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Atazanavir Powder for Oral Suspension and Axid Oral Solution

Determining the interaction of Atazanavir Powder for Oral Suspension and Axid Oral Solution and the possibility of their joint administration.

Check result:
Atazanavir Powder for Oral Suspension <> Axid Oral Solution
Relevance: 16.11.2022 Reviewer: Shkutko P.M., M.D., in

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.

Consumer:

Talk to your doctor before using atazanavir together with raNITIdine. Combining these medications may interfere with the absorption of atazanavir and reduce its effectiveness. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. 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.

Professional:

ADJUST DOSE: Concurrent administration of H2-receptor antagonists may decrease the oral bioavailability of atazanavir and substantially reduce its concentrations in plasma. Atazanavir solubility decreases with increasing pH, thus inhibition of gastric acid secretion may interfere with dissolution of the drug. Subtherapeutic antiretroviral drug levels may lead to reduced viral susceptibility and development of resistance.

ADJUST DOSE: Concurrent administration of atazanavir/cobicistat or atazanavir/ritonavir with tenofovir and H2-receptor antagonists may decrease the oral bioavailability of atazanavir by an additional 10% to 20%, compared to concurrent use with an H2 antagonist alone.

MANAGEMENT: When used with atazanavir/cobicistat or atazanavir/ritonavir once daily in adults, the dosage of the H2-receptor antagonist should be no more than the equivalent of famotidine 40 mg twice daily in antiretroviral treatment-naive patients and 20 mg twice daily in treatment-experienced patients. Atazanavir/cobicistat or atazanavir/ritonavir should be administered simultaneously with, and/or at least 10 hours after, the H2-receptor antagonist. If tenofovir is also prescribed, no additional precaution is necessary in treatment-naive patients, whereas the dosage of atazanavir/ritonavir should be increased to 400 mg/100 mg once a day in treatment-experienced patients. All three antiretroviral agents should be administered as a single daily dose with food. In the event that ritonavir is not tolerated by a treatment-naive patient, atazanavir may be administered at an increased dosage of 400 mg once daily at least 2 hours before and at least 10 hours after the H2-receptor antagonist. Dosage of the H2-receptor antagonist should not exceed the equivalent of famotidine 20 mg twice daily. Atazanavir without ritonavir is not recommended for treatment-experienced patients with prior virologic failure or pregnant women. For treatment-experienced pregnant women during the second or third trimester, when atazanavir is coadministered with either an H2-receptor antagonist or tenofovir, atazanavir 400 mg with ritonavir 100 mg once daily is recommended. There are insufficient data to recommend an atazanavir dosage for use with both an H2-receptor antagonist and tenofovir in treatment-experienced pregnant women. No dosage adjustment is required for postpartum patients. However, patients should be closely monitored for adverse events because atazanavir exposures could be higher during the first 2 months after delivery. Coadministration of atazanavir/cobicistat in combination with tenofovir and an H2 receptor antagonist should generally be avoided. There are insufficient data to recommend an atazanavir/cobicistat dosage for use with both an H2-receptor antagonist and tenofovir.

References
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  • Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
  • "Product Information. Reyataz (atazanavir)." Bristol-Myers Squibb, Princeton, NJ.
  • "Product Information. Evotaz (atazanavir-cobicistat)." Bristol-Myers Squibb, Princeton, NJ.
  • Klein CE, Chiu YL, Cai Y, et al. "Effects of Acid-reducing agents on the pharmacokinetics of lopinavir/ritonavir and ritonavir-boosted atazanavir." J Clin Pharmacol 48 (2008): 553-62
  • Ray JE, Marriott D, Bloch MT, McLachlan AJ "Therapeutic drug monitoring of atazanavir: surveillance of pharmacotherapy in the clinic." Br J Clin Pharmacol 60 (2005): 291-9
  • "Drug interactions. Atazanavir and acid-reducing agents." TreatmentUpdate 18 (2006): 4
  • Agarwala S, Persson A, Eley T, et al "Effect of famotidine 20 and 40 mg dosing regimens on the bioavailability of atazanavir with ritonavir in combination with tenofovir in healthy subjects. Available from: URL: http://www.natap.org/2007/CROI/croi_62.htm." ([2007 Feb 25-7]):
Atazanavir Powder for Oral Suspension

Generic Name: atazanavir

Brand name: Reyataz

Synonyms: Atazanavir

Axid Oral Solution

Generic Name: nizatidine

Brand name: Baciguent, Probiotic Formula, Proferrin-ES

Synonyms: n.a.

In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.