Can you take Actos with Atazanavir?

Atazanavir has a major potential interaction with 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).

Atazanavir has a moderate potential interaction with Abnormal Glucose Tolerance.

New onset diabetes mellitus, exacerbation of preexisting diabetes mellitus, hyperglycemia, and some cases of diabetic ketoacidosis have been reported during postmarketing surveillance in HIV-infected patients treated with protease inhibitors. Some patients required either initiation or dosage adjustments of insulin or oral hypoglycemic agents for treatment of these events. In some cases, hyperglycemia persisted despite discontinuation of protease inhibitor therapy. A causal relationship has not been established between protease inhibitor therapy and these events. Monitoring patients for hyperglycemia, new onset diabetes mellitus, or exacerbation of diabetes mellitus should be considered during protease inhibitor therapy.

The pioglitazone in Actos has a minor potential interaction with Anemia.

Thiazolidinediones can cause slight decreases in hemoglobin and hematocrit. In clinical studies, hemoglobin levels were reduced primarily within the first 4 to 12 weeks of therapy but remained relatively constant thereafter. These changes may be related to increased plasma volume and have rarely been associated with any significant hematologic clinical effects. Nevertheless, caution may be advisable when thiazolidinediones are prescribed to patients with certain anemias.

The pioglitazone in Actos has a moderate potential interaction with Bladder Cancer.

There are insufficient data to determine if pioglitazone has an effect on preexisting bladder tumors or if it can cause bladder cancer. However, the manufacturer does not recommend the use of pioglitazone in patients with active bladder cancer. In patients with history of bladder cancer the benefit of treatment versus the risk of cancer recurrence during treatment should be considered.

Atazanavir has a moderate potential interaction with Coagulation Defects and Disorders.

There have been reports of increased bleeding, including spontaneous skin hematomas and hemarthrosis, in patients with hemophilia type A and B 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. Patients with hemophilia or other coagulation defects should be monitored closely for bleeding during protease inhibitor therapy.

Atazanavir has a major potential interaction with Dehydration.

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.

The pioglitazone in Actos has a major potential interaction with Diabetes, Type 1.

Thiazolidinediones exert their hypoglycemic effect only in the presence of insulin. Therefore, these agents should not be used in patients with type I diabetes or for the treatment of diabetic ketoacidosis.

The pioglitazone in Actos has a moderate potential interaction with Diabetes Mellitus.

New onset or worsening diabetic macular edema with decreased visual acuity have been reported in postmarketing reports in some diabetic patients who were taking thiazolidinedione drugs. Some patients presented with blurred vision or decreased visual acuity, but some patients appear to have been diagnosed on routine ophthalmologic examination. Most patients had peripheral edema at the time macular edema was diagnosed. Some patients had improvement in their macular edema after discontinuation of their thiazolidinedione. Patients with diabetes should have regular eye exams by an ophthalmologist according to current standards of care. Additionally, any diabetic who reports any kind of visual symptom should be promptly referred to an ophthalmologist, regardless of the patient's underlying medications or other physical findings.

Atazanavir has a moderate potential interaction with Diabetes Mellitus.

New onset diabetes mellitus, exacerbation of preexisting diabetes mellitus, hyperglycemia, and some cases of diabetic ketoacidosis have been reported during postmarketing surveillance in HIV-infected patients treated with protease inhibitors. Some patients required either initiation or dosage adjustments of insulin or oral hypoglycemic agents for treatment of these events. In some cases, hyperglycemia persisted despite discontinuation of protease inhibitor therapy. A causal relationship has not been established between protease inhibitor therapy and these events. Monitoring patients for hyperglycemia, new onset diabetes mellitus, or exacerbation of diabetes mellitus should be considered during protease inhibitor therapy.

The pioglitazone in Actos has a major potential interaction with Diabetic Ketoacidosis.

Thiazolidinediones exert their hypoglycemic effect only in the presence of insulin. Therefore, these agents should not be used in patients with type I diabetes or for the treatment of diabetic ketoacidosis.

