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Atazanavir Disease Interactions

There are 6 disease interactions with atazanavir:

Major

Atazanavir (Includes Atazanavir) ↔ Heart Block

Severe Potential Hazard, Moderate plausibility

Applies to: Heart Block, Abnormal Electrocardiogram

Atazanavir may prolong the PR interval of the electrocardiogram in some patients. In one study, the mean maximum change in PR interval from baseline was 24 msec following a 400 mg oral dose of atazanavir versus 13 msec following placebo dosing. In studies of healthy volunteers and HIV patients, abnormalities in atrioventricular (AV) conduction were asymptomatic and limited to first-degree AV block. Rarely, second-degree AV block and other conduction abnormalities have occurred in overdose. Due to limited clinical experience, therapy with atazanavir should be administered cautiously in patients with preexisting conduction abnormalities (e.g., marked first-degree AV block or second- or third-degree AV block).

References

  1. "Product Information. Reyataz (atazanavir)." Bristol-Myers Squibb, Princeton, NJ.
Major

Atazanavir (Includes Atazanavir) ↔ Nephrolithiasis

Severe Potential Hazard, Moderate plausibility

Applies to: Dehydration, Nephrolithiasis, History - Nephrolithiasis, Renal Dysfunction, Liver Disease

Cases of nephrolithiasis, some of which resulted in acute interstitial nephritis, renal failure, and/or hospitalization, have been reported during postmarketing surveillance in HIV-infected patients receiving atazanavir therapy. Because these events were reported voluntarily during clinical practice, estimates of frequency cannot be made. The median time between atazanavir initiation and the onset of nephrolithiasis was 1.7 years, with a range of 5 weeks to 6 years. Therapy with atazanavir should be administered cautiously in patients with a current or past history of nephrolithiasis, as well as possible risk factors such as renal and/or hepatic insufficiency. Adequate hydration and/or urine acidification may help reduce the risk. However, urine acidification may be poorly tolerated and possibly harmful, particularly in patients receiving concomitant treatment with sulfonamide antibiotics. Patients who are dehydrated may also be at increased risk and should be encouraged to consume additional amounts of liquid or given intravenous fluids if necessary. Patients should be instructed to seek medical attention if they experience potential signs and symptoms of nephrolithiasis/urolithiasis such as flank pain, hematuria, dysuria, anuria, and urinary urgency. Temporary interruption or discontinuation of therapy may be required.

Major

Pis (Includes Atazanavir) ↔ Hemophilia

Severe Potential Hazard, Low plausibility

Applies to: Coagulation Defect

There have been postmarketing reports of increased bleeding, including spontaneous skin hematomas and hemarthrosis, in types A and B hemophiliac patients treated with protease inhibitors. However, a causal relationship has not been established. In some patients, additional Factor VIII was given. In more than half of the reported cases, protease inhibitor therapy was continued or reintroduced following an interruption. Hemophiliacs and patients with other coagulation defects should be monitored closely for bleeding during protease inhibitor therapy.

References

  1. "Product Information. Crixivan (indinavir)." Merck & Co, Inc, West Point, PA.
  2. "Product Information. Kaletra (lopinavir-ritonavir)" Abbott Pharmaceutical, Abbott Park, IL.
  3. "Product Information. Agenerase (amprenavir)." Glaxo Wellcome, Research Triangle Pk, NC.
View all 10 references
Moderate

Atazanavir (Includes Atazanavir) ↔ Liver Disease

Moderate Potential Hazard, High plausibility

Applies to: Liver Disease

Patients with underlying hepatitis B or C viral infections or marked elevations in transaminases prior to atazanavir treatment may be at increased risk for developing further transaminase elevations or hepatic decompensation during use of atazanavir. In addition, atazanavir is primarily metabolized by the liver and may accumulate in patients with moderate or severe hepatic impairment. Therapy with atazanavir should be administered cautiously in patients with preexisting liver disease, liver enzyme abnormalities, or hepatitis.

