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Atazanavir / cobicistat and Alcohol / Food Interactions

There are 3 alcohol/food/lifestyle interactions with atazanavir / cobicistat which include:

Minor

Caffeine ↔ atazanavir

Minor Drug Interaction

Consumer information for this minor interaction is not currently available. Some minor drug interactions may not be clinically relevant in all patients. Minor drug interactions do not usually cause harm or require a change in therapy. However, your healthcare provider can determine if adjustments to your medications are needed.

For clinical details see professional interaction data.

Moderate

atazanavir ↔ food

Moderate Food Interaction

Consumer information for this interaction is not currently available.

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

High Cholesterol (Hyperlipoproteinemia, Hypertriglyceridemia, Sitosterolemia)

Moderate Potential Hazard, High plausibility

PIs - hyperlipidemia

Hyperlipidemia has 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. Invirase (saquinavir)." Roche Laboratories, Nutley, NJ.
  2. "Product Information. Lexiva (fosamprenavir)." GlaxoSmithKline, Research Triangle Park, NC.
  3. "Product Information. Crixivan (indinavir)." Merck & Co, Inc, West Point, PA.
  4. "Product Information. Agenerase (amprenavir)." Glaxo Wellcome, Research Triangle Pk, NC.
  5. "Product Information. Reyataz (atazanavir)." Bristol-Myers Squibb, Princeton, NJ.
  6. "Product Information. Fortovase (saquinavir)" Roche Laboratories, Nutley, NJ.
  7. Costa A, Pulido F, Rubio R, Cepeda C, Torralba M, Costa JR "Lipid changes in HIV-infected patients who started rescue therapy with an amprenavir/ritonavir-based highly active antiretroviral therapy." AIDS 16 (2002): 1983-4
  8. Noor MA, Lo JC, Mulligan K, Schwarz JM, Halvorsen RA, Schambelan M, Grunfeld C "Metabolic effects of indinavir in healthy HIV-seronegative men." Aids 15 (2001): f11-8
  9. "Product Information. Aptivus (tipranavir)." Boehringer-Ingelheim, Ridgefield, CT.
  10. "Product Information. Norvir (ritonavir)." Abbott Pharmaceutical, Abbott Park, IL.
  11. Flynn TE, Bricker LA "Myocardial infarction in HIV-infected men receiving protease inhibitors." Ann Intern Med 131 (1999): 548
  12. Segerer S, Bogner JR, Walli R, Loch O, Goebel FD "Hyperlipidemia under treatment with proteinase inhibitors." Infection 27 (1999): 77-81
  13. "Product Information. Viracept (nelfinavir)." Agouron Pharma Inc, La Jolla, CA.
  14. Sullivan AK, Feher MD, Nelson MR, Gazzard BG "Marked hypertriglyceridaemia associated with ritonavir therapy." AIDS 12 (1998): 1393-4
  15. "Product Information. Kaletra (lopinavir-ritonavir)" Abbott Pharmaceutical, Abbott Park, IL.
  16. Echevarria KL, Hardin TC, Smith JA "Hyperlipidemia associated with protease inhibitor therapy." Ann Pharmacother 33 (1999): 859-63
  17. Tsiodras S, Mantzoros C, Hammer S, Samore M "Effects of protease inhibitors on hyperglycemia, hyperlipidemia, and lipodystrophy - A 5-year cohort study." Arch Intern Med 160 (2000): 2050-6
  18. Struble K, Piscitelli SC "Syndromes of abnormal fat redistribution and metabolic complications in HIV-infected patients." Am J Health Syst Pharm 56 (1999): 2343-8
  19. Karmochkine M, Raguin G "Severe coronary artery disease in a young HIV-infected man with no cardiovascular risk factor who was treated with indinavir." AIDS 12 (1998): 2499
View all 19 references

Atazanavir / cobicistat drug interactions

There are 932 drug interactions with atazanavir / cobicistat

Atazanavir / cobicistat disease interactions

There are 9 disease interactions with atazanavir / cobicistat which include:

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.
Unknown No information available.

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

Further information

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

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