax: decreased 96%; Cmin: decreased 95%Decreased atazanavir effectsDecreased GI absorption of atazanavir due to reduced acidity

Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients.

Alternative Agents:
H2 receptor antagonists

Omeprazole
(Prilosec)
40 mg x 1 on d 7 and 20400 mg QD on d 1-12Omeprazole AUC: increased 45%; Cmax: increased 24%-Increased omeprazole effectsDecreased GI absorption of atazanavir due to reduced acidity

Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients.

Alternative Agents:
H2 receptor antagonists

Pantoprazole240, 727
(Protonix)
----Decreased atazanavir effectsDecreased GI absorption of atazanavir due to reduced acidity

Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients.

Alternative Agents:
H2 receptor antagonists

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Phenobarbital727
(others)(Luminal)
---Not studied, may decrease atazanavir levelsPotential loss of antiviral efficacy.-

Avoid combination if possible; Do not use with unboosted atazanavir. Consider alternative agents. If using, monitor and adjust phenobarbital levels as indicated.

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Phenytoin727
(Dilantin)
---Not studied; may decrease atazanavir levels.Potentially decreased antiviral effects.-

Avoid combination if possible; do not coadminister with unboosted atazanavir. Consider alternative agents. If using, monitor phenytoin levels and adjust as indicated and monitor for virologic response.

Alternative Agents:
Gabapentin Lamotrigine Tiagabine Topiramate

Pimozide
(Orap)(Orap)
--Not studied; may increase pimozide levels-Increased pimozide effects (eg, hypotension, cardiac arrhythmias)Inhibition of CYP450 3A4 by atazanavir

Do not coadminister

Pitavastatin515, 605
(Livalo)
4 mg QD300 mg QD x 5 daysPitavastatin AUC: increased 31%; Cmax: increased 60%No significant changePossibly increased pitavastatin effects-

Start at lowest dose and titrate to effect

Posaconazole501, 424
(Noxafil)
400 mg BID300 mg QD-Atazanavir AUC: increased 268%; Cmax: increased 155%Increased atazanavir effectsInhibition of CYP450 3A4 by posaconazole

Dose adjustment not established; Monitor closely for adverse effects during coadministration

Posaconazole519, 424
(Noxafil)
400 mg BID300 mg QD with 100 mg ritonavir QD-Atazanavir AUC: increased 146%; Cmax: increased 53%Increased atazanavir effectsInhibition of CYP450 3A4 by posaconazole

Dose adjustment not established; Monitor closely for adverse effects during coadministration

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Proguanil487
(Malarone)(Malarone)
100 mg with 250 mg atovaquone x 1300 mg with 100 mg ritonavir QDProguanil AUC: decreased 41%; Cmax: no significant change-Potentially compromised antimalarial activityIncreased atovaquone glucuronidation; induction of CYP450 3A4 by atazanavir/ritonavir

Dose adjustment not established

Rabeprazole240
(Aciphex)
----Decreased atazanavir effectsDecreased GI absorption of atazanavir due to reduced acidity

Do not coadminister PPIs with unboosted atazanavir. PPIs may be administered 12 hours before atazanavir when boosted with ritonavir or cobicistat, in treatment naive patients. Doses should not exceed the equivalent of omeprazole 20 mg daily. PPIs are not recommended for treatment experienced patients.

Alternative Agents:
H2 receptor antagonists

Raltegravir3
(RAL)(Isentress)
100 mg x 1400 mg QDRaltegravir AUC: increased 72%; Cmax: increased 53%; Cmin: increased 95%-Possibly increased raltegravir effects-

No dose adjustment necessary

Raltegravir3
(RAL)(Isentress)
400 mg BID300 mg with 100 mg ritonavir QDRaltegravir AUC: increased 41%; Cmax: increased 24%; Cmin: increased 77%-Possibly increased raltegravir effects-

No dose adjustment necessary

Raltegravir461
(RAL)(Isentress)
400 mg BID300 mg BIDRAL AUC: no significant change---

Dose adjustment not established

Raltegravir428
(RAL)(Isentress)
400 mg BID on days 1-5 and days 13-26300 mg BID on days 6-12 and days 13-26Raltegravir AUC: increased 54%; Cmin: increased 48%; Cmax: increased 39%Atazanavir AUC: decreased 17%; Cmin: decreased 29% (compared to atazanavir BID)Possibly increased raltegravir effects-

Dose adjustment not established

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Ranitidine240
(Zantac)
----May decrease atazanavir effectsPossible decreased GI absorption

Unboosted atazanavir 400 mg: give atazanavir 2 hrs before or 10 hours after H2-blocker. Single doses of H2-blockers should not exceed 20 mg of famotidine (or equivalent). Additionally, if treatment naive, total daily dose of H2 blocker should not exceed 40 mg of famotidine (or equivalent). Atazanavir 300 mg boosted with ritonavir or cobicistat: Give boosted atazanavir at same time as H2 blocker or 10 hours or more after. Total doses of H2 blocker should not exceed the equivalent of 40 mg BID famotidine (treatment naive) or 20 mg BID for (treatment experienced patients). If using tenofovir disoproxil fumarate, atazanavir, and H2 blocker in treatment experienced patient, increase atazanavir dose to 400 mg in addition to boosting with ritonavir or cobicistat.

