Brand names: Evotaz
50 interactions on record
Other Agents Alpha 1-adrenoreceptor antagonist: alfuzosin ↑ alfuzosin Coadministration of EVOTAZ with alfuzosin is contraindicated due to the potential for increased alfuzosin concentrations, which can result in hypotension [see Contraindications (4) ] .
Source: FDA drug label - atazanavir and cobicistat
Antineoplastics: apalutamide ↓ atazanavir ↓cobicistat Coadministration with apalutamide is contraindicated due to the potential for substantial decrease in plasma concentrations of atazanavir and cobicistat, which may result in loss of virologic response of EVOTAZ and possible resistance to atazanavir or to other protease inhibitors. Mechanism: The mechanism of interaction is CYP3A4 induction by apalutamide.
Source: FDA drug label - atazanavir and cobicistat
Hepatitis C Direct-Acting Antivirals : elbasvir/grazoprevir ↑ grazoprevir Coadministration of EVOTAZ with elbasvir/grazoprevir is contraindicated due to increased risk of ALT elevations [see Contraindications (4) ] .
Source: FDA drug label - atazanavir and cobicistat
encorafenib ↓ atazanavir ↓ cobicistat ↑ encorafenib Coadministration with encorafenib is contraindicated due to the potential for loss of virologic response of EVOTAZ, development of resistance, and risk of serious adverse events such as QT interval prolongation. Mechanism: The mechanism of interaction is CYP3A4 induction by encorafenib.
Source: FDA drug label - atazanavir and cobicistat
glecaprevir/pibrentasvir ↑ glecaprevir ↑ pibrentasvir Coadministration of EVOTAZ with glecaprevir/ pibrentasvir is contraindicated due to increased risk of ALT elevations [see Contraindications (4 )] .
Source: FDA drug label - atazanavir and cobicistat
Hepatitis C Direct-Acting Antivirals : elbasvir/grazoprevir ↑ grazoprevir Coadministration of EVOTAZ with elbasvir/grazoprevir is contraindicated due to increased risk of ALT elevations [see Contraindications (4) ] .
Source: FDA drug label - atazanavir and cobicistat
HIV Antiretroviral Agents: Protease Inhibitor indinavir Coadministration with indinavir is contraindicated [see Contraindications (4) ] . Both atazanavir and indinavir are associated with indirect (unconjugated) hyperbilirubinemia.
Source: FDA drug label - atazanavir and cobicistat
ivosidenib ↓ atazanavir ↓ cobicistat ↑ ivosidenib Coadministration with ivosidenib is contraindicated due to the potential for loss of virologic response of EVOTAZ, development of resistance, and risk of serious adverse events such as QT interval prolongation. Mechanism: The mechanism of interaction is CYP3A4 induction by ivosidenib.
Source: FDA drug label - atazanavir and cobicistat
HMG-CoA reductase inhibitors : lovastatin simvastatin ↑lovastatin ↑simvastatin Coadministration with lovastatin or simvastatin is contraindicated due to the potential for serious reactions such as myopathy, including rhabdomyolysis [see Contraindications (4) ] .
Source: FDA drug label - atazanavir and cobicistat
Sedatives/Hypnotics: Benzodiazepines midazolam (oral) triazolam ↑ midazolam ↑ triazolam Coadministration of triazolam or orally administered midazolam is contraindicated due to the potential for serious and/or life-threatening events such as prolonged or increased sedation or respiratory depression. Triazolam and orally administered midazolam are extensively metabolized by CYP3A4 [see Contraindications (4) ] . Other Benzodiazepines : clorazepate diazepam estazolam flurazepam parenterally administered midazolam ↑ sedatives/hypnotics Parenterally administered midazolam: Coadministration should be done in a setting which ensures close clinical monitoring and appropriate medical management in case of respiratory depression and/or prolonged sedation.
Source: FDA drug label - atazanavir and cobicistat
glecaprevir/pibrentasvir ↑ glecaprevir ↑ pibrentasvir Coadministration of EVOTAZ with glecaprevir/ pibrentasvir is contraindicated due to increased risk of ALT elevations [see Contraindications (4 )] .
Source: FDA drug label - atazanavir and cobicistat
HMG-CoA reductase inhibitors : lovastatin simvastatin ↑lovastatin ↑simvastatin Coadministration with lovastatin or simvastatin is contraindicated due to the potential for serious reactions such as myopathy, including rhabdomyolysis [see Contraindications (4) ] .
Source: FDA drug label - atazanavir and cobicistat
Sedatives/Hypnotics: Benzodiazepines midazolam (oral) triazolam ↑ midazolam ↑ triazolam Coadministration of triazolam or orally administered midazolam is contraindicated due to the potential for serious and/or life-threatening events such as prolonged or increased sedation or respiratory depression. Triazolam and orally administered midazolam are extensively metabolized by CYP3A4 [see Contraindications (4) ] .
