Microsoft word - table 19

Table 19 - Drug Interactions with Atazanavir (ATV, Reyataz) #
Interaction
Recommendations
drug levels can cause cardiac arrhythmias, sedation, life- rifabutin levels and potential toxicity. rifabutin to 150 mg every day or 300 mg 3 times per week. Monitor for rifabutin efficacy; consider rifabutin monitoring. Coadministration of unboosted ATV with bosentan is not If on ATV/r >10 days, start bosentan at 62.5 mg once daily or every other day. If starting ATV/r: Stop bosentan ≥36 hours before starting ATV/r. After 10 days of ATV/r, restart bosentan as above. cisapride levels and potential cardiac arrhythmia. Contraindicated with all PIs. Consider metoclopramide. Avoid coadministration if renal or liver dysfunction. Acute Gout: 0.6 mg (1 tablet) x 1 dose, followed by 0.3 mg (half tablet) 1 hour later. Dose to be repeated no earlier than 3 days. Gout prophylaxis: 0.3 mg colchicine once daily or every other day. Treatment of familial Mediterranean fever (FMF): see package insert. dihydroergotamine, ergotamine, ergonovine, methylergonovine Antidepressants: TCA and trazodone levels and drug toxicity. Use lowest dose of trazodone and TCAs, monitor for drug toxicity. Oral midazolam and triazolam contraindicated with all PIs. Cautious use of single dose parenteral midazolam under close Consider oxazepam, temazepam, or lorazepam. amiodarone, bepridil, digoxin, lidocaine Use cautiously and monitor levels for toxicity. Contraindicated. Consider prazosin, terazosin, or doxazosin. Avoid atovaquone AUC 46% and proguanil AUC 41%. Consider alternative drug for malaria prophylaxis. AUC of sildenafil, vardenafil, and tadalafil. Sildenafil contraindicated for pulmonary hypertension. If on ATV or ATV/r X 1 week start tadalafil 20 mg once daily up to maximum of 40 mg once daily. Avoid use of tadalafil for 24 hr when starting ATV/r or ATV, then start ATV or ATV/r as above. Agents for erectile dysfunction: Limit sildenafil to 25 mg in 48 hours; tadalafil to 10 mg in 72 hours; vardenafil initially to 2.5 mg in 24 hours and in 72 hours if "boosted" with ritonavir. Monitor for toxicity. simvastatin and lovastatin levels and risk of Coadministration contraindicated with simvastatin and lovastatin. Alternatives include pravastatin, pitavastatin, fluvastatin, low-dose rosuvastatin (10 mg max/daily), or low-dose atorvastatin. pitavastatin pravastatin rosuvastatin simvastatin Tenofovir (Viread) Use only ritonavir boosted atazanavir 300 mg/ritonavir 100 mg daily. If using tenofovir and H2 receptor blockers in ARV experienced
patients, use ATV/r 400 mg/100 mg daily.
Monitor for tenofovir toxicity.
ethinyl estradiol AUC 19% and Cmin 37%; Use oral contraceptives with at least 35 mcg ethinyl estradiol with ritonavir boosted atazanavir or a maximum of 30 mcg ethinyl Naïve persons: administer atazanavir 400 mg daily plus ritonavir
100 mg daily with food with 600 mg efavirenz/day on empty Experienced persons: Do not use efavirenz with atazanavir.
Do not coadminister with nevirapine due to risk of virologic failure and hepatotoxicity. Do not administer with delavirdine. Do not coadminister atazanavir with etravirine. Monitor anticonvulsant and atazanavir levels. Ritonavir boosted in other anticonvulsant levels. atazanavir preferred. Consider alternative anticonvulsants (levetiracetam, gabapentin). diltiazem dosage by 50%, monitor EKG for cardiac toxicity. Monitor for CCB toxicity and adjust dose as needed. atazanavir levels with concurrent administration of PPI. Naïve persons: do not exceed 20 mg dose equivalent/day of
omeprazole taken twelve hours before ritonavir boosted atazanavir.
Avoid PPIs in experienced persons or in those on unboosted
atazanavir.
atazanavir levels with concurrent administration of H2 Naïve persons: use ritonavir 100 mg daily plus atazanavir 300 mg
daily given at the same time or >10 hours after maximum of
famotidine 40 mg BID or equivalent.
For unboosted atazanavir 400 mg/daily, give 2 hr before or 10 hr
after a maximum of 20 mg BID famotidine or equivalent.
Experienced persons: use ritonavir 100 mg daily plus atazanavir
300 mg daily given at the same time or >10 hours after maximum of
famotidine 20 mg BID or equivalent.
If coadministered with tenofovir and H2 receptor antagonists,
ritonavir 100 mg daily plus atazanavir 400 mg daily.
atazanavir levels 87% with concurrent administration of Give atazanavir 2 hours before or 1 hour after antacids/buffered atazanavir levels and azole effects with Maximum of 200 mg/day of ketoconazole and itraconazole with ritonavir boosted atazanavir more than unboosted atazanavir/r AUC 146% and unboosted ATV AUC Monitor for atazanavir toxicity with posaconazole. Avoid coadministration of voriconazole with PI unless benefits outweigh risks. Monitor for voriconazole and ATV toxicities. voriconazole levels 39% with ritonavir 100 mg BID. voriconazole and ATV levels. clarithromycin dosage 50%; monitor for QT prolongation/cardiac ATV Cmin 91% with risk of QT prolongation. toxicity. Consider alternative therapy with azithromycin. AUC of oral, inhaled, or nasal steroids and significant. Avoid fluticasone and ritonavir "boosted" atazanavir unless benefit AUC of plasma cortisol causing Cushing's and adrenal Consider alternative steroids (e.g., mometasone). Consider alternative steroid for chronic administration. (e.g., QT prolongation, palpitations, and sinus tachycardia). Consider formoterol. AUC of didanosine by 34% if taken with atazanavir, Administer atazanavir with food 2 hours before or 1 hour after didanosine EC. Administer didanosine EC separately on empty stomach apart from atazanavir. Avoid coadministration of unboosted ATV with buprenorphine. Monitor for increased sedation with ATV/r-consider DRV/r, LPV/r No change in methadone levels with unboosted atazanavir. Methadone dosage change unlikely. Monitor for methadone withdrawal and adjust dose if needed. Use normal doses of ATV/r and telaprevir; Potential for additive hyperbilirubinemia with indinavir. Unclear dosing with other PIs except for darunavir/r and Except for darunavir/ritonavir and lopinavir/ritonavir, do not coadminister atazanavir with other PIs. Administer atazanavir 300 mg daily with standard doses of ritonavir "boosted" darunavir and lopinavir. atovaquone AUC 46% and proguanil AUC 41%. Consider alternative agents for malaria prophylaxis. levels of cyclosporine, tacrolimus, and sirolimus. toxicity of immunosuppressants, monitor levels. AUC = area under the curve.
Cmin = lowest concentration for ARV efficacy
# Table 15 lists absolute contraindications.

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