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Reyataz, also known as atazanvir, is an anti-HIV treatment in the class of drugs called Protease Inhibitors (PIs). Protease inhibitors work by blocking, or inhibiting, a part of HIV called protease. HIV needs protease to make new copies of itself. When protease is blocked, the copies that HIV makes of itself cannot infect new cells. Reyataz is one of eight approved protease inhibitors used to treat HIV.
Reyataz is taken as part of a carefully chosen combination of anti-HIV drugs. In order to get the most benefit, Reyataz must be taken with two other anti-HIV drugs known as Nucleoside Reverse Transcriptase Inhibitors (NRTIs). Combination HIV treatment (also known as HAART) helps people live longer and develop less opportunistic infections. Reyataz should not be taken as your only anti-HIV drug or the virus very quickly becomes resistant to it. Drug resistance tests (genotypic or phenotypic) have been shown to be useful in choosing the optimal anti-HIV treatment regimen specific to an individual. See the FactSheets Combination Therapy & Understanding Drug Resistance for more information.
The Public Health Service HIV treatment guidelines list Reyataz as an alternative for an initial HIV treatment regimen using a protease inhibitor in combination with two NRTIs. According to the guidelines panel, Reyataz's advantages over other protease inhibitors include once-daily dosing and low pill burden and fewer increases in blood levels of fats such as cholesterol and triglycerides. See Lipodystrophy FactSheet. Disadvantages include the need to take Reyataz with food, as well as some side effects and drug interations.
Reyataz was approved based on two clinical trials involving over 1,200 people who had never taken HIV treatment before.
In one study (AI424-034), volunteers received Retrovir (AZT, zidovudine) and Epivir (3TC, lamivudine) with either Reyataz or Sustiva (efavirenz). After 48 weeks of treatment, similar numbers in each group had HIV viral loads below 400 copies: 67% for volunteers receiving Reyataz and 62% for volunteers receiving Sustiva.
In another study (AI424-008), volunteers received Zerit (d4T, stavudine) and Epivir (3TC, lamivudine) with either Reyataz or Viracept (nelfinavir). After 48 weeks of treatment, similar numbers in each group had HIV viral loads below 400 copies: 67% for volunteers receiving Reyataz and 59% for volunteers receiving Viracept.
Reyataz comes in 100 mg, 150 mg, and 200 mg capsules that can be stored at room temperature.
The approved dosage of Reyataz is 400 mg once a day, taken as two pills with food. Many doctors also prescribe 300 mg of Reyataz (taken as two 150 mg pills) with 100 mg of Norvir (ritonavir) once a day, taken together. Norvir boosts the blood levels of Reyataz. The Reyataz/ritonavir combination is useful for people who already have some drug resistance to protease inhibitors. Reyataz has not been approved for children.
If you take Reyataz with Videx (ddI) or Videx EC, Reyataz should be taken with food either two hours before or one hour after you take Videx.
Reyataz increases the levels of bilirubin in about one-third of people who take it. Bilirubin is a chemical made by the liver; an increased bilirubin level is called hyperbilirubinemia. Hyperbilirubinemia can lead to jaundice, where the eyes or skin turn yellow. About one in ten people taking Reyataz develop jaundice. Hyperbilirubinemia and jaundice can be signs of liver damage, but Reyataz does not seem to damage the liver. However, people with hepatitis B or C should be closely monitored for liver function when taking Reyataz.
Reyataz can cause changes in heartbeat by causing irrregular blood flow in the heart. These changes usually are not serious, but Reyataz should be used with caution if you take other medications that can have this effect. Tell your doctor if you get dizzy or lightheaded, since these can be symptoms of heart problems.
Reyataz may also cause headaches, nausea and vomiting, stomach pain, diarrhea, rash, and tingling hands or feet.
Tenofovir (Viread) and Efavirenz (Sustiva) lower the blood levels of Reyataz. If used with either of these drugs, the 300 mg dose of Reyataz in combination with 100 mg Norvir should be used. Indinavir (Crixivan) should not be used with Reyataz because both drugs can increase bilirubin levels.
Other drugs can interact with Reyataz, changing the blood levels or one or both medications. Reyataz should not be taken with simvastatin (Zocor) or lovastatin (Mevacor), rifampin or rifapentine (Priftin), pimozide (Orap), midazolam (Versed) or triazolam (Halcion), astemizole (Hismanal) or terfenadine (Seldane), St. John's wort, cisapride (Propulsid), bepridil (Vascor), irinotecan (Camptosar) or dihydroergotamine (Migranal) or ergotamine.
Reyataz may also interact with drugs for the treatment of erectile dysfunction (inability to get or maintain an erection), including sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis). Reyataz increase the levels of these drugs in the blood. This can lead to high blood pressure and other effects. Tell your doctor about all of the drugs that you take, including non-prescription medicine and herbs.
Bristol-Myers Squibb, the maker of atazanavir (Reyataz), has a patient assistance program for people having problems getting the drug. The number to call is (800) 272-4878.
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