Formulary
Atazanavir: Indications, Dosing, Side Effects and Interactions
Atazanavir clinical drug profile including indications, dosing, side effects, cautions and interactions.
MedNext Academy | 4 min read
Atazanavir: Indications, Dosing, Side Effects and Interactions
Atazanavir clinical drug profile including indications, dosing, side effects, cautions and interactions.
Indications and dose
**HIV infection, in combination with other antiretroviral drugs-with low-dose ritonavir (initiated by a specialist)**
- **Adult** (By Mouth): 300 mg once daily.
**HIV infection, in combination with other antiretroviral drugs-with cobicistat (initiated by a specialist)**
- **Adult** (By Mouth): 300 mg once daily.
**HIV infection, in combination with other antiretroviral drugs-with low-dose ritonavir (initiated by a specialist) for atazanavir**
- **Child 6-17 years (body-weight 15-34 kg)** (By mouth): 200 mg once daily.
- **Child 6-17 years (body-weight 35 kg and above)** (By mouth): 300 mg once daily.
**HIV infection, in combination with other antiretroviral drugs-with cobicistat (initiated by a specialist) for atazanavir**
- **Child 12-17 years (body-weight 35 kg and above)** (By mouth): 300 mg once daily.
Cautions
For all protease inhibitors Haemophilia (increased risk of bleeding) Cautions For atazanavir Cardiac conduction disorders; electrolyte disturbances; predisposition to QT interval prolongation
Contraindications
For all protease inhibitors Acute porphyrias
Side effects
For all protease inhibitors Common or very common Angioedema; anxiety; appetite abnormal; arthralgia; asthenia; diabetes mellitus; diarrhoea; dizziness; dyslipidaemia; fever; gastrointestinal discomfort; gastrointestinal disorders; headache; hepatic disorders; hypersensitivity; hypertension; myalgia; nausea; oral ulceration; pancreatitis; peripheral neuropathy; seizure; skin reactions; sleep disorders; syncope; taste altered; urinary frequency increased; vomiting Uncommon Alopecia; dry mouth; immune reconstitution inflammatory syndrome; myocardial infarction; osteonecrosis; weight increased Rare or very rare Stevens-Johnson syndrome Side-effects For atazanavir Uncommon Chest pain; chronic kidney disease; depression; disorientation; drowsiness; drug reaction with eosinophilia and systemic symptoms (DRESS); dyspnoea; gallbladder disorders; gynaecomastia; haematuria; malaise; memory loss; myopathy; nephritis tubulointerstitial; nephrolithiasis; proteinuria; torsade de pointes Rare or very rare Gait abnormal; oedema; palpitations; QT interval prolongation; renal pain; vasodilation Side-effects, further information Mild to moderate rash occurs commonly, usually within the first 3 weeks of therapy. Severe rash occurs less frequently and may be accompanied by systemic symptoms. Discontinue if severe rash develops.
Interactions
**Severe interactions:**
- Effects of lansoprazole on other medicinal products Medicinal products with pH dependent absorption Lansoprazole may interfere with the absorption of other medicinal products where gastric pH is an...
- Inhibitors of UGT1A1 Co-administration of atazanavir with raltegravir 1,200 mg once daily significantly increased plasma levels of raltegravir; therefore, co-administration of raltegravir 1,200 mg...
- HIV protease inhibitors Co-administration of pantoprazole is not recommended with HIV protease inhibitors for which absorption is dependent on acidic intragastric pH such as atazanavir due to...
- Co-administration of bictegravir with medicinal products that potently inhibit both CYP3A and UGT1A1, such as atazanavir, may significantly increase plasma concentrations of bictegravir, therefore...
- Possible toxicity with phenytoin on stopping primidone); stiripentol, tiagabine, valproic acid, zonisamide.
- Atazanavir/ Ritonavir 48% in AUC, 149% Cmax of rifabutin.
**Other interactions (57):**
- Nelfinavir, atazanavir The plasma levels of nelfinavir and atazanavir are decreased in case of co-administration with omeprazole.
- Concomitant administration of omeprazole with atazanavir is not recommended (see section 4.4).
- Concomitant administration of omeprazole (40 mg once daily) and atazanavir 300 mg/ritonavir 100 mg to healthy volunteers resulted in a 75 % decrease of the atazanavir exposure.
- Increasing the atazanavir dose to 400 mg did not compensate for the impact of omeprazole on atazanavir exposure.
- The co-administration of omeprazole (20 mg once daily) with atazanavir 400 mg/ritonavir 100 mg to healthy volunteers resulted in a decrease of approximately 30 % in the atazanavir exposure as...
- Table 1 Pharmacokinetic Interaction Data Medicinal products by therapeutic area Interaction (mechanism, if known) Recommendations concerning co-administration ANTI-RETROVIRAL Protease inhibitors...
Pregnancy
Theoretical risk of hyperbilirubinaemia in neonate if used at term. M For use with cobicistat, see atazanavir with cobicistat . Monitoring in pregnancy In pregnancy, monitor viral load and plasma-atazanavir concentration during second and third trimesters. Postpartum patients should be closely monitored for adverse reactions. M
Hepatic impairment
For all protease inhibitors In general, manufacturers advise use with caution in patients with chronic hepatitis B or C (increased risk of hepatic side-effects). Hepatic impairment For atazanavir Manufacturer advises caution in mild impairment; avoid in moderate to severe impairment (no information available).
Renal impairment
Avoid in patients undergoing haemodialysis (limited information available). M
Medicinal forms
Clinical governance
**Author:** MedNext Clinical Team. **Clinical reviewer:** Dr Shameer Deen, MBBS, MS, MRCS. **Sources:** BNF, Indian Pharmacopoeia, CIMS India. **Correction:** Report errors at support@mednext.academy.
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