Reyataz – brand name

atazanavir – generic name

Reyataz belongs to a class of HIV drugs called protease inhibitors (PIs).

The PIs block protease, a protein that HIV needs to make more copies of itself. This may slow down HIV disease.

The Food and Drug Administration (FDA) has approved Reyataz for use in combination with other HIV drugs for the treatment of HIV infection in adults and children over six years old.

Reyataz comes in:

• 100 milligram (mg), 150 mg, 200 mg, and 300 mg capsules
  

The standard adult dose of Reyataz is one 300 mg capsule plus one 100 mg Norvir (ritonavir) capsule once a day. The small “booster” dose of Norvir helps Reyataz work better.

For people who have not taken HIV medications before and are unable to tolerate Norvir, two 200 mg capsules (400 mg) of Reyataz once a day without Norvir is acceptable depending on what other medications are included in the drug regimen.

Check with your child’s health care provider for children’s dosing. (Children’s dosing is based on body weight.)

Reyataz needs to be taken with food.

Reyataz must be used with other HIV medications to treat HIV.

Before taking Reyataz, tell your health care provider if you have diabetes, liver problems, hemophilia, or heart problems.

Take Reyataz at the same time every day. If you miss your dose of Reyataz, take it as soon as possible. If there are less than six hours before your next dose, do not take the missed dose. Just wait and take the next scheduled dose at your regular time. Do not double the next dose if you missed one.

Reyataz is one of the easiest HIV drugs to take because you only have to take it once a day. Once-daily dosing is convenient, but you have to make sure to take Reyataz exactly as prescribed.

Missing or skipping doses can cause your blood levels of Reyataz to fall too low and resistance can develop. This may cause Reyataz and any other HIV drugs you may be taking to stop working.

Reyataz may be used by people being treated for the first time.

Reyataz can also be used by people whose HIV has become resistant to other HIV drugs. Because it may work against HIV that is resistant to the other PIs, Reyataz (plus Norvir) may be a good choice for people who need to switch therapies because of PI resistance.

You and your health care provider should use resistance testing and your treatment history to help guide the use of Reyataz and to determine which drugs will work best for you.

If your virus develops resistance to Reyataz then it may stop working or not work as well for you. You also may not get as much benefit from the other PIs.

Sometimes taking more than one medication can cause drug interactions. This can lead to the drugs not working as well or an increased risk of side effects.

Reyataz can interact with other medications. Taking Reyataz with certain drugs can change the amount of each drug in your blood. Your health care provider may need to either adjust the doses of your drugs to avoid under- or overdosing or to change the drugs you currently take.

Reyataz should not be combined with:

• Crixivan (indinavir)
• Viramune (nevirapine)
• Migraine headache drugs called ergot medicines
• Orap (pimozide)
• Propulsid (cisapride)
• Halcion (triazolam)
• Versed (midazolam)
• Camptosar (irinotecan)
• Mevacor (lovastatin)
• Zocor (simvastatin)
• Rifampin
• St. John’s wort (herbal product)

If you are taking Reyataz and Norvir together, do not take:

• Vfend (voriconazole)

If you are taking any of the following medications with Reyataz, speak to your health care provider as your doses may need to be adjusted:

• Videx EC (didanosine or ddI)
• Viread (tenofovir)
• Sustiva (efavirenz)
• Invirase (saquinavir)
• Hormonal contraceptives such as birth control pills or the contraceptive patch
• Cialis (tadalafil)
• Levitra (vardenafil)
• Viagra (sildenafil)
• Lipitor (atorvastatin)
• Crestor (rosuvastatin)
• Cordarone (amiodarone)
• Lidocaine
• Cardioquin and Quinidex (quinidine)
• Vascor (bepridil)
• Coumadin (warfarin)
• Elavil (amitriptyline)
• Norpramin (desipramine)
• Sinequan (doxepin)
• Surmontil (trimipramine)
• Tofranil (imipramine)
• VIivactil (protriptyline)
• Sandimmune or Neoral (cyclosporin)
• Rapamune (sirolimus)
• Prograf (tacrolimus)
• Desyrel (trazodone)
• Advair, Flonase, Flovent (fluticasone propionate)
• Antacids or buffered medicines
• Myconbutin (rifabutin)
• Cardizem or Taiazac (diltiazem)
• Overa-HS or Isoptin SR (verapamil)
• Biaxin (clarithromycin)
• Antacids known as H2-receptor antagonists such as Tagemet (cimetidine), Pepcid (famotidine), and Zantac (ranitidine)

A small study has shown that tobacco smoking and marijuana use can significantly decrease blood levels of Reyataz.

Because there are so many possible drug interactions with Reyataz, it is very important to go over all your medications with your health care provider. Be sure your health care provider knows about all the medications you are taking (including over-the-counter, prescription, street drugs, and herbs), even if you only use them occasionally.

