Atazanavir Capsules and Viekira

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.

Atazanavir is often used with ritonavir (brand name Norvir) to treat HIV infection. However, since ritonavir is one of the components of your hepatitis C medication, you do not need a separate dose of ritonavir with atazanavir if you are also receiving paritaprevir. The important thing is to take atazanavir in the morning, since only the morning doses of your hepatitis C medication contain ritonavir. Ask your doctor or pharmacist if you have any questions on how to take your medications properly. Another concern with respect to using atazanavir together with paritaprevir is the potential for increased risk of developing excessive bilirubin levels in the blood, which in severe cases can lead to seizures and brain damage. However, in clinical trials, bilirubin elevations usually resolved with continued treatment. Talk to your doctor if you have any questions or concerns. You should seek immediate medical attention if you notice yellowing of the skin or eyes, as it may indicate too much bilirubin in the circulation. 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.

ADJUST DOSE: Coadministration of atazanavir plus ritonavir in combination with ombitasvir/paritaprevir/ritonavir plus dasabuvir may significantly increase the plasma concentrations of paritaprevir. The mechanism may involve inhibition of both CYP450 3A4-mediated metabolism and P-glycoprotein-mediated transport by atazanavir and ritonavir. In 12 study subjects, administration of once daily morning doses of ombitasvir/paritaprevir/ritonavir (25 mg/150 mg/100 mg) plus twice daily doses of dasabuvir concomitantly with atazanavir 300 mg plus ritonavir 100 mg once daily in the evening (12 hours after morning doses of ombitasvir/paritaprevir/ritonavir plus dasabuvir) resulted in increases of approximately 2.2-, 3.2- and 12-fold in mean paritaprevir peak plasma concentration (Cmax), systemic exposure (AUC) and trough plasma concentration (Cmin), respectively. Mean ritonavir Cmax, AUC and Cmin also increased by approximately 1.6-, 3.2- and 24.7-fold, respectively, presumably due to dose-related increases from the additional dose of ritonavir per day. The mean Cmax and AUC of ombitasvir and dasabuvir were reduced slightly, by less than 20%, while the AUC and Cmin of atazanavir were increased by 19% and 68%, respectively.

MONITOR CLOSELY: Coadministration of atazanavir with ombitasvir/paritaprevir/ritonavir plus dasabuvir may increase the risk of hyperbilirubinemia. Both atazanavir and paritaprevir can cause elevations in indirect (unconjugated) bilirubin, the former by inhibition of UGT1A1 and the latter by inhibition of OATP1B1/1B3. In 63 subjects with HCV/HIV-1 coinfection, elevations in total bilirubin (mostly indirect) greater than two times the upper limit of normal occurred in 34 (54%) of subjects receiving ombitasvir/paritaprevir/ritonavir plus dasabuvir with ribavirin, 15 of whom were also receiving atazanavir at the time of bilirubin elevation. Nine of these patients also had adverse events of ocular icterus, jaundice, or hyperbilirubinemia. None of the subjects with hyperbilirubinemia had concomitant elevations of aminotransferases.

MANAGEMENT: When coadministered with ombitasvir/paritaprevir/ritonavir plus dasabuvir, atazanavir 300 mg should be given in the morning without ritonavir. The ritonavir component of the HIV antiretroviral regimen should be restarted after completion of treatment with ombitasvir/paritaprevir/ritonavir plus dasabuvir.

Atazanavir Capsules

Generic Name: atazanavir

Brand name: Reyataz

Synonyms: Atazanavir

What is Atazanavir Capsules?

Viekira

Generic Name: dasabuvir / ombitasvir / paritaprevir / ritonavir

Brand name: Viekira XR, Viekira Pak

Synonyms: Ombitasvir, Paritaprevir, Ritonavir, and Dasabuvir Extended-Release Tablets, and Dasabuvir

What is Viekira?