Infectious Disease Compendium

Atazanavir (Reyataz®)

Dosing

CrCl Formula

For up-to-date information, go to http://hivinsite.ucsf.edu/.

CrCl > 80: 400 mg po qd.

- The recommended dose is 300 mg with ritonavir 100 mg once daily in combination with other antiretrovirals. Atazanavir without ritonavir is not recommended for treatment-experienced patients with prior virologic failure.

- When combined with efavirenz, dose efavirenz 600 mg plus with atazanavir 400 mg plus ritonavir 100 mg; all of these should be given once daily with food. Atazanavir alone without ritonavir is not recommended concurrently with efavirenz.

- When combined with tenofovir, it is recommended that tenofovir 300 mg be given with atazanavir 300 mg plus ritonavir 100 mg; all of these agents should be given once daily with food. Atazanavir alone without ritonavir is not recommended concurrently with tenofovir.

- When combined with didanosine buffered formulations, atazanavir should be taken with food, either two hours before or one hour after a dose of didanosine .

Decrease to 300 mg once daily should be considered for patients with moderate hepatic impairment (Child-Pugh Class B) who have not experienced prior virologic failure. Atazanavir should not be used in patients with severe hepatic impairment (Child-Pugh Class C).

CrCl 80-50:

CrCl 50-10:

CrCl < 10:

Hemodialysis

Peritoneal dialysis:

Important side effects

Birth Defects (PubMed).

Body fat redistribution, lipid abnormalities, lactic acidosis, kidney stones, esp if ritonavir boosted (PubMed).

Atazanavir can cause chemical gallstones (PubMed).

Important drug interactions

Aluminum carbonate, aluminum hydroxide, aluminum phosphate, amiodarone, benzodiazepines, calcium, calcium channel blockers, cannabis, cisapride, clarithromycin, class ia antiarrhythmic agents, cyclosporin, desogestrel, didanosine, dihydroxyaluminum aminoacetate, dihydroxyaluminum sodium carbonate, drospirenone, efavirenz, ergot derivatives, erlotinib, ethinyl estradiol, etonogestrel, fentanyl, garlic, h2 blockers, hmgcoa reductase inhibitors, indinavir, irinotecan, lidocaine, magaldrate, magnesium carbonate, magnesium hydroxide, magnesium oxide, magnesium trisilicate, mestranol, nevirapine, norelgestromin, norethindrone, norgestrel, pimozide, proton pump inhibitors, ribavirin, rifampin, ritonavir, saquinavir, sildenafil, sirolimus, sodium bicarbonate, st john's wort, tacrolimus, tadalafil, tenofovir, tricyclic antidepressants, vardenafil, voriconazole, warfarin. Look them up.

Rants and Screeds

Pearls

Treatment of choice

Use for

HIV.

Don't use for

Class

Protease inhibitors.