Skip to Content

Atazanavir Dosage

Medically reviewed on March 14, 2018.

Applies to the following strengths: 300 mg; 100 mg; 150 mg; 200 mg; 50 mg

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)

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

Hide