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 adolescents over 16 years old. 

Reyataz comes in:

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

For people who have not taken HIV medications before, the standard adult dose of Reyataz is two 200 mg capsules once a day.

For people who have taken HIV medications before, Reyataz should be combined with a small “booster” dose of Norvir (ritonavir) to increase its potency. When Reyataz and Norvir are combined, the usual dose is two 150 mg capsules of Reyataz, or the new 300 mg capsule, plus one 100mg capsule of Norvir once a day.

Reyataz should be taken with food.

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

Reyataz is one of the easiest HIV drugs to take—you take two pills, once a day. Once-daily drugs are convenient but more demanding, because good adherence is crucial. Missing or skipping doses can cause your blood levels of the drug to fall too low and resistance can develop. When your virus becomes resistant to an HIV medication, that drug may stop working.

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

Reyataz may work against HIV that is resistant to some of the other PIs, especially if it is combined with low-dose Norvir.

Your doctor can run a resistance test to help determine whether Reyataz is likely to work 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. Taking certain drugs (including some other HIV drugs, TB drugs, antifungals, antidepressants, drugs to treat erectile dysfunction such as Viagra, and drugs to lower cholesterol) with Reyataz can change the amount of each drug in your blood. Your doctor may need to adjust the doses of your drugs to avoid under- or overdosing.

Reyataz should be combined (“boosted”) with low-dose Norvir if taken with Viread (tenofovir) or Sustiva (efavirenz).

Reyataz should be taken two hours before or one hour after Videx EC (didanosine or ddI).

Reyataz should not be taken with proton-pump inhibitors (used to treat heartburn and acid reflux) such as Prilosec (omeprazole). Reyataz can be taken with other antacids known as H2-receptor antagonists such as Tagemet (cimetidine), Pepcid (famotidine), and Zantac (ranitidine). However, these medications must be used carefully because they can decrease the amount of Reyataz in the bloodstream. Reyataz should be taken two hours before or ten hours after H2-receptor antagonists.

Certain medications (including rifampin, some headache drugs, acid reflux/heartburns drugs, antibiotics, calcium channel blockers, antihistamines, sedatives, and antipsychotics) should not be taken with Reyataz. Do not take the PI Crixivan (indinavir) or St. John’s wort with Reyataz either.

Be sure your doctor 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.

So far it seems that most people find Reyataz easy to tolerate, but it is possible that unexpected long-term side effects could show up later.

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 doctor for advice. Do not just stop taking your medication.

• Nausea
• Diarrhea
• Abdominal pain
• Headaches
• Skin rash

More serious side effects:

• Liver toxicity: this may be indicated by elevated liver enzymes or yellowing of the skin or eyes (jaundice).
• Reyataz can also cause jaundice by increasing levels of bilirubin (a blood pigment). High bilirubin levels can be a sign of liver damage. However, this is not usually the case for people taking Reyataz.
• Reyataz may cause changes in heart rhythm. Tell your doctor if you feel dizzy.
• Peripheral neuropathy (nerve damage). This can cause numbness, pain, or tingling, especially in the feet and hands.
• 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.
• 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.

If you are experiencing persistent, unusual, or serious side effects, call your doctor 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.

Some studies suggest that the metabolic side effects (lipodystrophy) associated with PIs may be somewhat different in women and men. However, it is still unclear if women are more likely to gain or lose body fat in certain areas than men.

Studies have shown that 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. However, Reyataz may cause an increase in bilirubin which could be a problem for an infant even though it does not appear to negatively affect adults.

Check with your doctor 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 doctor know right away so you can be evaluated and, if necessary, treated.

1		Murphy, R., et. al. (2002). Switch to atazanavir from nelfinavir associated with cholesterol and triglyceride improvement:12 week results from BMS AI424-044. 14th International AIDS Conference. Barcelona, Spain. Abstract LbPeB9013.
2		Pantaleo, G., et. al. (2001). Atazanavir (BMS-232632): 48 week safety and efficacy vs nelfinavir, each in combination with stavudine and lamivudine, in treatment naïve, HIV-positive subjects (AI424-008). 8th European Conference on Clinical Aspects and Treatment of HIV Infection. Athens, Greece. Abstract 011.
3		Sanne, I., et. al. (2003). Results of a phase 2 clinical trial at 48 weeks (AI424-007): a dose-ranging, safety, and efficacy comparative trial of atazanavir at three doses in combination with didanosine and stavudine in antiretroviral-naive subjects. Journal of Acquired Immune Deficiency Syndromes, 32(1). 18-29.
4		Squires, K., et. al. (2002). Atazanavir (ATV) qd and efavirenz (EFV) qd with fixed-dose ZDV+3TC: comparison of antiviral efficacy and safety through wk 24 (AI424-034). 42nd Interscience Conference on Antimicrobial Agents and Chemotherapy. San Diego, CA. Abstract H-1076.