Atazanavir Dosage

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for HIV Infection

THERAPY-NAIVE PATIENTS:
-Recommended dose: Atazanavir 300 mg plus ritonavir 100 mg orally once a day
-If unable to tolerate ritonavir: 400 mg orally once a day
-If used with efavirenz: Atazanavir 400 mg plus ritonavir 100 mg orally once a day

THERAPY-EXPERIENCED PATIENTS:
-Recommended dose: Atazanavir 300 mg plus ritonavir 100 mg orally once a day
-If used with both an H2-receptor antagonist and tenofovir: Atazanavir 400 mg plus ritonavir 100 mg orally once a day

PREGNANCY:
Therapy-naive and Therapy-experienced Patients:
-Recommended dose: Atazanavir 300 mg plus ritonavir 100 mg orally once a day

Therapy-experienced Patients during the Second or Third Trimester:
-If used with either an H2-receptor antagonist or tenofovir: Atazanavir 400 mg plus ritonavir 100 mg orally once a day
-If used with both an H2-receptor antagonist and tenofovir: Not recommended.

Comments:
-This drug must be used with ritonavir during pregnancy.
-This drug should only be used in pregnant women with HIV-1 strains susceptible to atazanavir.
-No dose adjustment needed for pregnant patients with the above exceptions.
-No dose adjustment needed for postpartum patients; close monitoring for side effects recommended (higher drug exposures possible during first 2 months after delivery).

Use: In combination with other antiretroviral agents, for the treatment of HIV-1 infection

Usual Adult Dose for Nonoccupational Exposure

US CDC recommendations:
-Recommended dose: 400 mg orally once a day
-If used with tenofovir: Atazanavir 300 mg plus ritonavir 100 mg orally once a day

Duration of therapy: 28 days

Comments:
-Recommended as an alternative regimen for nonoccupational postexposure prophylaxis of HIV infection
-This drug should be used with (lamivudine or emtricitabine) plus (zidovudine or stavudine or abacavir or didanosine) or (tenofovir plus ritonavir [100 mg/day]).
-Prophylaxis should be started as soon as possible, within 72 hours of exposure.
-Not approved by US FDA.

Usual Pediatric Dose for HIV Infection

ORAL POWDER:
Therapy-naive and Therapy-experienced Patients:
3 months or older:
10 to less than 15 kg: Atazanavir 200 mg plus ritonavir 80 mg orally once a day
15 to less than 25 kg: Atazanavir 250 mg plus ritonavir 80 mg orally once a day

CAPSULES:
Therapy-naive and Therapy-experienced Patients:
6 to less than 18 years:
15 to less than 20 kg: Atazanavir 150 mg plus ritonavir 100 mg orally once a day
20 to less than 40 kg: Atazanavir 200 mg plus ritonavir 100 mg orally once a day
40 or more: Atazanavir 300 mg plus ritonavir 100 mg orally once a day

Therapy-naive Patients Unable to Tolerate Ritonavir:
13 to less than 18 years:
40 kg or more: 400 mg orally once a day

Comments:
-Each packet of the oral powder contains 50 mg of atazanavir.
-The oral powder should be administered after mixing with food or beverage; ritonavir should be administered immediately after that.
-The oral powder is not recommended for patients weighing less than 10 kg or 25 kg or more.
-The capsules and ritonavir should be administered simultaneously with food.
-The capsules must be used with ritonavir in therapy-experienced patients.
-According to the Panel on Antiretroviral Therapy and Medical Management of HIV-infected Children, some experts recommend increasing atazanavir to 300 mg at a weight of at least 35 kg to avoid underdosing, especially when tenofovir is coadministered.

Use: In combination with other antiretroviral agents, for the treatment of HIV-1 infection

Renal Dose Adjustments

Without hemodialysis: No adjustment recommended.

Liver Dose Adjustments

Therapy-naive Adults:
-Mild liver dysfunction (Child-Pugh A): 400 mg orally once a day
-Moderate liver dysfunction (Child-Pugh B): 300 mg orally once a day
-Severe liver dysfunction (Child-Pugh C): Not recommended.

Patients with Any Degree of Liver Dysfunction: Atazanavir/ritonavir is not recommended.

Dose Adjustments

The manufacturer product information should be consulted regarding coadministration with acid-reducing agents (e.g., H2-receptor antagonists, proton-pump inhibitors) and other antiretroviral drugs (e.g., efavirenz, tenofovir, didanosine).

Precautions

This drug is not recommended for use in patients younger than 3 months due to risk of kernicterus.

Consult WARNINGS section for additional precautions.

Dialysis

End-stage Renal Disease Managed with Hemodialysis:
-Therapy-naive patients: Atazanavir 300 mg plus ritonavir 100 mg orally once a day
-Therapy-experienced patients: Not recommended.

Other Comments

Administration advice:
-Administer the capsules and oral powder with food; use in combination with other antiretroviral drugs.
-Do not open the capsules.
-Do not use the capsule formulation without ritonavir in therapy-experienced patients with previous virologic failure.
-Do not use the oral powder formulation without ritonavir.
-Administer the entire dose of the oral powder (mixed with food or beverage) within 1 hour of preparation; ensure patient eats or drinks all the food or beverage containing the powder; may give more food after the entire mixture has been consumed.
-For infants younger than 6 months who cannot eat solid food or drink from a cup: Use an oral dosing syringe to administer the oral powder mixed with infant formula; do not use an infant bottle as the full dose may not be delivered.
-Dose depends on treatment history of patient and use of concomitant drugs; dose separation may be necessary with H2-receptor antagonists or proton-pump inhibitors; consult the manufacturer product information for further guidance.
-Consult the manufacturer product information regarding missed doses.

Storage requirements:
-Oral powder: Store below 30C (86F) in the original packet (do not open until ready to use); once mixed with food or beverage, may keep at 20C to 30C (68F to 86F) for up to 1 hour before administration.

Reconstitution/preparation techniques:
-The oral powder should preferably be mixed with food such as applesauce or yogurt; may mix with a beverage (milk, infant formula, water) for infants who can drink from a cup; for infants younger than 6 months who cannot eat solid food or drink from a cup, should mix with infant formula.
-The manufacturer product information should be consulted for further guidance preparing the oral powder.

General:
-Use of atazanavir/ritonavir in therapy-experienced patients should be guided by the number of baseline primary protease inhibitor resistance substitutions.
-Use with ritonavir doses greater than 100 mg per day is not recommended (higher doses may alter the safety of this drug); the manufacturer product information for ritonavir should be consulted.

Monitoring:
-Cardiovascular: ECG in patients with preexisting conduction disorders
-General: For side effects in postpartum patients (at least first 2 months after delivery)
-Hematologic: For bleeding in hemophiliacs
-Hepatic: Hepatic laboratory tests in patients with HBV, HCV, or marked transaminase elevations at baseline (before starting and during therapy); for severe hyperbilirubinemia in all infants (first few days of life)

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