The pioglitazone in Actos has a moderate potential interaction with Diabetic Macular Edema.

New onset or worsening diabetic macular edema with decreased visual acuity have been reported in postmarketing reports in some diabetic patients who were taking thiazolidinedione drugs. Some patients presented with blurred vision or decreased visual acuity, but some patients appear to have been diagnosed on routine ophthalmologic examination. Most patients had peripheral edema at the time macular edema was diagnosed. Some patients had improvement in their macular edema after discontinuation of their thiazolidinedione. Patients with diabetes should have regular eye exams by an ophthalmologist according to current standards of care. Additionally, any diabetic who reports any kind of visual symptom should be promptly referred to an ophthalmologist, regardless of the patient's underlying medications or other physical findings.

The pioglitazone in Actos has a moderate potential interaction with Fluid Retention.

Thiazolidinediones can cause dose-related edema. Therapy with thiazolidinediones should be administered cautiously in patients at risk for congestive heart failure as well as those with fluid overload or other conditions that may be adversely affected by excess fluid such as hypertension. Patients should be monitored for signs and symptoms of heart failure such as dyspnea, swelling of legs or ankles, and weight gain.

Atazanavir has a major potential interaction with Heart Block.

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).

The pioglitazone in Actos has a major potential interaction with Heart Failure.

The use of thiazolidinediones, alone or in combination with other antidiabetic agents, has been associated with fluid retention and new onset or exacerbation of heart failure. An increased risk of cardiovascular events (heart failure worsening; new or worsening edema; new or worsening dyspnea; increases in heart failure medication; myocardial infarction; angina; cardiovascular hospitalization and deaths) has been reported with rosiglitazone therapy in type II diabetic patients with New York Heart Association (NYHA) Class I or II congestive heart failure compared to placebo. Likewise, overnight hospitalization for CHF was observed in 9.9% of diabetic patients with NYHA Class II and III heart failure on pioglitazone compared to 4.7% of patients on glyburide. An increased incidence of cardiovascular adverse events including edema and cardiac failure has also been reported in patients receiving a thiazolidinedione in combination with insulin relative to insulin and placebo. Therapy with thiazolidinediones should be administered cautiously and initiated at the lowest recommended dosage in patients with congestive heart failure. Thiazolidinediones are contraindicated for the treatment of patients with NYHA Class III or IV cardiac status. Patients should be monitored for signs of worsening heart failure such as increased dyspnea, edema, and weight gain. Therapy should be discontinued if any deterioration in cardiac status occurs.

Atazanavir has a major potential interaction with Hemodialysis.

Atazanavir is not recommended for use in HIV- treatment experienced patients with end stage renal disease managed with hemodialysis.

The pioglitazone in Actos has a moderate potential interaction with High Blood Pressure.

Thiazolidinediones can cause dose-related edema. Therapy with thiazolidinediones should be administered cautiously in patients at risk for congestive heart failure as well as those with fluid overload or other conditions that may be adversely affected by excess fluid such as hypertension. Patients should be monitored for signs and symptoms of heart failure such as dyspnea, swelling of legs or ankles, and weight gain.

Atazanavir has a moderate potential interaction with High Cholesterol.

Treatment with ritonavir alone or in combination with other protease inhibitors (e.g., lopinavir, saquinavir, tipranavir, fosamprenavir) has resulted in substantial increases in the concentration of total cholesterol and triglycerides. These effects have also been reported with other protease inhibitors but may be the most dramatic with ritonavir. The clinical significance of these elevations is unclear. Marked elevation in triglyceride levels is a risk factor for development of pancreatitis. Triglyceride and cholesterol testing is recommended before starting ritonavir (with or without other protease inhibitors) and periodically during therapy. Lipid disorders should be managed as clinically appropriate.

Atazanavir has a major potential interaction with History, Nephrolithiasis.

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.

Atazanavir has a major potential interaction with 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.

