Atazanavir and cobicistat and Viramune O/S

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Using atazanavir together with nevirapine may alter the blood levels and effects of both drugs. Combining these medications may significantly reduce the blood levels and effects of atazanavir and increase the blood levels and effects of nevirapine. Contact your doctor if your condition changes or you experience increased side effects such as rash on any parts of your body, loss of appetite, nausea, vomiting, jaundice (yellowing of the skin and/or eyes), dark colored urine, pale colored stools, or pain or ache in the right abdominal area below your ribs. Your doctor may be able to prescribe alternatives that do not interact. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

CONTRAINDICATED: Coadministration with nevirapine may decrease the plasma concentrations of atazanavir, with or without cobicistat or low-dose ritonavir as a pharmacokinetic booster, while the plasma concentrations of nevirapine may be increased. The plasma concentrations of cobicistat may also be reduced. Reduced plasma concentrations of atazanavir may lead to a loss of therapeutic effect and development of resistance to atazanavir. Increased nevirapine plasma concentrations may increase the risk of nevirapine-associated toxicity, including hepatotoxicity, fatal and non-fatal skin reactions (e.g., Stevens Johnson syndrome), and hypersensitivity reactions. The proposed mechanisms are induction of the CYP450 3A4 isoenzyme by nevirapine and the inhibition of CYP450 3A4 by atazanavir and cobicistat. No clinically significant interaction has been reported between nevirapine and ritonavir. When atazanavir-ritonavir (300 mg-100 mg once daily) was given in combination with nevirapine (200 mg twice daily) in HIV-infected patients, there was a reduction in atazanavir mean systemic exposure (AUC), peak plasma concentration (Cmax) and trough plasma concentration (Cmin) of 42%, 28%, and 72%, respectively. In contrast, the mean AUC, Cmax, and Cmin of nevirapine increased by 25%, 17%, and 32%, respectively. Data are not available for atazanavir-cobicistat.

MANAGEMENT: Given the risk of reduced viral susceptibility and resistance development associated with subtherapeutic antiretroviral drug levels, along with the increased risk of nevirapine-associated toxicity, it is not recommended to prescribe unboosted atazanavir or atazanavir-boosted with cobicistat or low-dose ritonavir in combination with nevirapine. Some authorities consider concomitant use of nevirapine with unboosted atazanavir or atazanavir boosted with cobicistat contraindicated.

Atazanavir and cobicistat

Generic Name: atazanavir / cobicistat

Brand name: Evotaz

Synonyms: Atazanavir and Cobicistat

What is Atazanavir and cobicistat?

Viramune O/S

Generic Name: nevirapine

Brand name: Viramune, Viramune XR

Synonyms: Nevirapine

What is Viramune O/S?