Ranolazine709
(Ranexa)
--Not studied; may increase ranolazine levelsNot studied; may increase atazanavir levelsPotential increased ranolazine adverse effects (e.g. prolonged QT, cardiac arrythmias).-

Do not coadminister

Rifabutin341
(Mycobutin)
150 mg QD on days 15-28400 mg QD on days 1-14, 400 mg QD with ritonavir 100 mg QD on days 15-28Not studiedAtazanavir AUC: increased 191%; Cmax: increased 81%Increased atazanavir effects-

Reduce rifabutin dose to 150 mg daily or 300 mg 3x/week. Monitor for antimicrobial activity and/or consider therapeutic drug monitoring.

Rifabutin341
(Mycobutin)
150 mg QD on days 15-28400 mg QD on days 1-28Not studiedAtazanavir Cmax: increased 34%--

Reduce rifabutin dose to 150 mg daily or 300 mg 3x/week. Monitor for antimicrobial activity and/or consider therapeutic drug monitoring.

Rifabutin
(Mycobutin)
300 mg QD on days 1-10, then 150 mg QD on days 11-20600 mg QD on days 11-20Rifabutin AUC: increased 110%; Cmax: increased 118%; Cmin: increased 243%; 25-O-desacetylrifabutin AUC: increased 2101%; Cmax: increased 720%; Cmin: increased 7460%Not studiedIncreased rifabutin effects (eg, uveitis)Inhibition of CYP450 3A4 by atazanavir

Reduce rifabutin dose to 150 mg daily or 300 mg 3x/week. Monitor for antimicrobial activity and/or consider therapeutic drug monitoring.

Rifampin
(Rifampicin)(Rifadin)
----Decreased atazanavir effectsInduction of CYP450 3A4 by rifampin

Do not coadminister

Alternative Agents:
Rifabutin

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Rifampin727
(Rifampicin)(Rifadin)
600 mg QD x 10 d300 mg with ritonavir 100 mg QD x 21 d-Atazanavir AUC: decreased 72%; Cmax: decreased 53%; Cmin: decreased 98%Decreased atazanavir effectsInduction of CYP450 3A4 by rifampin

Do not coadminister

Alternative Agents:
Rifabutin

Rifampin247
(Rifampicin)(Rifadin)
600 mg QD x 10 d300 mg with ritonavir 100 mg QD x 10 d-Atazanavir AUC: decreased 57%; Cmax: decreased 56%; Cmin: decreased 93%(compared to atazanavir 400 mg QD)Decreased atazanavir effectsInduction of CYP450 3A4 by rifampin

Do not coadminister; consider rifabutin

Rifampin247
(Rifampicin)(Rifadin)
600 mg QD x 10 d400 mg with ritonavir 200 mg QD x 10 d-Atazanavir AUC: no significant change; Cmax: decreased 18%; Cmin: decreased 40%(compared to atazanavir 400 mg QD)Decreased atazanavir effectsInduction of CYP450 3A4 by rifampin

Do not coadminister; consider rifabutin

Rifampin247
(Rifampicin)(Rifadin)
600 mg QD x 10 d300 mg with ritonavir 200 mg QD x 10 d-Atazanavir AUC: decreased 31%; Cmax: decreased 40%; Cmin: decreased 80%(compared to atazanavir 400 mg QD)Decreased atazanavir effectsInduction of CYP450 3A4 by rifampin

Do not coadminister; consider rifabutin

Ritonavir99,
(RTV)(Norvir)
100 mg QD on days 11-20300 mg QD on days 1-20Not studiedAtazanavir AUC: increased 238%; Cmax: increased 86%; Cmin: increased 1089%Increased atazanavir effectsInhibition of CYP450 3A4 by ritonavir

Dose adjustment not established

Rivaroxaban727
(Xarelto)
--Not studied; may increase rivaroxaban levels-Potential for increased risk of bleedingInhibition of rivaroxaban metabolism via CYP3A4

Avoid concomitant use; consider alternative anticoagulant

Alternative Agents:
dabigatran

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Rosiglitazone
(Avandia)
4 mg x 1400 mg QDRosiglitazone AUC: increased 35%- Possibly increased rosiglitazone effects-

-

Rosiglitazone
(Avandia)
4 mg x 1300 mg QD with 100 mg ritonavir QDRosiglitazone AUC: decreased 17%---

-

Rosuvastatin411
(Crestor)
10 mg QD300 mg atazanavir QD with ritonavir 100 mg QDRosuvastatin AUC: increased 213%; Cmax: increased 600%-Increased rosuvastatin effectsPossibly atazanavir induced increase in rosuvastatin bioavailability

Initiate lowest dose and titrate carefully. Do not exceed 10mg rosuvastatin daily.