References

  1. "Product Information. Reyataz (atazanavir)." Bristol-Myers Squibb, Princeton, NJ.
  2. Eholie SP, Lacombe K, Serfaty L, Wendum D, Girard PM "Acute hepatic cytolysis in an HIV-infected patient taking atazanavir." AIDS 18 (2004): 1610-1
Moderate

Pis (Includes Atazanavir) ↔ Hyperglycemia

Moderate Potential Hazard, Moderate plausibility

Applies to: Abnormal Glucose Tolerance, Diabetes Mellitus

New onset or exacerbation of preexisting diabetes mellitus, glucose intolerance, and hyperglycemia have been reported during postmarketing surveillance in HIV patients treated with protease inhibitors (PIs). Frequently, insulin resistance may accompany fat redistribution and serum lipid elevations in what is collectively termed the HIV-associated lipodystrophy syndrome. Although a causal relationship has not been established, these metabolic disturbances have most often occurred in HIV patients during treatment with potent antiretroviral regimens containing PIs. Patients with or predisposed to glucose disorders should be monitored during PI therapy. Dosage adjustments in insulin or oral hypoglycemic medications may be necessary in patients with diabetes. In some cases, glucose abnormalities persisted despite discontinuation of PI therapy.

References

  1. Hardy H, Esch LD, Morse GD "Glucose disorders associated with HIV and its drug therapy." Ann Pharmacother 35 (2001): 343-51
  2. "Product Information. Viracept (nelfinavir)." Agouron Pharma Inc, La Jolla, CA.
  3. "Product Information. Invirase (saquinavir)." Roche Laboratories, Nutley, NJ.
View all 22 references
Moderate

Pis (Includes Atazanavir) ↔ Hyperlipidemia

Moderate Potential Hazard, High plausibility

Applies to: History - Myocardial Infarction, Hyperlipidemia, Ischemic Heart Disease

Hyperlipidemia have been observed in 10% of patients receiving ritonavir during clinical trials. Increases of 30% to 40% from baseline have been reported for total cholesterol and 200% to 300% or more for triglycerides. These effects have also been reported during postmarketing experience with other protease inhibitors (PIs) but may be the most dramatic with ritonavir. The clinical significance of these elevations is unclear. Severe hyperlipidemia is known to sometimes cause pancreatitis. In addition, some patients have reportedly developed symptomatic atherosclerosis and coronary artery disease after initiating PI treatment. Patients with preexisting hyperlipidemia may require closer monitoring during PI therapy, and adjustments made accordingly in their lipid-lowering regimen. PI therapy should be administered cautiously in patients with coronary artery disease or a history of ischemic heart disease.

References

  1. "Product Information. Lexiva (fosamprenavir)." GlaxoSmithKline, Research Triangle Park, NC.
  2. "Product Information. Agenerase (amprenavir)." Glaxo Wellcome, Research Triangle Pk, NC.
  3. "Product Information. Invirase (saquinavir)." Roche Laboratories, Nutley, NJ.
View all 19 references

atazanavir drug Interactions

There are 640 drug interactions with atazanavir

atazanavir alcohol/food Interactions

There are 3 alcohol/food interactions with atazanavir

Drug Interaction Classification

The classifications below are a general guideline only. It is difficult to determine the relevance of a particular drug interaction to any individual given the large number of variables.

Major Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit.
Moderate Moderately clinically significant. Usually avoid combinations; use it only under special circumstances.
Minor Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan.

Do not stop taking any medications without consulting your healthcare provider.

Disclaimer: Every effort has been made to ensure that the information provided by Multum is accurate, up-to-date and complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time sensitive and should not be utilized as a reference resource beyond the date hereof. This material does not endorse drugs, diagnose patients, or recommend therapy. Multum's information is a reference resource designed as supplement to, and not a substitute for, the expertise, skill, knowledge, and judgement of healthcare practitioners in patient care. The absence of a warning for a given drug or combination thereof in no way should be construed to indicate that the drug or combination is safe, effective, or appropriate for any given patient. Multum Information Services, Inc. does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. Copyright 2000-2016 Multum Information Services, Inc. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse, or pharmacist.

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