Atazanavir: Difference between revisions

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== Drug interactions ==
== Drug interactions ==


The absorption of indinavir is decreased by [[St. John's Wort]], [[Vitamin C]], antacids, such as [[aluminum]], [[bismuth]], [[calcium]], [[magnesium]], [[magnesium oxide]] and [[magnesium sulfide]], by [[efavirenz]], [[omeprazole]] and related compounds ([[esomeprazole]], [[lansoprazole]], [[pantoprazole]] and [[rabeprazole]]) and by [[Rifampin]] and its derivitive [[Rifabutin]]. The effects of indinavir are increased when taken with [[clarithromycine]], [[delavirdine]] or [[ketoconazole]].  [[Saquinavir]], also a protease inhibitor, may be an agonist of indinavir.
The absorption of indinavir is decreased by [[St. John's Wort]], antacids and other gastric pH modifiers, such as [[aluminum]], [[bismuth]], [[calcium]], [[cimetidine]], [[Dihydroxyaluminium]], [[famotidine]], [[magnesium]], [[magnesium oxide]], [[magnesium sulfide]], [[Nizatidine]], [[Ranitidine]] and [[sodium bicarbonate]], by [[efavirenz]], [[omeprazole]] and related compounds ([[esomeprazole]], [[lansoprazole]], [[pantoprazole]] and [[rabeprazole]]) and by [[Rifampin]] and its derivitive [[Rifabutin]]. It is also decreased when taking [[Nevirapine]] or [[Tenofovir]].
 
Indinavir increases the anticoagulant effect of [[anisindione]], [[acenocoumarol]], [[dicumarol]], and [[warfarin]] and also increases the effect of [[benzodiazepine]]. Benzodiazepine related drugs include [[Alprazolam]], [[Chlordiazepoxide]], [[Clonazepam]], [[Clorazepate]], [[Diazepam]], [[Estazolam]], [[Flurazepam]], [[Halazepam]], [[Midazolam]], [[Prazepam]], [[Quazepam]] and [[Triazolam]].
 
An increased risk of cardiotoxicity and [[arrhythmia]]s occurs when taken with [[astemizole]], [[cisapride]] or [[terfenadine]].  The effects and toxicity of [[amiodarone]], [[atorvastatin]], [[carbamazepine]], [[cyclosporine]], [[fentanyl]], [[fusidic acid]], [[pimozide]], [[sildenafil]],  [[tacrolimus]] and [[Vardenafil]] are increased when taken with indinavir. The effect and toxicity of ergot derivatives, such as [[ergotamine]] and [[dihydroergotamine]], and  [[erlotinib]], [[quinupristin]], [[ranolazine]] and [[trazodone]] are also increased. An increase in extrapyramidal symptoms may occur with [[risperidone]] and increased risks of [[hyperbilirubinemia]] are associated with [[atazanavir]] use.
 
 
 
Amiodarone Increased risk of cardiotoxicity and arrhythmias
Amitriptyline Increases the effect and toxicity of tricyclics
Amoxapine Increases the effect and toxicity of tricyclics
Anisindione The protease inhibitor increases the anticoagulant effect
Atorvastatin Increases the effect and toxicity of the statin
Bepridil Increases the effect and toxicity of bepridil 
Cimetidine This gastric pH modifier decreases the levels/effects of atazanavir
Cisapride Increased risk of cardiotoxicity and arrhythmias
Clarithromycin Increases levels of clarithromycin
Clomipramine Increases the effect and toxicity of tricyclics
Cyclosporine Increases the effect and toxicity of immunosuppressant
Desipramine Increases the effect and toxicity of tricyclics
Dicumarol The protease inhibitor increases the anticoagulant effect
Dihydroergotamine Increases the effect and toxicity of ergot derivative
Dihydroquinidine barbiturate Increased risk of cardiotoxicity and arrhythmias
Dihydroxyaluminium This gastric pH modifier decreases the levels/effects of atazanavir
Diltiazem Increases the effect and toxicity of diltiazem
Doxepin Increases the effect and toxicity of tricyclics
Ergotamine Increases the effect and toxicity of ergot derivative
Erlotinib This CYP3A4 inhibitor increases levels/toxicity of erlotinib
Famotidine This gastric pH modifier decreases the levels/effects of atazanavir
Imipramine Increases the effect and toxicity of tricyclics
Indinavir Increased risk of hyperbilirubinemia with this association
Irinotecan Increases levels/effect of irinotecan 
Lidocaine Increased risk of cardiotoxicity and arrhythmias
Lovastatin Increased risk of myopathy/rhabdomyolysis
Methylergonovine Increases the effect and toxicity of ergot derivative
Midazolam Increases the effect and toxicity of benzodiazepine
Nevirapine Nevirapine decreases levels/effect of atazanavir
Acenocoumarol The protease inhibitor increase the anticoagulant effect
Nizatidine This gastric pH modifier decreases the levels/effects of atazanavir
Nortriptyline Increases the effect and toxicity of tricyclics 
Pimozide The protease inhibitor increases the effect and toxicity of pimozide
Protriptyline Increases the effect and toxicity of tricyclics
Quinidine Increased risk of cardiotoxicity and arrhythmias
Quinidine barbiturate Increased risk of cardiotoxicity and arrhythmias 
Ranitidine This gastric pH modifier decreases the levels/effects of atazanavir
Ranolazine Increased levels of ranolazine- risk of toxicity
Rifabutin Increases levels/toxicity of rifabutin
Rifampin Rifampin reduces levels and efficacy of atazanavir
Ritonavir Association with dose adjustment
Sildenafil Increases the effect and toxicity of sildenafil
Simvastatin Increased risk of myopathy/rhabdomyolysis
Sirolimus Increases the effect and toxicity of immunosuppressant
Sunitinib Possible increase in sunitinib levels
Tacrolimus Increases the effect and toxicity of immunosuppressant
Triazolam Increases the effect and toxicity of benzodiazepine
Trimipramine Increases the effect and toxicity of tricyclics
Warfarin The protease inhibitor increases the anticoagulant effect
Sodium bicarbonate This gastric pH modifier decreases the levels/effect of atazanavir
Tenofovir Tenofovir decreases the levels/effects of atazanavir
 
