Atazanavir (Oral)

Atazanavir is a medication which is used to prevent human immunodeficiency virus from multiplying in the body of a person who is infected with the virus.

Overview

Atazanavir is an FDA approved medication which is used in the treatment of HIV. Atazanavir is used in conjunction with other HIV treatments in order to help prevent the replication of HIV cells in the patient. It belongs to a group of HIV treatment medications referred to as protease inhibitors or PIs. They work to block the protease enzyme which is responsible for accelerating the speed at which the HIV virus multiplies.

This medication is not intended to cure HIV or AIDS but is successful in slowing the progression of the disease. Atazanavir is also known by the brand name Reyataz and is an oral capsule that is intended for use in individuals who are 6 years of age or older. This drug should be taken with food and the capsule should not be opened. Individuals who are under the age of 6 years should only take atazanavir under the strict supervision of a doctor, and possibly in another form of the medication.

Take your medication as directed and if you miss a dose take it as soon as you remember. If it is almost time for you to take the next dose of atazanavir, then you should only take one capsule. Do not take two doses at one time. It is important to discuss your medical history and any health problems you may have with your doctor. Tell them all about the medications you are currently taking, including any herbal supplements or vitamins. You should also discuss physical activity and the risks that are associated with taking this drug.

Atazanavir is often associated with a variety of side effects which range from mild to life-threatening. If you feel you are having a serious side effect, or develop an allergic reaction associated with taking this drug, you should go immediately to the emergency room and contact your physician. Document any side effects you experience while taking this medication and alert your doctor at your regular appointments so they can monitor any changes and developments throughout your therapy with atazanavir. Make sure to inform your doctor of any changes to your diet or exercise as they may affect your treatment plan. Go to your appointments regularly to help your healthcare provider to monitor your tolerance to this medication and to help detect any potential health issues associated with this treatment or the HIV or AIDS virus.

Conditions treated

  • Human immunodeficiency virus
  • Acquired immune deficiency syndrome

Type of medicine

  • Protease inhibitor

Side effects

Unknown incidence:

  • Abdominal discomfort either with or without pain and fullness
  • Bloating
  • Blood in urine
  • Blurry vision
  • chest pain
  • Light or clay-colored stool
  • Constipation
  • Dark urine
  • Decreased appetite
  • Diarrhea
  • Lightheadedness or dizziness
  • Dry mouth
  • Fainting
  • Shallow or fast breathing
  • Fever
  • Dry, flushed skin
  • Breath odor that is fruit-like
  • Gaseous abdomen
  • Headache
  • Skin rash, hives, or itching
  • Hunger increase
  • Thirst
  • Urination increase
  • Indigestion
  • Irregular heartbeat
  • Appetite loss
  • Loss of consciousness
  • Muscle pain or cramping
  • Nausea
  • Groin and genital pain
  • Pain in the side, abdomen, stomach that may radiate to the back
  • Pain below the ribs and in the back
  • Severe vomiting or nausea
  • Sleepiness
  • Irregular or slow heartbeat
  • Stomachache
  • Sweating
  • Swelling
  • Tightness in chest
  • Trouble breathing
  • weight loss
  • Foul breath
  • Vomiting
  • Vomiting blood
  • Yellowing of the skin or eyes
  • Rash with flat lesions
  • Hair loss

Common side effects:

If the back pain you experience persists or becomes increasingly painful, you should tell your doctor and determine what your options may be for relief while you are taking atazanavir.

  • Cough

If you develop a cough while taking this drug, or a preexisting cough worsens, you should alert your health care professional and monitor your situation closely. In some cases, it may signal a developing and serious health problem that requires immediate treatment.

  • Discouragement

If you begin to experience discouragement, you should ask your doctor for advice or a reference to a mental health specialist who can help you treat this side effect in conjunction with your current treatment with atazanavir.

  • Increase in body fat

An increase in body fat is common in individuals who are undergoing treatment with atazanavir. If this persists or becomes problematic, your doctor may be able to prescribe medication to help or give you a guideline for a healthier diet.

