Used For:

• Treatment of HIV-1 infection in adults and adolescents

Contraindications:

• Do NOT use with:Hypersensitivity to atazanavir or ritonavirSevere hepatic impairmentConcomitant use of drugs highly dependent on CYP3A metabolism, such as:RifampicinSimvastatin, LovastatinErgot alkaloidsOral midazolam, triazolamSt. John’s WortProton Pump Inhibitors (PPIs) (e.g., omeprazole) – markedly reduce atazanavir level

Side Effects:

• Common Side EffectsHyperbilirubinemia → jaundice, yellow eyes/skin (common, benign, reversible)Nausea, vomiting, abdominal painDiarrheaHeadache, dizzinessFatigueSerious / Less Common Side EffectsHepatotoxicity (↑ liver enzymes)PR interval prolongation → heart conduction issuesKidney stones (nephrolithiasis)GallstonesLipid abnormalities (less than other PIs)Immune reconstitution inflammatory syndrome (IRIS)

Precautions:

• Use with caution in:Liver disease (hepatitis B or C)Cardiac conduction disordersRenal diseasePatients with history of kidney stonesPregnancy: generally considered safe, but specialist monitoring required⚠️ Important points:Do not stop abruptly → risk of viral resistanceMonitor:Bilirubin levelsLiver function testsECG if cardiac riskDrug–drug interactions are very common (always review ART chart)

Dietary Restrictions:

• Take with a full meal (improves absorption)❌ Avoid Proton Pump Inhibitors⚠️ If needed:H2 blockers → take at least 12 hours apartAntacids → separate by 2 hoursAvoid alcohol (↑ liver toxicity)Maintain adequate hydration (prevents kidney stones)Avoid herbal products, especially St. John’s Wort