 
 
 
 
 
 


Atazanavir increases the anticoagulant effect of [[anisindione]], [[acenocoumarol]],  [[dicumarol]], and [[warfarin]] and also increases the effect of [[benzodiazepine]] when taken with [[Midazolam]] or [[Triazolam]].  An increased risk of cardiotoxicity and [[arrhythmia]]s occurs when taken with [[amiodarone]], [[cisapride]], [[Dihydroquinidine barbiturate]], [[lidocaine]], [[quinidine]], and [[quinidine barbiturate]].


The effects and toxicity of some [[statin]]s, such as [[atorvastatin]], [[lovastatin]] and [[simvastatin]], is increased when taking atazanavir.  The effects of [[Cyclosporine]], [[pimozide]], [[sildenafil]] and [[tacrolimus]] are increased when taken with atazanavir. The effect and toxicity of ergot derivatives, such as [[ergotamine]], [[dihydroergotamine]] and  [[methylergonovine]], and the drugs [[erlotinib]] and [[ranolazine]] are also increased. The effects and toxicity of tricyclic compounds are increased when atazanavir is taken with [[amitriptyline]], [[amoxapine]], [[clomipramine]], [[desipramine]], [[doxepin]], [[imipramine]], [[nortriptyline]], [[protriptyline]], or [[trimipramine]].  The effects or levels of the following are also increased:  [[Bepridil]], [[clarithromycin]], [[diltiazem]], [[irinotecan]], [[sirolimus]] and [[sunitinib]].  Increased risk of [[hyperbilirubinemia]] exists when [[indinavir]] and atazanavir are taken together.


== External Links ==
== External Links ==
* {{DailyMed}}
* {{DailyMed}}
* Drug Bank at http://www.drugbank.ca/cgi-bin/getCard.cgi?CARD=DB01072.txt
* Drug Bank at http://www.drugbank.ca/cgi-bin/getCard.cgi?CARD=DB01072.txt

Revision as of 15:42, 29 January 2008

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Atazanavir, widely known as ATZ, and also called ATV and formerly called BMS-232632, is an antiretroviral protease inhibitor (PI) used to treat HIV/AIDS. Unlike most protease inhibitors, atazanavir can be given once a day and hence has fewer effects on patient lipid profiles. Like most protease inhibitors, it is used in combination with other HIV medications. It is sold under the brand names Latazanavir®, Reyataz® and Zrivada®. It inhibits the proteolytic cleavage of the viral polyprotein precursors (Gag and Gag-Pol) so that the individual active proteins of HIV cannot be made, thus stopping the formation of mature, infectious viral particles. This and other protease inhibitors are almost always used in combination with at least two other anti-HIV drugs.

Its IUPAC chemical name is methyl N-[(2S)-1-[[(2S,3S)-3-hydroxy-4-[[[(2S)-2-(methoxycarbonylamino)- 3,3-dimethylbutanoyl]amino]-[(4-pyridin-2-ylphenyl)methyl]amino]-1-phenylbutan-2-yl]amino]-3,3-dimethyl-1-oxobutan-2-yl]carbamate, and its chemical formula is C38H52N6O7.


Drug interactions

The absorption of indinavir is decreased by St. John's Wort, antacids and other gastric pH modifiers, such as aluminum, bismuth, calcium, cimetidine, Dihydroxyaluminium, famotidine, magnesium, magnesium oxide, magnesium sulfide, Nizatidine, Ranitidine and sodium bicarbonate, by efavirenz, omeprazole and related compounds (esomeprazole, lansoprazole, pantoprazole and rabeprazole) and by Rifampin and its derivitive Rifabutin. It is also decreased when taking Nevirapine or Tenofovir.

Atazanavir increases the anticoagulant effect of anisindione, acenocoumarol, dicumarol, and warfarin and also increases the effect of benzodiazepine when taken with Midazolam or Triazolam. An increased risk of cardiotoxicity and arrhythmias occurs when taken with amiodarone, cisapride, Dihydroquinidine barbiturate, lidocaine, quinidine, and quinidine barbiturate.

The effects and toxicity of some statins, such as atorvastatin, lovastatin and simvastatin, is increased when taking atazanavir. The effects of Cyclosporine, pimozide, sildenafil and tacrolimus are increased when taken with atazanavir. The effect and toxicity of ergot derivatives, such as ergotamine, dihydroergotamine and methylergonovine, and the drugs erlotinib and ranolazine are also increased. The effects and toxicity of tricyclic compounds are increased when atazanavir is taken with amitriptyline, amoxapine, clomipramine, desipramine, doxepin, imipramine, nortriptyline, protriptyline, or trimipramine. The effects or levels of the following are also increased: Bepridil, clarithromycin, diltiazem, irinotecan, sirolimus and sunitinib. Increased risk of hyperbilirubinemia exists when indinavir and atazanavir are taken together.

External Links