  • Sadness or feelings of emptiness

If you begin to feel sad or empty during your treatment with this medication, you should ask your doctor for a referral to a mental health provider who can help you get on a treatment plan to combat this side effect and help you with your current course of treatment.

  • Irritability

Irritability is common, especially during the adjustment phase of treatment. Monitor your mood closely and if you notice erratic changes or an increase in irritability you should tell your doctor so the issue can be addressed through medication adjustment or the addition of a prescription to help combat this side effect.

  • Loss of pleasure or interest

If you begin to lose interest in activities or hobbies you once enjoyed, or you notice a loss of pleasure, you should discuss this with your doctor so they can help alleviate this side effect through additional therapy or treatment through a mental health care provider.

  • Difficulty concentrating

This side effect is common initially, but if this issue persists past the adjustment phase, or becomes severe, you should immediately tell your doctor because it could be a sign of a more serious medical condition that may require immediate attention.

You may have trouble sleeping initially when taking this medication. If the problem persists for an extended period of time or becomes severe, you should tell your healthcare provider so they can either adjust your therapy or prescribe medication to help alleviate this common side effect of atazanavir.

Uncommon side effects:

  • Painful sensations, numbness, burning, or tingling

If you begin to experience any of these side effects, especially if they are in conjunction with other known side effects, you should tell your doctor right away or seek emergency medical treatment. This could be a sign of intolerance or some other type of interaction.

  • Trouble moving

This can be a serious side effect that should be immediately treated by either your local emergency facility or your health care provider. Trouble moving can signal a life-threatening emergency and should not be overlooked.

  • Muscle stiffness

If you experience muscle stiffness while beginning your treatment with atazanavir, you should tell your doctor right away and monitor any changes in your overall well being. Some individuals do not tolerate this medication well, and this could be a sign of intolerance or a more serious health issue.

  • Pain

Patients who begin to experience pain in the body or the extremities should alert their doctor as soon as possible. You may need to have your dose changed, or you may be experiencing an adverse reaction to the drug. If the pain is severe you should seek emergency medical assistance.

  • Joint pain

Joint pain can be a common side effect when taking atazanavir therapy and should be reported to your doctor so that your reactions can be monitored closely to avoid any potential serious health issues. In some cases, you may need to have your dose changed or begin a different type of therapy.

  • Unsteadiness

If you begin to notice that you have become increasingly unsteady or you become more awkward, you should tell your doctor and monitor your condition closely. If you experience this side effect in conjunction with other side effects you may not tolerate the treatment well and should consider other options with your doctor.

  • Weakness in the extremities

If you begin to experience weakness in your extremities, you should report this to your doctor right away or proceed to the nearest emergency facility for treatment. This can be a side effect, or it can signal a life-threatening event that requires emergency treatment.

Dosage

Recommended adult dose for individuals with HIV infection:

The normal dose for adults is 300 mg of atazanavir in conjunction with ritonavir 100 mg once per day orally. If for some reason the patient has trouble tolerating the ritonavir, the dose of atazanavir can be increased to 400 mg orally per day. This medication can also be used in conjunction with efavirenz. The dose should be 400 mg of atazanavir and 100 mg of ritonavir orally once per day.

Over the course of treatment, the dose may be adjusted later on. The normal adjusted dose is 300 mg of atazanavir and 100 mg of ritonavir orally once per day. This medication can also be administered in conjunction with a H2 receptor antagonist as well as tenofovir. The dose would then be 400 mg of atazanavir and 100 mg of ritonavir orally once per day.

During pregnancy:

The dose should be 300 mg of atazanavir and 100 mg of ritonavir orally once per day. If the patient has been taking the course of treatment for some time or is taking the medication with a H2 receptor antagonist or tenofovir then the dose should be 400 mg of atazanavir and 100 mg of ritonavir orally once per day, but is not recommended during pregnancy.

