Atazanavir interaction

NA /D, abd pain, bleeding, fevCT, T QT Interactions t Effects W7 atazanavir, clarithromycin, CT5rthromycin, indinavir, itraconazole, ketoconazole, nefazodone, nelfi-navir, ritonavir, saquinavir, telithromycin X effects W7 antacids, carbamazqjine, dexamethasone, phenobarbital, phenytoin, rifampicin, St. John s wort EMS Drug contains lactose, may cause D/abd discomfort in pts w/ lactose intolerance OD Sxs unknown symptomatic and supportive... 

As an inhibitor of CYP3A4 and CYP2C9, the potential for drug-drug interactions with atazanavir is great (Tables 49-3 and 49-4). Atazanavir AUC is reduced by 76% when combined with omeprazole thus, the combination is to be avoided. In addition, co-administration of atazanavir with other drugs that inhibit UGT1A1, such as indinavir and irinotecan, is contraindicated because of enhanced toxicity. Tenofovir and efavirenz should not be -administered with atazanavir unless ritonavir is added to boost levels. 

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... 

Subsequently, studies have shown that M3 can be administered successfully in a tablet form rather than by an oral solution. Also, two drug interaction clinical trials of M3, in combination with the approved HIV drugs ritonavir and atazanavir. 

Clinically important, potentially hazardous interactions with amisulpride, amprenavir, atazanavir, celiprolol, ciprofloxacin, enoxacin, epirubicin, fosamprenavir, gatifloxacin, lomefloxacin, lopinavir, mistletoe, moxifloxacin, nilotinib, norfloxacin, ofloxacin, quinolones, ritonavir, sparfloxacin, tipranavir... 

Clinically important, potentially hazardous interactions with atazanavir, chlorpromazine, cimetidine, co-trimoxazole, degarelix, fluphenazine, ketoconazole, medroxyprogesterone, megestrol, mesoridazine, phenothiazines, prochlorperazine, progestins, promethazine, ranolazine, thioridazine, trifluoperazine, trimethoprim, verapamil, zuclopenthixol... 

Clinically important, potentially hazardous interactions with atazanavir, carbamazepine, clarithromycin, itraconazole, ketoconazole, nefazodone, nelfinavir, phenobarbital, phenytoin, rifabutin, rifampin, rifapentine, ritonavir, saquinavir, St John s wort, troleandomycin, voriconazole, warfarin... 

Clinically important, potentially hazardous interactions with atazanavir, fosamprenavir, NNRTIs, ritonavir, tipranavir... 

Clinically important, potentially hazardous interactions with alprazolam, astemizole, atazanavir, chlordiazepoxide, clonazepam, clorazepate, conivaptan, dasatinib, delavirdine, diazepam, dihydroergotamine, ergot alkaloids, estazolam, fentanyl, fesoterodine, flurazepam, halazepam, ixabepilone, lapatinib, methysergide, midazolam, pimozide, quazepam, rifapentine, sildenafil, solifenacin, St John s wort, temsirolimus, triazolam, vardenafil... 

Clinically important, potentially hazardous interactions with atazanavir, azithromycin, bosentan, cholestyramine, clarithromycin, cyclosporine, darunavir, delavirdine, erythromycin, exenatide, fenofibrate, fosamprenavir, gemfibrozil, grapefruit juice, imatinib, itraconazole, red rice yeast, tacrolimus, telithromycin, tipranavir, tolvaptan, verapamil... 

Clinically important, potentially hazardous interactions with atazanavir... 

Clinically important, potentially hazardous interactions with amiodarone, amprenavir, anisindione, antacids, anticoagulants, aprepitant, atazanavir, atovaquone, beclomethasone, buprenorphine, corticosteroids, cortisone, cyclosporine, cyproterone, dabigatran, dapsone, darunavir, delavirdine, dexamethasone, dicumarol, digoxin, eszopiclone, flunisolide, fosamprenavir, gadoxetate, gestrinone, halothane, imatinib, isoniazid, itraconazole, ketoconazole, lapatinib, lorcainide, methylprednisolone, midazolam, nelfinavir, nifedipine, oral contraceptives, phenylbutazone, prednisone, protease inhibitors, pyrazinamide, ramelteon, ritonavir, saquinavir, solifenacin, sunitinib, tacrolimus, telithromycin, temsirolimus, tipranavir, tolvaptan, trabectedin, triamcinolone, triazolam, voriconazole, warfarin, zaleplon... 

Clinically important, potentially hazardous interactions with alfentanil, alfuzosin, alprazolam, amiodarone, amprenavir, aprepitant, astemizole, atazanavir, bepridil, buprenorphine, bupropion, carbamazepine, chlordiazepoxide, ciclesonide, clozapine, conivaptan, cyclosporine, cyproterone, dasatinib, diazepam, dihydroergotamine, ergot alkaloids, estazolam, eszopidone, etravirine, ezetimibe, fentanyl, fesoterodine, flecainide, flurazepam, fluticasone, halazepam, ivabradine, ixabepilone, ketoconazole, lapatinib, levothyroxine, meperidine, meptazinol, methysergide, midazolam, nifedipine, nilotinib, oral contraceptives, phenytoin, pimozide, piroxicam, propafenone, propoxyphene, quazepam, quinidine, ranolazine, rifabutin, rifampin, rifapentine, rimonabant, rivaroxaban, saquinavir, sildenafil, silodosin, simvastatin, solifenacin, St John s wort, tadalafil, temsirolimus, trabectedin, triazolam, vardenafil, voriconazole, zolpidem... 

Clinically important, potentially hazardous interactions with amprenavir, amyl nitrite, atazanavir, delavirdine, erythromycin, fosamprenavir, indinavir, isosorbide dinitrate, isosorbide mononitrate, itraconazole, ketoconazole, nelfinavir, nitrates, nitroglycerin, ritonavir, saquinavir... 

Fig. 15 Experimental (grayscale traces) and modeled sensorgrams (solid black lines) for the interaction between HIV 1 protease inhibitors (in twofold serial dilutions) at 25 °C. The modeled sensorgrams were based on the kinetic parameters obtained from global analysis of the experimental data using a 1 1 binding model accounting for mass transport. a Amprenavir (1.6-400 nM) b Indinavir (1.6-400 nM) c Lopinavir (0.4-50 nM) d Nelfinavir (3.2-200nM) e Ritonavir (1.6-400 nM) f Saquinavir (1.6-200nM) and g Atazanavir (0.4-200 nM). Reproduced from [11] with permission from John Wiley and Sons 2004...

Although tenofovir is not known to induce CYPs, it has been reported to reduce the atazanavir AUC by approximately 26%. In addition, low-dose ritonavir (100 mg twice daily) increases the tenofovir AUC by 34%, and atazanavir increases the tenofovir AUC by 25%. The mechanism of these interactions is unknown. 

Bruce RD, Altice FL. Three case reports of a clinical pharmacokinetic interaction with buprenorphine and atazanavir plus ritonavir. AIDS (2006) 20, 783-4. 

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