Reyataz

Most common side effects may include nausea, ocular icterus (yellowing of the eyes as a result of increased bilirubin levels), jaundice, and rash. The ocular icterus and jaundice are reversible upon discontinuation of the drug. Other less common side effects may include kidney stones, gallstones, abnormal heart rhythm, and elevated liver enzymes (more common in people with hepatitis B or C). Capsules do not contain phenylalanine but oral powder does; thus, use with caution in individuals with phenylketonuria (PKU). Kidney laboratory testing should be performed on all patients before starting Reyataz, and continued during treatment. Renal laboratory testing should include serum creatinine, estimated creatinine clearance, and urinalysis with microscopic examination. Rarely, chronic kidney disease has been observed.

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). 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.

Do not use with alfuzosin, rifampin, irinotecan, ergot derivatives, triazolam, oral midazolam, St. John’s wort, Revatio, or Viramune (nevirapine). Do not use lovastatin, simvastatin, or co-formulations containing them (Advicor and Vytorin) for treatment of high cholesterol. Alternatives for these are atorvastatin, rosuvastatin, pravastatin, pitavastatin, and fluvastatin, but should be used with caution and started at the lowest dose possible; monitor for increased side effects. Note: Tybost is not interchangeable with Norvir. Proton pump inhibitors (PPIs, like Aciphex, Dexilant, Nexium, Prilosec, Protonix, and Prevacid) and H2-receptor antagonists (H2RAs, like Pepcid, Zantac, and Tagamet) can prevent Reyataz from being absorbed. Treatment-experienced people should not take PPIs while on Reyataz. See package insert for antacid dosing adjustment recommendations.

If taking chewable antacids such as Rolaids and Tums, take Reyataz with food two hours before or one hour after. Treatment-experienced people should not take Reyataz with Sustiva. Viread decreases levels of Reyataz, and Reyataz/Norvir increases Viread levels; monitor for adverse events. Reyataz can be taken unboosted with Epzicom if absolutely necessary (Reyataz dose of 400 mg daily). Bepridil, amiodarone, quinidine, and lidocaine should be taken with caution because of the risk for worsening abnormal heart rhythm. Close monitoring is required when used with warfarin. Calcium channel blockers should be monitored. Use caution when using the antifungals itraconazole or ketoconazole. Voriconazole is not recommended. Reducing dose and frequency of rifabutin to 150 mg every other day or three times a week is recommended. Reyataz + Norvir increases levels of fluticasone (found in Advair, Breo Ellipta, Arnuity Ellipta, Flonase, and Flovent); monitor for signs of Cushing’s syndrome (increased abdominal fat, fatty hump between the shoulders, rounded face, red/purple stretch marks, bone loss, increased appetite, possible high blood pressure, and sometimes diabetes). An alternative corticosteroid is recommended.

Reyataz can be taken with birth control pills that contain no more than 30 mcg of ethinyl estradiol if taking Reyataz without Norvir, and at least 35 mcg if taken with Norvir. Use caution with carbamazepine, phenobarbital, and phenytoin. Erectile dysfunction drugs should not exceed 10 mg Cialis, or 2.5 mg Levitra per 72 hours, or 25 mg Viagra per 48 hours. A lower dose of trazodone is recommended. Use with caution with bosentan, salmeterol, and immunosuppressants, and use lower dose of colchicine. Use with Norvir when taking buprenorphine; monitor for sedation. Do not take with Zepatier. Reyataz/Norvir is not recommended with Harvoni if tenofovir DF (TDF, in Truvada) is part of an HIV regimen. With Epclusa, monitor for tenofovir toxicities if TDF is part of an HIV 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 many other drug interactions not listed here.

Yellowing of the eyes and skin is a common reason for discontinuation. Reyataz plus Norvir and 2 NRTIs is still recommended as a preferred regimen during pregnancy. Reyataz plus Tybost (co-formulated as Evotaz) is not recommended during pregnancy. Maintaining adequate hydration is important with Reyataz. Reyataz + Norvir + Epzicom is no longer included in the list of “Recommended Initial Regimens in Certain Clinical Situations,” because it has disadvantages compared to other regimens in this category.

Dr. Melanie Thompson:

Atazanavir became popular because it was once daily, lipid-neutral, and more tolerable than first generation PIs. It is approved unboosted at a high dose, but it is recommended only when used with ritonavir or cobicistat. It is no longer a first-line agent because of its substantial side effects, including jaundice, gallstones, and kidney stones, as well as many drug interactions associated not only with boosters, but also with the drug itself. In fact, it’s unclear that atazanavir plays any role at all in the landscape of current therapy.

Reyataz should not be paired with ABC/3TC due to higher risk of virologic failure.

Acid-blocking medications lower the absorption of atazanavir, and should be avoided.

Atazanavir has not been associated with increased rates of cardiovascular disease in large cohort studies.

Activist Bridgette Picou:

When taking Reyataz you may notice yellowing of the skin and eyes. This usually reverses once the medication is stopped and is a result of bilirubin. Monitor the kidneys and liver. While drug-drug interactions, such as with antacids, should be monitored, Reyataz is lipid friendly.