This drug requires the use of ritonavir if the patient is pregnant and is only recommended for patients who have HIV-1 strains which are susceptible to atazanavir. Once the patient has delivered, they should be closely monitored for the occurrence of side effects which show an increased likelihood of affecting the patient during the first two months after delivery.

Recommended adult dose for nonoccupational exposure to HIV:

The dose should be 400 mg of atazanavir orally once per day or 300 mg of atazanavir and 100 mg of ritonavir if used with tenofovir and should be administered for 28 days following the postexposure prophylaxis of the HIV virus.

Interactions

There are 666 drugs in total which are known to pose an interaction risk with atazanavir. Of these, 242 are considered a major drug interaction. There are another 362 moderate drug risks and 62 minor drug interactions.

The most common drugs on the market which pose an interaction risk include Celexa, Flomax, Kaletra, Stribild, Suboxone, Truvada, Nexium, Norvir, and Zyprexa.

There are 3 lifestyle/food/alcohol interactions associated with atazanavir:

  • Caffeine

Caffeine is considered a minor interaction risk, but could compound the problem of arrhythmia. If you consume caffeine and notice any changes or issues with your heart, you should let your doctor know in case you may need to change your diet or have your therapy adjusted.

There was evidence of hyperlipidemia in 10% of the patients taking this medication. If you have a history of high cholesterol you should discuss the risks of using this medication. You may be able to take other medication to keep the risk to a minimum. This poses a moderate risk and should be monitored closely during your treatment.

  • Food

Some food can increase the levels of this medication in our body. Always take this medication with a meal so it is easier for your body to absorb and reduce the risk of complications.

There are 8 disease interactions associated with atazanavir:

  • Heart Block

This drug can possibly prolong the PR interval during an electrocardiogram. A high degree of caution should be used due to this potential issue, especially in patients with pre-existing heart conditions.

  • Nephrolithiasis

In some cases, there have been reports of patients developing nephrolithiasis which, in turn, resulted in acute interstitial nephritis, hospitalization, and even renal failure after receiving HIV therapy with atazanavir.

  • Renal Impairment

If you already have renal impairment, you should discuss this condition with your doctor because this treatment can further impair your renal function and can in some cases, lead to renal failure which is a life-threatening condition.

  • Hemophilia

This medication can possibly increase the risk of bleeding and developing skin hematomas and hemarthrosis in both type A and B hemophiliacs. It is possible to continue this therapy after a break in the schedule. This condition should be continuously monitored for complications throughout the treatment.

Individuals who suffer from hepatitis B and C infections are at an increased risk for hepatic decompensation while using atazanavir. This medication is metabolized in the liver and will accumulate in patients with decreased hepatic function. Anyone who has liver disease or impairment should consult their doctor and be monitored closely while they are taking this medication.

  • Pku

Individuals who suffer from hepatitis B and C infections are at an increased risk for hepatic decompensation while using atazanavir. This medication is metabolized in the liver and will accumulate in patients with decreased hepatic function. Anyone who has liver disease or impairment should consult their doctor and be monitored closely while they are taking this medication.

This medication has been known to complicate and exacerbate preexisting glucose intolerance, diabetes mellitus, and hyperglycemia. Glucose levels should be monitored closely when undergoing this treatment to help detect any developing or worsening issues. If you notice changes to your baseline glucose levels frequently you should contact your doctor immediately.

  • Hyperlipidemia

There has been a significant increase in total cholesterol and triglycerides in patients who use this medication. Hyperlipidemia has been documented at an increase of 30 to 40% in patients after beginning treatment with atazanavir. This can in some cases, lead to pancreatitis. Other patients reported atherosclerosis and coronary artery disease after beginning the treatment. Your doctor can prescribe lipid reducing medication to help with this condition. Caution should be used when taking this medication.

Warnings

This drug can cause serious side effects, which, in some cases, can be life-threatening. Some of the warning signs to look for include drug interactions, allergic reaction, severe rash, liver problems, and heart rhythm problems. You should immediately contact your doctor and go to the emergency room if you notice any of these symptoms because it could signal heart rhythm issues:

  • Lightheadedness
  • Dizziness

These side effects should be taken seriously and should be immediately attended to by your health care provider or the emergency room.

