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Drug Interactions between atazanavir and Mavyret

This report displays the potential drug interactions for the following 2 drugs:

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Interactions between your drugs

Major

atazanavir glecaprevir

Applies to: atazanavir and Mavyret (glecaprevir / pibrentasvir)

CONTRAINDICATED: Coadministration with atazanavir plus ritonavir may significantly increase the plasma concentrations of glecaprevir. The proposed mechanism is inhibition of organic anion transporting polypeptide (OATP) 1B1-mediated hepatic uptake of glecaprevir by atazanavir and ritonavir. Inhibition of P-glycoprotein-mediated intestinal efflux and CYP450 3A4-mediated metabolism of glecaprevir may also contribute. When glecaprevir-pibrentasvir 300 mg-120 mg once daily was administered with atazanavir 300 mg plus ritonavir 100 mg once daily to 12 study subjects, glecaprevir peak plasma concentration (Cmax), systemic exposure (AUC) and trough plasma concentration (Cmin) increased by approximately 4.1-, 6.5- and 14.3-fold, respectively. Pibrentasvir pharmacokinetics were modestly affected, with Cmax, AUC and Cmin increasing by approximately 1.3-, 1.6- and 2.3-fold, respectively. High plasma levels of glecaprevir may increase the risk of adverse effects such as alanine aminotransferase (ALT) and bilirubin elevations. In addition, both glecaprevir and atazanavir inhibit OATP1B1 and uridine diphosphate glucuronosyl transferase (UGT) 1A1, which may impact transport and metabolism of bilirubin, including both direct and indirect. Additive effects may occur and increase the risk of hyperbilirubinemia.

MANAGEMENT: Concomitant use of glecaprevir with atazanavir is considered contraindicated.

References (1)
  1. (2017) "Product Information. Mavyret (glecaprevir-pibrentasvir)." Abbott Pharmaceutical

Drug and food interactions

Moderate

atazanavir food

Applies to: atazanavir

ADJUST DOSING INTERVAL: Administration of atazanavir with food enhances oral bioavailability and reduces pharmacokinetic variability. According to the manufacturer, administration with a light meal increased the peak plasma concentration (Cmax) and area under the concentration-time curve (AUC) of a single 400 mg dose of atazanavir by 57% and 70%, respectively, relative to the fasting state. Administration with a high-fat meal resulted in a mean increase of 35% in atazanavir AUC and no change in Cmax compared to fasting. The coefficient of variation of AUC and Cmax decreased by approximately one-half when given with either a light or high-fat meal compared to the fasting state.

MANAGEMENT: To ensure maximal oral absorption, atazanavir should be administered with or immediately after a meal.

References (1)
  1. (2003) "Product Information. Reyataz (atazanavir)." Bristol-Myers Squibb
Moderate

glecaprevir food

Applies to: Mavyret (glecaprevir / pibrentasvir)

ADJUST DOSING INTERVAL: Food enhances the oral bioavailability of glecaprevir and pibrentasvir. Relative to fasting conditions, mean glecaprevir systemic exposure (AUC) increased by 83% to 163% and mean pibrentasvir AUC increased by 40% to 53% when administered with moderate to high fat meals.

MANAGEMENT: Glecaprevir-pibrentasvir should be administered with food.

References (1)
  1. (2017) "Product Information. Mavyret (glecaprevir-pibrentasvir)." Abbott Pharmaceutical

Therapeutic duplication warnings

Therapeutic duplication is the use of more than one medicine from the same drug category or therapeutic class to treat the same condition. This can be intentional in cases where drugs with similar actions are used together for demonstrated therapeutic benefit. It can also be unintentional in cases where a patient has been treated by more than one doctor, or had prescriptions filled at more than one pharmacy, and can have potentially adverse consequences.

Duplication

Protease inhibitors

Therapeutic duplication

The recommended maximum number of medicines in the 'protease inhibitors' category to be taken concurrently is usually one. Your list includes two medicines belonging to the 'protease inhibitors' category:

  • atazanavir
  • Mavyret (glecaprevir/pibrentasvir)

Note: In certain circumstances, the benefits of taking this combination of drugs may outweigh any risks. Always consult your healthcare provider before making changes to your medications or dosage.

See also

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Drug Interaction Classification

These classifications are only a guideline. The relevance of a particular drug interaction to a specific individual is difficult to determine. Always consult your healthcare provider before starting or stopping any medication.
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.
Unknown No interaction information available.

Further information

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

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