Atazanavir

Please read this factsheet together with the patient information leaflet carefully before taking your medicine. Please speak to your clinic doctor or pharmacist if you would like more information about how these drugs work.

Atazanavir, also known as Reyataz®, belongs to a class of drugs called protease inhibitors. Protease Inhibitors are used for the treatment of HIV infection, in combination with other anti-HIV drugs. If you would like more information about how these drugs work in the body, a leaflet is available. Please ask the pharmacist for details.

Before taking atazanavir
Tell your doctor about:

* All other drugs that you are taking, including any that you buy over the counter in a community pharmacy, herbal medicines and recreational drugs.
* Previous allergy to any medicines.
* If you have ever had any liver disease.
* If you have ever had any kidney problems.
* If you are pregnant / planning to become pregnant.
* If you are breast feeding.
* If you are diabetic.
* If you are a haemophiliac.

Taking your atazanavir

* Atazanavir is available as 100mg, 150mg and 200mg capsules. The 100mg capsules are dualcoloured blue and white capsules, the 150mg capsules are dual-coloured blue and powder blue capsules and the 200mg capsules are blue.
* Atazanavir is taken once a day. It is normally taken in combination with ritonavir which boosts the amount of atazanavir in the body, making it more effective.
* The recommended dose is 300mg (2x150mg capsules) once a day and one ritonavir capsule (100mg) taken at the same time, once a day.
* You should always take atazanavir with food. This helps the drug to be absorbed from the stomach. Do not open the capsules, always swallow them whole.
* Try to take your atazanavir as close as possible to twenty four hours apart, at the same time each day. It is essential that you do not miss your daily dose. If you do miss a dose take it as soon as you remember, but do not double-up the next dose.

Do not run out of atazanavir. If you are going on holiday and need additional supplies, tell your doctor. When receiving a supply from pharmacy, ensure that you have an adequate supply to last until your next appointment.

Other drugs and atazanavir
Atazanavir is metabolised (processed in the body) by the liver. Some other drugs are metabolised in the same way. This is why it is important to tell your doctor about all the medicines that you take even if you only take them occasionally, including herbal and recreational drugs.

Examples of some drugs that are metabolised in the same way as atazanavir and should NOT be taken are rifampicin, phenytoin, carbamazepine, simvastatin, ergotamine, certain benzodiazepines, St. Johns Wort and terfenadine (Triludan®). Other examples of drugs that are metabolised in the same way as atazanavir include rifabutin, warfarin, methadone, drugs for erectile dysfunction (e.g. Viagra®), NNRTIs and other protease inhibitors. Your doctor may alter your doses if you are taking one of these drugs. Atazanavir can stop hormonal contraceptives from working effectively, so you must use an alternative form of contraception, e.g. barrier methods.

Proton pump inhibitors (e.g. omeprazole and lansoprazole) should not be taken if you are on atazanavir. Atazanavir requires an acid environment to be absorbed, and these medicines lower the amount of acid that is present in the stomach. When taken with an H2-receptor antagonist (e.g Ranitine) the dosing of the two medications should be separated. Atazanavir with ritonavir should be taken 2 hours before or at least 10 hours following the administration of an H2-receptor antagonist. If you are taking antacids (for indigestion) or the chewable tablet formulation of didanosine, take atazanavir at least two hours before or one hour afterwards.

Side effects
Atazanavir, like all other medicines has some side effects. The most important ones are:

* Yellowing of the skin or eyes. This may be caused by a build up of bilirubin levels in the blood (hyperbilirubinaemia). This is thought to be harmless but inform your doctor if this occurs.
* If you feel a change in the way your heart beats or feel dizzy or light-headed inform your doctor.
* Other side effects that are common with all anti HIV drugs include nausea, headache, rash, diarrhoea, numbness, and tingling or burning of hands and feet.

Combination regimes containing protease inhibitors have been associated with redistribution of body fat in some patients. They are also associated with metabolic abnormalities such as raised cholesterol, increased risk of diabetes and heart disease. Clinical trials so far have shown that this is less of a problem with atazanavir compared to other protease inhibitors, however your clinic doctor will monitor you for all of these.

If you experience any of these side effects or any new symptoms after you start atazanavir, tell your doctor who will advise you on what to do. If you decide to stop atazanavir it is important you tell your doctor so that he or she can discuss other treatment options with you.

Admission to hospital
If you are admitted to hospital please bring all your medicines with you. This is especially important for anti-HIV drugs, as they have to be taken regularly. Thomas Macaulay Ward operates a self medication programme. Some people are able to self administer their own medicines to enable them to stick to the routine they are used to at home.

Storing your atazanavir
Atazanavir should be stored at room temperature. Do not store in damp place e.g. bathroom cabinet.