Atazanavir and ritonavir (ATV/r) basically is a combination medication used in the treatment of HIV/AIDS. It combines atazanavir and ritonavir. It can be a replacement of lopinavir/ritonavir.
Atazanavir is not a cure for HIV infection. Advise patients to remain under the care of a healthcare provider while using atazanavir. Following are the some warnings and precautions of atazanavir and ritonavir combination medication, which should be followed by the healthcare professionals as well as patients:
Severe Skin Reactions: Immediately discontinue if severe rash develops. Inform patients that there have been reports of severe skin reactions (eg, Stevens-Johnson syndrome, erythema multiforme, and toxic skin eruptions) with atazanavir use. Advise patients that if signs or symptoms of severe skin reactions or hypersensitivity reactions develop, they must discontinue atazanavir and seek medical evaluation immediately.
Hyperbilirubinemia: Most patients experience asymptomatic increases in indirect bilirubin, which is reversible upon discontinuation. Do not dose reduce. If a concomitant transaminase increase appears, should be evaluated for alternative etiologies.
Inform patients that asymptomatic elevations in indirect bilirubin have occurred in patients
receiving atazanavir. This could be accompanied by the whites of the eyes or yellowing of the skin and alternative ARV therapy can be considered if the patient has cosmetic concerns.
Cardiac conduction abnormalities: PR interval prolongation may occur in some patients. In patients with preexisting conduction system disease ECG monitoring should be considered, when administered with other medications that may prolong the PR interval.
Chronic kidney diseases: These have been reported during postmarketing surveillance in HIV-infected patients treated with atazanavir, with or without ritonavir. Consider alternatives in patients at high risk for renal disease or with pre-existing renal disease. Renal laboratory tests should be monitored prior to the therapy and also during the treatment. Patients with progressive renal disease discontinuation of atazanavir sulfate should be considered. Inform patients about the treatment with atazanavir may lead to the development of chronic kidney disease, and to maintain adequate hydration while taking atazanavir capsules.
Hepatotoxicity: Those patients who carry hepatitis B or C infection are more likely to get the risk of increased hepatic decompensation or transaminases. Need to monitor hepatic laboratory tests prior to the therapy and during the treatment.
Nephrolithiasis and cholelithiasis: These events have been reported. Consider temporary interruption or discontinuation.
Instruct patients that gallstones or kidney stones have been reported with the use of atazanavir. Some patients with kidney stones or gallstones required hospitalization for additional management and some had complications. Discontinuation of atazanavir may be necessary as part of the medical management of these adverse events.
Drug Interactions:
The concomitant use of atazanavir ritonavir and certain other medications may result in known or potentially significant drug interactions. Consult for the full prescribing information before and also during the treatment for the potential drug interactions.
New onset or exacerbations of diabetes mellitus, immune reconstitution syndrome, and redistribution:
Patients receiving atazanavir may develop new onset or exacerbations of diabetes mellitus/hyperglycemia, immune reconstitution syndrome, and redistribution/accumulation of body fat. Instruct patients in order to inform their doctor or healthcare professionals right away about any symptoms of infection, as in some patients with advanced HIV infection (AIDS), signs and symptoms of the inflammation from previous infections may appear soon after the initiation of anti-HIV treatment.
Hemophilia: In some cases with Atazanavir ritonavir tablets spontaneous bleeding has been reported.
