Atazanavir-Ritonavir

• Greater care should be taken in people with underlying liver problems.
• The safety and efficacy of atazanavir 300mg has not been established in patients with significant underlying liver disorders.
• Those patients who carried chronic hepatitis B or hepatitis C and are treated with the combination of antiretroviral therapy are more likely at the increased risk for severe and potentially fatal hepatic adverse reactions.
• There have been reports of increased bleeding, including spontaneous skin haematomas and haemarthroses in the patients with type A and B haemophiliac, treated with protease inhibitors.
• Chronic disease (like kidney disease) in HIV-infected patients treated with atazanavir, with or without ritonavir, has been reported during postmarketing surveillance.
• Patients are advised to ask for medical advice if they experience joint aches and pain, joint stiffness or difficulty in movement.
• Rashes are usually mild -to-moderate maculopapular skin eruptions that occur within the first 3 weeks of starting therapy with atazanavir.
• Patients should be advised of the signs and symptoms and monitored closely for skin reactions and Atazanavir should be discontinued if severe rash develops.
• Alcohol should be avoided for the initial few weeks (first 4) of therapy and should be used with caution thereafter.
• Atazanavir and ritonavir should be administered simultaneously with, or at least 10 hours after, the H2-receptor antagonist.

Patients taking atazanavir should not use medicinal products that are substrates of the CYP3A4 isoform of cytochrome P450 and have narrow therapeutic windows. Coadministration may result in competitive inhibition of the metabolism of these medicinal products and create the potential for serious and/or life-threatening adverse events such as cardiac arrhythmia (e.g. cisapride, pimozide), prolonged sedation or respiratory depression such as midazolam, triazolam, or other events such as ergot derivatives.