Atazanavir (patient information)

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Why this medication is prescribed

Atazanavir is used in combination with other medications to treat human immunodeficiency virus (HIV) in patients with or without acquired immunodeficiency syndrome (AIDS). Atazanavir is in a class of medications called HIV protease inhibitors. It works by preventing the spread of HIV in the body. Atazanavir does not cure HIV and may not prevent you from developing HIV related illnesses. Atazanavir does not prevent the spread of HIV to other people.

How this medication should be used

Atazanavir comes as a capsule to take by mouth. It is usually taken once a day with a meal or snack. To help you remember to take atazanavir, take it at around the same time every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take atazanavir exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

You will take other medications for HIV while you are taking atazanavir. Your doctor will tell you whether these medications should be taken at the same time as atazanavir, or several hours before or after you take atazanavir. Follow this schedule carefully, and ask your doctor or pharmacist if you have questions about the times you should take your medications.

Swallow the capsules whole; do not split, chew, or open them.

Atazanavir controls HIV but does not cure it. Continue to take atazanavir even if you feel well. Do not stop taking atazanavir without talking to your doctor. If you miss doses or stop taking atazanavir, your condition may become more difficult to treat.

Other uses for this medicine

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Special precautions

Before taking atazanavir:

• tell your doctor and pharmacist if you are allergic to atazanavir or any other medications.
• do not take atazanavir if you are taking cisapride (Propulsid), ergot alkaloids such as dihydroergotamine (Migranal, D.H.E. 45), ergonovine (Ergotrate), ergotamine (Cafergot, Ercaf, others), or methylergonovine (Methergine); midazolam (Versed); pimozide (Orap); and triazolam (Halcion).
• tell your doctor and pharmacist what other prescription and nonprescription medications, vitamins, and nutritional supplements you are taking. Be sure to mention amiodarone (Cordarone); anticoagulants ('blood thinners') such as warfarin (Coumadin); antidepressants (mood elevators) such as amitriptyline (Elavil ), amoxapine (Asendin), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Adapin, Sinequan), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), imipramine (Tofranil), nefazodone (Serzone), nortriptyline (Aventyl, Pamelor), protriptyline (Vivactil), and trimipramine (Surmontil); antifungals such as fluconazole (Diflucan), itraconazole (Sporanox), and ketoconazole (Nizoral); beta blockers such as atenolol (Tenormin), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal); calcium channel blockers such as bepridil (Vascor), diltiazem (Cardizem, Dilacor, Tiazac, others), felodipine (Plendil), nicardipine (Cardene), nifedipine (Adalat, Procardia) and verapamil (Calan, Isoptin, Verelan); carbamazepine (Tegretol); celecoxib (Vioxx); cholesterol-lowering medications (statins) such as atorvastatin (Lipitor), lovastatin (Mevacor), or simvastatin (Zocor); cimetidine (Tagamet); clarithromycin (Biaxin); clozapine (Olozaril); cyclobenzaprine (Flexeril); danazol (Danocrine); dexamethasone (Decadron); diclofenac (Voltaren); digoxin (Lanoxin); ethosuximide (Zarontin); famotidine (Pepcid); fluvastatin (Lescol); glipizide (Glucotrol); ibuprofen (Advil, Motrin); irbesartan (Avapro); irinotecan (Camptosar); isoniazid (INH, Nydrazid); medications for irregular heartbeat; medications that suppress the immune system such as cyclosporine (Neoral, Sandimmune), sirolimus (Rapamune), and tacrolimus (Prograf); metronidazole (Flagyl); mexiletine (Mexetil); naproxen (Aleve, Naprosyn); nizatidine (Axid); oral contraceptives (birth control pills); other medications for HIV or AIDS such as delavirdine (Rescriptor), efavirenz (Sustiva), indinavir (Crixivan), nelfinavir (Viracept); ritonavir (Norvir), saquinavir (Fortovase, Invirase) and tenofovir (Viread); phenobarbital (Luminal, Solfoton); phenytoin (Dilantin); piroxicam (Feldene); proton-pump inhibitors used for indigestion, heartburn, or ulcers such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and rabeprazole (Aciphex); quinidine (Quinidex); ranitidine (Zantac); rifabutin (Mycobutin); rifampin (Rimactane, Rifadin, others); tacrine (Cognex); theophylline (Theo-Dur, others); tolbutamide (Orinase); torsemide (Demadex); troleandomycin (TAO); and zafirlukast (Accolate). Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• If you are taking antacids, didanosine chewable or dispersible buffered tablets (Videx), or any other buffered medication such as buffered aspirin (Bufferin), take atazanavir 2 hours before or 1 hour after you take these medications. Ask your doctor or pharmacist if you are not sure if any of the medications you are taking are buffered.
• tell your doctor what herbal products you are taking, especially St. John's wort.
• tell your doctor if you are taking medications for erectile dysfunction such as sildenafil (Viagra), tadalafil (Cialis), or vardenafil (Levitra). You should know that atazanavir may increase the chance that you will experience serious side effects from these medications. If you are taking any of these medications and you experience dizziness, fainting, upset stomach, changes in vision, or a painful erection that lasts for several hours, call your doctor right away.
• tell your doctor if you have or have ever had an irregular heartbeat, diabetes, hemophilia (a condition in which the blood does not clot normally), liver disease such as hepatitis (a viral infection of the liver), or kidney, or heart disease.
• tell your doctor if you are pregnant or plan to become pregnant. If you become pregnant while taking atazanavir, call your doctor. You should not breastfeed if you are infected with HIV or are taking atazanavir.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking atazanavir.
• you should know that your body fat may increase or move to different areas of your body such as your breasts, waist, and upper back.

Special dietary instructions

Talk to your doctor about drinking grapefruit juice while taking this medicine.

What to do if you forget a dose

Take the missed dose as soon as you remember it. However, if you are scheduled to take your next dose within the next 6 hours, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Side Effects

MInor Side Effects

Atazanavir can cause high blood sugar (hyperglycemia). If you have any of these symptoms of high blood sugar, call your doctor immediately:

• thirst
• dry mouth
• tiredness
• flushing
• dry skin
• frequent urination
• loss of appetite
• trouble breathing

Atazanavir may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• headache
• diarrhea
• depression
• cough
• difficulty falling asleep or staying asleep
• pain, especially in joints, back, or muscles

Severe Side Effects

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

• dizziness
• lightheadedness
• upset stomach
• vomiting
• stomach pain
• extreme weakness and tiredness
• trouble breathing
• numbness, pain, or tingling in arms and legs
• fever
• yellowing of skin or eyes
• rash
• hives
• itching
• swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• difficulty swallowing
• hoarseness

Atazanavir may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/MedWatch/report.htm] or by phone [1-800-332-1088].

Storage conditions needed for this medication

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include:

• dizziness
• lightheadedness
• yellowing of skin or eyes

Other information

Keep all appointments with your doctor and the laboratory. Your doctor may order certain lab tests to check your body's response to atazanavir.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

Brand names

• Reyataz®