|Systematic (IUPAC) name|
|Pregnancy cat.||B2 (AU) B (US)|
|Legal status||POM (UK) ℞-only (US)|
|Excretion||Fecal and renal|
|Mol. mass||704.856 g/mol|
|(what is this?)|
Atazanavir (pronunciation: //, A-tə-ZA-nə-vir), marketed under the trade name Reyataz by Bristol Myers, (formerly known as BMS-232632) is an antiretroviral drug of the protease inhibitor (PI) class. Like other antiretrovirals, it is used to treat infection of human immunodeficiency virus (HIV).
Atazanavir is distinguished from other PIs in that it can be given once-daily (rather than requiring multiple doses per day) and has lesser effects on the patient's lipid profile (the amounts of cholesterol and other fatty substances in the blood). Like other protease inhibitors, it is used only in combination with other HIV medications.
The U.S. Food and Drug Administration (FDA) approved atazanavir on June 20, 2003. Atazanavir is the first PI approved for once-daily dosing, and also appears to be less likely to cause lipodystrophy and elevated cholesterol as side effects. It may also not be cross-resistant with other PIs. When boosted with ritonavir it is equivalent in potency to lopinavir for use in salvage therapy in patients with a degree of drug resistance, although boosting with ritonavir reduces the metabolic advantages of atazanavir.
On October 20, 2006, the FDA approved a new formulation of atazanavir (300 mg capsules) to be taken as part of combination drug therapy. This formulation should reduce pill burden, as one 300 mg capsule may replace two 150 mg capsules.
Newer research has been investigating the potential anticancer effects of atazanavir. For example, laboratory studies have found that this drug can inhibit the growth of brain tumor cells in culture.
The efficacy of atazanavir has been assessed in a number of well designed trials in ART-naive and ART-experienced adults.
Bilirubin levels in the blood are normally asymptomatically raised with atazanavir. A single case of torsades de pointes attributable to atazanavir therapy has been described. Atazanavir has less effect on glucose levels than ritonavir.
In April 2009, the US FDA issued a warning: atazanavir should not be used with proton-pump inhibitors, such as omeprazole (Prilosec), esomeprazole (Nexium), or rabeprazole (Aciphex). According to the FDA, "A 76% reduction in atazanavir area under the concentration-time curve (AUC) and a 78% reduction in atazanavir trough plasma concentration (Cmin) were observed when Reyataz/ritonavir [another protease inhibitor, often prescribed with azatanavir] 300/100 mg was coadministered with omeprazole 40 mg." In other words, proton pump inhibitors reduce the absorption and effects of atazanavir due to their effect in decreasing stomach acidity.
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- Pyrko, P.; Kardosh, A; Wang, W; Xiong, W; Schönthal, AH; Chen, TC (2007). "HIV-1 protease inhibitors nelfinavir and atazanavir induce malignant glioma death by triggering endoplasmic reticulum stress". Cancer Research 67 (22): 10920–8. doi:10.1158/0008-5472.CAN-07-0796. PMID 18006837.
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- "Atazanavir, with or without ritonavir should not be coadministered with proton pump inhibitors". Food and Drug Administration. March 27, 2009. Retrieved August 26, 2013.