Standard DoseOne tablet once daily with food. Each tablet contains 300 mg of atazanavir boosted by 150 mg cobicistat. Must be taken in combination with another antiretroviral(s) which does not contain the medications in this drug or medication from the same drug classes. Use with Intelence or Sustiva is not recommended.
Use in treatment-experienced patients depends on protease inhibitor drug resistance. Co-administration with drugs containing tenofovir disoproxil fumarate (Viread, found in Atripla, Cimduo, Complera, Delstrigo, Stribild, Symfi, Symfi Lo, and Truvada) is not recommended if kidney function as measured by creatinine clearance is below 70 mL/min. Co-administration with drugs containing tenofovir alafenamide (Vemlidy, found in Biktarvy, Descovy, Genvoya, Odefsey, and Symtuza) is not recommended if kidney function as measured by creatinine clearance is below 30 mL/min.
Not recommended in people with any degree of liver impairment or those who are treatment-experienced and on hemodialysis.
Take missed dose as soon as possible, unless it is closer to the time of your next dose. Do not double up on your next dose. Evotaz is not recommended during pregnancy due to substantially lower exposures of atazanavir and cobicistat during pregnancy.
Potential Side Effects and Toxicity
- See the individual drugs contained in Evotaz: Reyataz and Tybost.
- See package insert for more complete information on potential side effects and interactions.
The most common (greater than 10%) side effects reported in clinical trials were nausea, ocular icterus (yellowing of the eyes), and jaundice. Rash has also been reported, though less common. Cobicistat can cause a small, reversible increase in serum creatinine (SCr, which indicates the eGFR or estimated CrCl lab values) within the first few weeks of treatment without affecting actual kidney function (see Tybost for more information). Patients experiencing a confirmed increase in serum creatinine of greater than 0.4 mg/dL from baseline should be closely monitored for renal safety. Serum phosphorus in patients with or at risk for kidney impairment should also be monitored. Kidney impairment, including cases of acute kidney failure and Fanconi syndrome, has been reported in patients taking both cobicistat and Viread (tenofovir DF or TDF, also found in Truvada). When used with TDF, a baseline CrCl, urine glucose, and urine protein is needed; CrCl, urine glucose, and urine protein should be monitored regularly while taking Tybost-containing regimens. Observational cohort studies reported an association between some PIs (including darunavir, found in Prezista and Prezcobix, and lopinavir/ritonavir, brand name Kaletra) and an increased risk of cardiovascular (CV) events; however, this has not been observed with Reyataz (atazanavir, or ATV), found in Evotaz. Another observational cohort study of predominantly male participants found a lower rate of cardiovascular events in those receiving atazanavir-containing regimens compared with other regimens. Further study is needed.
Potential Drug Interactions
Cobicistat interacts with many drugs, because as a booster it inhibits liver enzymes involved in drug metabolism. Do not take with ergot derivatives, triazolam, oral midazolam, lurasidone, pimozide, Revatio, simvastatin, lovastatin, St. John’s wort, Viramune, alfuzosin, ranolazine, rifampin, dronedarone, or irinotecan. Do not take with colchicine if there is kidney or liver impairment. Do not use with Olysio, Viekira Pak, or Zepatier. Can be used with Sovaldi, Daklinza (reduce Daklinza dose to 30 mg), or Harvoni (if TDF is not part of the HIV regimen). Monitor for tenofovir toxicities with Epclusa if TDF is part of the regimen. Tell your provider or pharmacist about all medications, herbals, and supplements you are taking or thinking of taking, prescribed or not, as there are other drug interactions which are not listed here.
Evotaz is an alternative PI for first-time therapy in DHHS HIV treatment guidelines, and is one of two PIs that are co-formulated with the booster cobicistat (the other is Prezcobix). Since most people who take Reyataz must use it with a PK enhancer like cobicistat (Tybost) or ritonavir (Norvir), this formulation makes for greater convenience, one less pill, and one less co-pay. Tybost is not an HIV medication. Similar to ritonavir, it is used to boost blood levels of other drugs. The two PK enhancers have a long list of drug interactions. Maintaining adequate hydration is important with Evotaz. Reyataz + Tybost + Epzicom is no longer included in the list of “Recommended Initial Regimens in Certain Clinical Situations” because it has disadvantages when compared with other regimens in this category.
Dr. David Hardy says:
Approved in early 2015 (at the same time as Prezcobix), this two-drug tablet combines Reyataz with a booster (Tybost) to ensure boosting and reduce pill number. There is and will not be (any time soon) an STR containing Reyataz. As discussed on the Reyataz page, the use of Reyataz as a first-time regimen for PLWH has significantly decreased due to its increased side effects compared to other ART options.
Activist Moisés Agosto-Rosario says:
Evotaz is atazanavir boosted with cobicistat, and is prescribed for treatment-experienced patients and those initiating HIV treatment for the first time. Evotaz is a once-a-day, single-tablet two-drug treatment for use in combination with other HIV medicines. Compared to previous PIs, it has a friendly lipid profile, eliminating any worries about metabolic complications. Even though cobicistat is not clinically inferior to boosting with ritonavir, as a single-tablet dual therapy it makes treatment easier for individuals by eliminating one pill and an extra co-payment. AbbVie, the maker of ritonavir, never licensed ritonavir to be used in a co-formulation with other HIV drugs. Drug interactions are a concern. Acid reflux medications can interfere with the absorption of atazanavir. With atazanavir there is an increase of bilirubin that, although not harmful, causes yellowing of the eyes and skin. Watch the kidneys and the liver. The brand name for atazanavir is Reyataz and it was originally boosted with ritonavir.