The pioglitazone in Actos has a moderate potential interaction with Liver Disease.

Initiation of rosiglitazone or pioglitazone therapy is not recommended in patients who exhibit clinical evidence of active liver disease or increased baseline serum transaminase levels (ALT exceeding 2.5 times upper limit of normal). Use of these agents is also not recommended in patients who have experienced jaundice during treatment with troglitazone. The use of troglitazone, another agent in the thiazolidinedione class, has been associated with clinically significant elevations in liver enzymes, reversible jaundice, and idiosyncratic hepatocellular injury including rare cases of liver failure, liver transplants, and death. Injury has occurred after both short- and long-term treatment. While these effects have not been associated with other thiazolidinediones in clinical trials, concerns exist because of their structural similarities. In addition, isolated cases of hepatitis and hepatic enzyme elevations to 3 or more times the upper limit of normal have been reported with both rosiglitazone and pioglitazone during postmarketing use. Rarely, these events have involved hepatic failure with and without fatal outcome, although causality has not been established. Until more safety data are available, patients who are prescribed thiazolidinedione therapy should have serum transaminase levels checked at baseline and periodically thereafter as clinically necessary. Mild to moderate elevations (ALT less than or equal to 2.5 times ULN) require cautious use with more frequent monitoring to determine if the elevations resolve or worsen. Patients who develop potential symptoms of hepatic injury such as unexplained nausea, vomiting, abdominal pain, fatigue, anorexia, and dark urine should have liver enzymes checked. Therapy should be withdrawn if ALT is elevated and persists above 3 times ULN or if jaundice develops.

Atazanavir has a moderate potential interaction with 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. Atazanavir is not recommended for use in patients with severe hepatic impairment, and the combination of atazanavir/ritonavir is not recommended for patients with any degree of hepatic impairment.

Atazanavir has a major potential interaction with Nephrolithiasis.

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.

Atazanavir has a moderate potential interaction with Phenylketonuria.

Atazanavir oral powder (Reyataz) contains phenylalanine (a component of aspartame) which can be harmful to patients with phenylketonuria (PKE). Each packet contains 35 mg of phenylalanine. Atazanavir in capsules (Reyataz) does not contain phenylalanine.

The pioglitazone in Actos has a moderate potential interaction with Pleural Effusion.

Thiazolidinediones can cause dose-related edema. Therapy with thiazolidinediones should be administered cautiously in patients at risk for congestive heart failure as well as those with fluid overload or other conditions that may be adversely affected by excess fluid such as hypertension. Patients should be monitored for signs and symptoms of heart failure such as dyspnea, swelling of legs or ankles, and weight gain.

The pioglitazone in Actos has a moderate potential interaction with Premenopausal Anovulation.

In premenopausal, anovulatory patients with insulin resistance, treatment with thiazolidinediones may result in resumption of ovulation. Due to improved insulin sensitivity, pregnancy can occur if adequate contraception is not used.

The pioglitazone in Actos has a moderate potential interaction with Pulmonary Edema.

Thiazolidinediones can cause dose-related edema. Therapy with thiazolidinediones should be administered cautiously in patients at risk for congestive heart failure as well as those with fluid overload or other conditions that may be adversely affected by excess fluid such as hypertension. Patients should be monitored for signs and symptoms of heart failure such as dyspnea, swelling of legs or ankles, and weight gain.

Atazanavir has a major potential interaction with Renal Dysfunction.

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.

The pioglitazone in Actos has a moderate potential interaction with Weight Loss.

Thiazolidinediones can cause dose-related weight gain, which may be undesirable in obese patients attempting to lose weight. The mechanism of weight gain is unclear but probably involves a combination of fluid retention and fat accumulation. In postmarketing experience with rosiglitazone, there have been reports of unusually rapid increases in weight, greater than those generally observed in clinical trials. Patients who experience such increases should be assessed for fluid retention and volume-related events such as excessive edema and congestive heart failure.