Atazanavir adverse effects

Sunirinib (Sutent) [Kinase Inhibitor] Uses Advanced GI stromal tumor refractory/intolerant of imatinib advanced RCC Action Kinase inhibitor Dose Adults. 50 mg PO daily x 4 wk, followed by 2 wk holiday = 1 cycle 4- to 37.5 mg w/ CYP3A4 inhibitors (Table VI-8), to T 87.5 mg w/ CYP3A4 inducers Contra w/ atazanavir Caution [D, -] Multiple interactions require dose modification (eg, St. John s wort) Disp Caps SE -l WBC pit, bleeding, T BP, -l ejection fraction, T QT interval, pancreatitis, DVT, Sz, adrenal insuff, N/V/D, skin discoloration, oral ulcers, taste perversion, hypothyroidism Interactions Multiple interactions require dose modification (eg, St. John s wort) EMS Monitor ECG for T QT interval grapefruit juice may T adverse effects may affect potassium level (hypo-/hyperkalemia) monitor for S/Sxs of heart failure drug can 4- ejection fraction OD May cause abd pain, muscle weakness, and chills symptomatic and supportive... 

The adverse effects of atazanavir include fever, jaundice/scleral icterus, myalgia and diarrhea. Its coadministration is not recommended with the drugs that induce cytochrome P-450 isoenzyme CYP3A4. Ritonavir increases plasma concentrations of atazanavir. It is an inhibitor of isoenzymes CYP3A4, CYP2C8 and UGT1A1. The coadministration of atazanavir with calcium channel blockers, HMG-CoA reductase inhibitors, immunosuppressants and phosphodiesterase 5 inhibitors should be carefully monitored. 

Lipid abnormalities are a major adverse effect of HIV protease inhibitors (160). In a 48-week comparison with nelfinavir, atazanavir did not significantly increase total cholesterol, fasting LDL cholesterol or triglyceride concentrations (+6.8%, -7.1%, +1.5% respectively), while the respective concentrations rose by 28%, 31%, and 42% in those who took nelfinavir. The incidence of grade 1—4 lipodystrophy was infrequent in both groups, but this endpoint was poorly defined in this study. 

AMITRIPTYLINE PROTEASE INHIBITORS t adverse effects when amitriptyline is co-administered with ritonavir (with or without lopinavir) and possibly atazanavir Inhibition of CYP3A4-mediated metabolism. Note that SSRIs are metabolized by a number of enzymes, including CYP2C9, CYP2C19, CYP2D6 as well as CYP3A4 therefore the effect of protease inhibitors is variable Monitor closely... 

AMOXAPINE, CLOMIPRAMINE, DOXEPIN, IMIPRAMINE, NORTRIPTYLINE, TRIMIPRAMINE PROTEASE INHIBITORS Possibly t adverse effects of amoxapine with atazanavir and ritonavir Inhibition of CYP3A4-mediated metabolism of amoxapine, clomipramine and doxepin inhibition of CYP3A4-, CYP2D6-and CYP2C9-mediated metabolism of imipramine inhibition of CYP2D6-mediated metabolism of nortriptyline and trimipramine Monitor closely... 

CLARITHROMYCIN, ERYTHROMYCIN PROTEASE INHIBITORS Possibly t adverse effects of macrolide with atazanavir, ritonavir (with or without lopinavir) and saquinavir Inhibition of CYP3A4- and possibly CYP1 A2-mediated metabolism. Altered transport via P-gp may be involved. Amprenavir and indinavir are also possibly t by erythromycin Consider alternatives unless there is Mycobacterium avium intracellulare infection if combined, 1 dose by 50% (75% in the presence of renal failure with a creatinine clearance of <30mL/min)... 

RIFABUTIN PROTEASE INHIBITORS t efficacy and t adverse effects of rifabutin Inhibition of CYP3A4-mediated metabolism. Nelfinavir also competitively inhibits 2C19 1 rifabutin dose by at least 50% when given with amprenavir, indinavir or nelfinavir, and by 75% with atazanavir, ritonavir (with or without lopinavir) or tipranavir... 

PROTEASE INHIBITORS ANTIHISTAMINES-ASTEMIZOLE, CHLORPHENAMINE, TERFENADINE Possibly t adverse effects with amprenavir, atazanavir, indinavir, ritonavir (with or without lopinavir), saquinavir and tipranavir Inhibition of CYP3A4-mediated metabolism of astemizole the risk is greatest in patients who are slow CYP2D6 metabolizers because chlorphenamine and terfenadine are also metabolized by this route Avoid co-administration... 

ATAZANAVIR INDINAVIR t efficacy and t adverse effects of indinavir t adverse effects of atazanavir, e.g. hyperbilirubinaemia t bioavailability. Inhibition of metabolism via CYP3A4 by atazanavir inhibition of UDGPT by indinavir Avoid co-administration... 

ATAZANAVIR SAQUINAVIR t efficacy and t adverse effects of saquinavir Inhibition of CYP3A4-mediated metabolism of saquinavir Monitor more closely... 

PROTEASE INHIBITORS PROGESTOGENS -NORETHISTERONE t adverse effects with amprenavir and atazanavir. Possibly 1 efficacy and risk of contraceptive failure with nelfinavir and ritonavir (with or without lopinavir) Uncertain Advise patients to use additional contraception for the period of intake and for 1 month after stopping coadministration with these drugs. Barrier methods are necessary to prevent transmission of infection from patients with HIV. Watch for early features of toxicity of amprenavir and atazanavir, and adjust the dose accordingly... 

NORETHISTERONE ANTIVIRALS - PROTEASE INHIBITORS t adverse effects with amprenavir and atazanavir Uncertain Watch for early features of toxicity of amprenavir and atazanavir, and adjust the dose accordingly... 

Rifampicin (rifampin) bioavaiiabiiity is increased by indinavir, but amprenavir has no effect. Rifampicin markedly reduces the bioavailability of amprenavir, atazanavir/ritonavir, indinavir, indinavir with ritonavir, iopinavir/ritonavir, nelfinavir and saquinavir, but oniy modestiy reduces that of ritonavir. The effects of rifampicin on iopinavir/ritonavir and saquinavir/ritona-vir can be overcome by increasing the protease inhibitor dose, but this appears to increase adverse effects (hepatotoxicity). 

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