For more information and additional resources to check interactions between the particular drugs you are taking, see our info sheet on drug interactions or go to:

http://www.hiv-druginteractions.org/
OR
http://hivinsite.ucsf.edu/insite?page=ar-00-02

Reyataz is generally well tolerated. If you do experience any side effects from Reyataz, they are likely to be temporary and go away as your body adjusts to the medication. If you experience any of the side effects listed below, call your health care provider for advice. Do not just stop taking your medication.

• Nausea
• Vomiting
• Depression
• Fever
• Dizziness
• Trouble sleeping
• Muscle pain
• Diarrhea
• Abdominal pain
• Skin rash
• Headaches
• Yellowing of the skin or eyes (without liver damage)
  

More serious side effects:

• Gallbladder disorders have been seen in people taking Reyataz.
• Liver damage: This may be more common in HIV+ people who have hepatitis B or C. Signs include abnormal liver blood tests or yellowing of the skin or eyes (jaundice).
• Reyataz can also cause jaundice by increasing levels of bilirubin (a blood pigment) without causing any liver damage. This is a common side effect of Reyataz. If you notice jaundice while taking Reyataz, a blood test can help determine if you have liver damage or not.
• Reyataz can cause a severe, life-threatening skin reaction. If you experience a severe rash or a rash together with any of the following symptoms, call your health care provider immediately: fever, lack of energy, excessive tiredness, muscle or joint pain, blisters, blisters in the mouth, and pink eye.
• Reyataz may cause changes in heart rhythm. Tell your health care provider if you feel dizzy.
• Peripheral neuropathy (nerve damage). This can cause numbness, pain, or tingling, especially in the feet and hands.
• Kidney stones: these may cause pain in your back or sides, or blood in your urine. You can reduce the risk by drinking plenty of water.
• Lipodystrophy, which may include elevated blood sugar (glucose), elevated lipid levels ( cholesterol and triglycerides), and fat gain or loss in certain areas. The exact causes of lipodystrophy are not known, but may include HIV and/or HIV drugs. It is unclear if Reyataz will cause or impact symptoms of lipodystrophy. However, in clinical trials Reyataz did not increase triglycerides or “bad” cholesterol the way some other protease inhibitors do. For more information on lipodystrophy, see our info sheet.
  

If you are experiencing persistent, unusual, or serious side effects, call your health care provider right away.

Studies of Reyataz pharmacokinetics (how the drug is processed by the body) have found that the drug behaves similarly in the bodies of women and men, but some research indicates that concentrations of Reyataz reach higher levels in women.

• Study AI424-034 compared Reyataz plus Retrovir (zidovudine or AZT) plus Epivir (lamivudine or 3TC) to Retrovir plus Epivir plus Sustiva in people who had not used HIV drugs before. This study included 35 percent women, or about 280 women out of 805 total participants. In this study, Reyataz and Sustiva had similar potency against HIV, but Reyataz was less likely to cause increased blood lipid levels.
• Study AI424-008, also done in people who hadn’t taken HIV drugs before, included 37 percent women, or about 294 women out of 467 total participants. This trial found that Reyataz plus Zerit (stavudine or d4T) plus Epivir worked about as well as Zerit plus Epivir plus Viracept (nelfinavir). Both of these studies included more women than most HIV drug trials.
• Study AI424-043 looked at people who had already used HIV drugs. This study included 19 percent women, or about 52 women out of 290 total participants. In this trial, Reyataz plus two nucleoside reverse transcriptase inhibitors (NRTIs) did not work as well as Kaletra (lopinavir/ritonavir) plus two NRTIs.

Studies have shown that HIV+ pregnant women who use HIV drugs can greatly reduce the risk of passing HIV on to their babies. There have been no formal studies on the use of Reyataz during pregnancy.

An Antiretroviral Pregnancy Registry has been established to collect information on pregnant women who take HIV drugs, including Reyataz. If you are pregnant and taking Reyataz or other HIV drugs, your health care provider can register you by calling 1-800-258-4263 or going to www.apregistry.com.

It is not known whether Reyataz passes into breast milk. HIV+ women should not breast-feed because their babies could be infected with HIV through the breast milk.

Check with your health care provider about the best treatment options for you and your baby if you are thinking of getting pregnant.

Click this link for more information about pregnancy.

People who are starting HIV treatment for the first time may develop Immune Reconstitution Syndrome or IRS (also called Immune Reconstitution Inflammatory Syndrome or IRIS). IRS can happen as a result of the immune system getting stronger and responding to an HIV-related infection such as Mycobacterium avium infection (MAC), cytomegalovirus (CMV), Pneumocystis jirovecii pneumonia (PCP), or tuberculosis (TB). People may have been treated for these infections in the past or not even know they have them. If you notice any unusual symptoms soon after starting HIV drugs for the first time, let your health care provider know right away so you can be evaluated and, if necessary, treated.