  • Flu-like symptoms or feelings of being ill

This can be a signal that you are having an adverse reaction to the medication, or it can be a sign of a more serious underlying condition which requires immediate treatment.

  • Fever

If you run a persistent or a high fever over 102 degrees, you should alert your doctor immediately or visit the emergency room.

  • Aches and pains in the muscles and joints

This can be a reaction to the medication which should be immediately addressed.

  • Red and puffy eyes that appear to be pink eye

This reaction can signal a life-threatening situation. You should alert your doctor right away if you develop this condition.

  • Blisters

You may experience blistering of the skin as a serious reaction to the medication which can pose a serious risk to your health if not treated immediately.

  • Sores around the mouth

This is another sign of an adverse reaction to the medication. Alert your doctor immediately and visit the nearest emergency room.

  • Facial swelling

You may experience swelling in the face or neck when you have an adverse reaction to atazanavir. Contact your doctor immediately or visit the emergency room.

  • Lumps under the skin that are painful to the touch

This is a severe reaction which can pose a threat to your life and should be addressed immediately by your health care provider or emergency room.

If you exhibit any of these symptoms, they could signal an infection of the liver or hepatitis B and C:

  • Yellow appearing in the whites of the eyes or in the skin
  • Urine is dark
  • Itching
  • Nausea
  • Abdominal pain

Any side effects which have a quick onset and are out of the ordinary should be treated as an emergency. Call your health care provider and proceed to the nearest emergency room. It is also critical to keep all of your scheduled appointments to help monitor your condition and reactions to this medication closely. If you have any pain in your chest or a radiating pain in your neck, arms, or back, you should call 911 immediately.

Do not take more than your prescribed dose of this medication because it could pose a toxicity risk or can cause and overdose. Do not give your medications to anyone else. Keep your medication in the prescription bottle it came in and do not store other pills in the same container.

Storage

When storing atazanavir, you should always keep it in a locked or childproof container. Store this medication away from excess moisture and avoid keeping it in areas such as the bathroom. Keep this medication away from light and heat. Do not keep this drug past the expiration date. If your medication expires please contact your healthcare provider to obtain a new prescription.

If you wish to dispose of this medication, please use your community take-back program if possible. If you do not have a community take-back program, you should read the information pamphlet provided by the FDA regarding proper disposal of prescription medication. Do not flush this drug down the toilet.

Keep this medication out of the reach of children and pets at all times. Do not store your medication where it can easily be accessed by others. Keep your medication in the original prescription bottle if you plan to travel.

Summary

Atazanavir is a protease inhibitor that is prescribed to prevent the progress of the HIV or AIDS virus in individuals who are over the age of 6 years. It is usually prescribed in conjunction with other preventative medication. This drug helps to prolong the life, and prevent complication to patients who are infected with the virus.

This medication has a variety of side effects which can range from minor to major, possibly life-threatening. Before beginning this therapy, it is important to talk with your doctor to discuss any medical issues you may already have. This is critical if you have some type of organ failure or chronic disease that could affect your treatment. In some cases, other medical problems can pose a risk of interaction.

Make sure your doctor discusses the risk of side effects and what to do if you develop any side effects or reactions. You should also read the handout that your doctor provides in regards to this medication. Do not quit taking your medication without the approval of your doctor. It is important to ensure your progress is monitored carefully throughout your course of treatment.

Keep your medication in a locked container and away from heat, light, and moisture. Do not store your medication in the bathroom or anywhere that it can be accessed easily by anyone other than yourself. Keep this drug away from children and pets. If you feel you have overdosed you should call poison control immediately and proceed to the emergency room. Do not alter your course of treatment without permission from your doctor. Do not share your medication with others or mix it with any other medications.

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Last Reviewed:
December 25, 2017
Last Updated:
April 04, 2018
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