Esomeprazole Atazanavir

PROTON PUMP INHIBITORS ATAZANAVIR, NELFINAVIR i plasma levels of atazanavir and nelfinavir with esomeprazole, and t risk of therapeutic failure of the antiviral agent Uncertain possibly due to enzyme induction Avoid co-administration... 

Clinically important, potentially hazardous interactions with amprenavir, aprepitant, atazanavir, carbamazepine, chlorpheniramine, cimetidine, clarithromycin, clorazepate, CNS depressants, darunavir, delavirdine, dexamethasone, efavirenz, erythromycin, esomeprazole, fluconazole, fluoxetine, fosamprenavir, grapefruit juice, griseofulvin, imatinib, indinavir, itraconazole, ivermectin, ketoconazole, lopinavir, nelfinavir, nevirapine, phenobarbital, phenytoin, primidone, rifabutin, rifampin, ritonavir, roxithromycin, saquinavir, St John s wort, telithromycin, tipranavir... 

Proton pump inhibitors (marked effect) and H2-receptor antagonists (modest effect) reduce atazanavir levels. Other drugs that increase gastric pH are also predicted to reduce plasma levels of atazanavir. Fosamprenavir may be similarly affected (moderate effects seen with ranitidine), although antacids and esomeprazole had little effect in one study. Omeprazole decreases indinavir levels and an antacid modestly decreased tipranavir levels. Neither ranitidine nor omeprazole had any effect on darunavir/ritonavir or lopinavir/ritonavir levels. In contrast, cimetidine, ranitidine and omeprazole have been shown to increase saquinavir levels. 

Atazanavir trough levels were significantly lower in patients taking proton pump inhibitors than in those taking H2-receptor antagonists in another studyA 65-year-old HIV-positive man had a marked reduction in atazanavir trough levels and AUC in a 12-hour study while receiving esomeprazole and atazanavir/ritonavir. ... 

Kiser JJ, Lichtenstein Anderson PL, Fletcher CV. Effects of esomeprazole on the pharmacokinetics of atazanavir and fosamprenavir in a patient with human immunodeficiency virus infection. Pharmacodierapy (200Q 26, 511-14. 

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