Alternative Agents:
Pravastatin, atorvastatin

Saquinavir162
(SQV)(Fortovase, Invirase)
1000 mg BID with ritonavir 100 mg BID200 mg BID with saquinavir 1500 mg BIDSaquinavir AUC: decreased 53%; Cmax: decreased 78%; Cmin: decreased 69% (when SQV/ATV BID compared to SQV/RTV BID)Not studiedDecreased saquinavir levels (when compared to SQV 100 mg with RTV 100 mg BID)Possible induction of P450 by atazanavir

Do not coadminister

Saquinavir
(SQV)(Fortovase, Invirase)
1200 mg (soft gel caps) QD on days 1-13400 mg QD on days 7-13Saquinavir AUC: increased 449%; Cmax: increased 339%; Cmin: increased 586%Not studiedIncreased saquinavir effectsInhibition of CYP450 3A4 by atazanavir

Dose adjustment not established

Saquinavir137
(SQV)(Fortovase, Invirase)
1600 mg QD with ritonavir 100 mg QD x 30 days300 mg QD x 30 daysSaquinavir AUC: increased 61%; Cmax: increased 42%; Cmin: increased 112%;Ritonavir AUC: increased 41%; Cmax: increased 58%; Cmin: decreased 27%Not studiedIncreased saquinavir effectsInhibition of CYP450 3A4 by atazanavir and ritonavir

Dose adjustment not established

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Saquinavir122
(SQV)(Fortovase, Invirase)
800 mg, 1200 mg, 1600 mg QD400 mg x 7 daysSaquinavir AUC: increased 440-610%; Cmin: increased 560-1660%No significant changeIncreased saquinavir effectsInhibition of CYP450 3A4 by atazanavir

Dose adjustment not established

Sildenafil739, 727
(Viagra)
----Potentially increased sildenafil effects (eg, hypotension, priapism)-

For erectile dysfunction, initiate sildenafil 25 mg every 48 hours and monitor for adverse effects. Manufacturer recommends not to exceed dose of 25 mg every 48 hours. Do not coadminister if using sildenafil for pulmonary arterial hypertension.

Simeprevir727
(Olysio)
-----Inhibition of CYP3A4 potentiating simeprevir effects

Do not coadminister

Simvastatin
(Zocor)(Zocor)
--Not studied; may increase simvastatin levels- Increased simvastatin effects (eg, myopathy, rhabdomyolysis)Inhibition of CYP450 3A4 by atazanavir

Do not coadminister

Alternative Agents:
Atorvastatin (low dose); Pravastatin

Sofosbuvir/velpatasvir751
(Epclusa)
400 mg /100 mg300 mg with ritonavir 100 mg dailySofosbuvir AUC increased 22%. Velpatasvir Cmax increased 55%; AUC increased 142%; Cmin increased 301% Atazanavir Cmax increased 9%; AUC increased 20%; Cmin increased 39%.--

No dose adjustment necessary

St. John's Wort
(Hypericum perforatum, hypericin, hyperforin)
---Not studied; may decrease atazanavir levelsDecreased atazanavir effectsInduction of CYP450 3A4 by St. John's Wort

Do not coadminister

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Stavudine122
(d4T)(Zerit)
also dosed with didanosine400 mg x 1Not studiedAtazanavir AUC: decreased 87%; Cmax: decreased 89%Decreased atazanavir effects-

Dose adjustment not established

Tadalafil727
-- Not studied; potentially increased tadalafil effects (e.g. hypotension, priapism)---

Initiate tadalafil at 5 mg QD; adjust dose as indicated; not recommended to exceed 10 mg in 72 hour period

Telaprevir571
(Incivek)
750 mg Q8H300 mg atazanavir QD with 100 mg ritonavir QDTelaprevir AUC: decreased 20%; Cmin: decreased 15%; Cmax: decreased 21%Atazanavir AUC: increased 17%; Cmin: increased 85%; Cmax: decreased 15%--

No dose adjustment necessary; monitor for telaprevir effectiveness and for toxicity of atazanavir.

Tenofovir disoproxil fumarate148
(TDF)(Viread)
300 mg QD300 mg QD with ritonavir 100 mg QD-Atazanavir AUC: no significant change; Cmax: no significant change; Cmin: decreased 21% (compared to atazanavir 300 QD with ritonavir 100 mg QD)Ritonavir AUC: increased 20%; Cmax: no signficant change; Cmin: no significant change-Unknown

No dose adjustment necessary

Tenofovir disoproxil fumarate8, 9, 10
(TDF)(Viread)
300 mg QD on days 15-42300 mg QD with ritonavir 100 mg QD on days 1-42Not studiedAtazanavir Cmax: decreased 28%; AUC: decreased 25%; Cmin: decreased 26%; Ritonavir Cmax: decreased 28%; AUC: decreased 25%; Cmin: no significant changeDecreeased atazanavir effects; possibly increased tenofovir effects-

Do not coadminister with unboosted atazanavir (400 mg); Administer 300 mg atazanavir with 100 mg ritonavir when used as part of a tenofovir containing regimen

Tenofovir disoproxil fumarate9, 123, 124,
(TDF)(Viread)
300 mg QD with a light meal400 mg QD with a light mealTenofovir AUC: increased 25%; Cmax: no significant changeAtazanavir AUC: decreased 26%; Cmax: decreased 24%; Cmin: decreased 40%Decreased atazanavir effects; increased tenofovir effectsUnknown

Do not coadminister with unboosted atazanavir (400 mg); Administer 300 mg atazanavir with 100 mg ritonavir when used as part of a tenofovir containing regimen

Coadministered DrugDose of DrugDose of AtazanavirEffect on Drug LevelsEffect on Atazanavir LevelsPotential Clinical EffectsMechanism of InteractionManagement
Tenofovir disoproxil fumarate155
(TDF)(Viread)
300 mg QD x 10 d400 mg QD with 100 mg ritonavir QD x 10 dTenofovir AUC: increased 55%; Cmax: increased 39%; Cmin: increased 70%Atazanavir AUC: increased 38%; Cmax: increased 31%; Cmin: increased 33%Increased atazanavir and tenofovir effects-

Do not coadminister

Tenofovir disoproxil fumarate155
(TDF)(Viread)
300 mg QD x 10 d, separated 12 hours away from atazanavir/ritonavir300 mg QD with 100 mg ritonavir QD x 10 dTenofovir AUC: increased 37%; Cmax: increased 34%; Cmin: increased 29%Atazanavir Cmin: decreased 20%Increased tenofovir effects-

Coadminister atazanavir/ritonavir together with tenofovir

Ticagrelor727
(Brilinta)
-- Not studied; may increase effects of ticagrelor- Potential for increased risk of bleeding Inhibition of ticagrelor metabolism via CYP3A4

Avoid concomitant use; consider alternative antiplatelet agent

Tipranavir154
(TPV)(Aptivus)
500 mg with 100 mg ritonavir BID300 mg QD with 100 mg ritonavir QDTipranavir AUC: increased 20%; Cmin: increased 75%Atazanavir AUC: decreased 68%; Cmax: decreased 57%; Cmin: decreased 81%Decreased atazanavir effectsInduction of CYP450 3A4 by tipranavir

Do not coadminister

Triazolam
(Halcion)
--Not studied; may increase triazolam levels-Increased triazolam effects (eg, increased sedation, confusion, respiratory depression)Inhibition of CYP450 3A4 by atazanavir

Do not coadminister; consider alternative agents

Alternative Agents:
Lorazepam; Oxazepam; Temazepam; Trazodone

Vorapaxar727
(Zontivity)
-- Not studied; may increase effects of vorapaxar- Potential for increased risk of bleeding Inhibition of vorapaxar metabolism via CYP3A4

Avoid concomitant use; consider alternative antiplatelet agent

Voriconazole727, 515
(VFend)
200 mg PO Q12H-Voriconazole AUC: decreased 39% when given with ritonavir 100 mg BID-Decreased voriconazole effectsPossible induction of CYP450 by ritonavir

With unboosted atazanavir no dose adjustment necessary; monitor for toxicity. Do not coadminister with boosted protease inhibitors unless benefit outweighs risks. If coadministering, consider therapeutic drug monitoring.

Zidovudine106,
(AZT, ZDV)(Retrovir)
300 mg BID with lamivudine 150 mg BID x 6 days400 mg QD x 6 daysNo significant changeNot studied--

No dose adjustment necessary

"-" indicates that there are no data available
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 9:Data on file. Bristol-Myers Squibb Company. Princeton, NJ.
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