Source: FDA drug label - atazanavir and cobicistat
These recommendations are based either on observed drug interactions in studies of cobicistat, atazanavir, or atazanavir coadministered with ritonavir or predicted drug interactions based on the expected magnitude of interaction and potential for serious events or loss of therapeutic effect of EVOTAZ [see Contraindications (4) , Warnings and Precautions (5.8) , and Clinical Pharmacology (12.3) ] . ritonavir or products containing ritonavir ↑ atazanavir Coadministration of EVOTAZ and ritonavir or ritonavir-containing regimens is not recommended due to similar effects of cobicistat and ritonavir on CYP3A [see Warnings and Precautions (5.9) ] . Switching from atazanavir coadministered with ritonavir to EVOTAZ: Maintain bosentan dose.
Source: FDA drug label - atazanavir and cobicistat
Calcium channel blockers: (e.g., amlodipine, diltiazem, felodipine, nifedipine, and verapamil) ↑ calcium channel blocker Clinical monitoring is recommended for coadministration with calcium channel blockers metabolized by CYP3A.
Source: FDA drug label - atazanavir and cobicistat
(4 , 7 , 12.3) 7.1 Potential for EVOTAZ to Affect Other Drugs Atazanavir is an inhibitor of CYP3A and UGT1A1 and a weak inhibitor of CYP2C8. 7.2 Potential for Other Drugs to Affect EVOTAZ Atazanavir and cobicistat are CYP3A4 substrates; therefore, drugs that induce CYP3A4 may decrease atazanavir and cobicistat plasma concentrations and reduce the therapeutic effect of EVOTAZ, leading to development of resistance to atazanavir (see Table 5). Coadministration of EVOTAZ with other drugs that inhibit CYP3A4 may increase the plasma concentrations of cobicistat and atazanavir (see Table 5).
Source: FDA drug label - atazanavir and cobicistat
7.4 Drugs with No Observed or Predicted Interactions with the Components of EVOTAZ Based on known metabolic profiles, clinically significant drug interactions are not expected between EVOTAZ and acetaminophen, atenolol, dapsone, fluconazole, trimethoprim/sulfamethoxazole, or azithromycin [see Clinical Pharmacology (12.3; Table 7) ].
Source: FDA drug label - atazanavir and cobicistat
Other HMG-CoA reductase inhibitors: atorvastatin, fluvastatin, pravastatin, rosuvastatin ↑ HMG-CoA reductase inhibitors Coadministration of EVOTAZ with atorvastatin is not recommended.
Source: FDA drug label - atazanavir and cobicistat
7.4 Drugs with No Observed or Predicted Interactions with the Components of EVOTAZ Based on known metabolic profiles, clinically significant drug interactions are not expected between EVOTAZ and acetaminophen, atenolol, dapsone, fluconazole, trimethoprim/sulfamethoxazole, or azithromycin [see Clinical Pharmacology (12.3; Table 7) ].
Source: FDA drug label - atazanavir and cobicistat
Antibacterials (macrolide or ketolide antibiotics): clarithromycin erythromycin telithromycin ↑ atazanavir ↑ cobicistat ↑ clarithromycin ↑ erythromycin ↑ telithromycin Consider alternative antibiotics.
Source: FDA drug label - atazanavir and cobicistat
Anticonvulsants that are metabolized by CYP3A (e.g., clonazepam) ↑ clonazepam Clinical monitoring of anticonvulsants is recommended with EVOTAZ coadministration.
Source: FDA drug label - atazanavir and cobicistat
(e.g., dasatinib, nilotinib, vinblastine, vincristine) ↑ other anticancer agents A decrease in the dosage or an adjustment of the dosing interval of dasatinib or nilotinib may be necessary upon coadministration with EVOTAZ. Consult the dasatinib and nilotinib full prescribing information for dosing instructions.
Source: FDA drug label - atazanavir and cobicistat
Other Benzodiazepines : clorazepate diazepam estazolam flurazepam parenterally administered midazolam ↑ sedatives/hypnotics Parenterally administered midazolam: Coadministration should be done in a setting which ensures close clinical monitoring and appropriate medical management in case of respiratory depression and/or prolonged sedation.
Source: FDA drug label - atazanavir and cobicistat
amiodarone, quinidine lidocaine (systemic), disopyramide, flecainide mexiletine, propafenone digoxin ↑ other antiarrhythmics ↑ digoxin Clinical monitoring is recommended upon coadministration with antiarrhythmics.
Source: FDA drug label - atazanavir and cobicistat
Antibacterials (macrolide or ketolide antibiotics): clarithromycin erythromycin telithromycin ↑ atazanavir ↑ cobicistat ↑ clarithromycin ↑ erythromycin ↑ telithromycin Consider alternative antibiotics.
Source: FDA drug label - atazanavir and cobicistat
Other Benzodiazepines : clorazepate diazepam estazolam flurazepam parenterally administered midazolam ↑ sedatives/hypnotics Parenterally administered midazolam: Coadministration should be done in a setting which ensures close clinical monitoring and appropriate medical management in case of respiratory depression and/or prolonged sedation.
Source: FDA drug label - atazanavir and cobicistat
Calcium channel blockers: (e.g., amlodipine, diltiazem, felodipine, nifedipine, and verapamil) ↑ calcium channel blocker Clinical monitoring is recommended for coadministration with calcium channel blockers metabolized by CYP3A.
Source: FDA drug label - atazanavir and cobicistat
7.4 Drugs with No Observed or Predicted Interactions with the Components of EVOTAZ Based on known metabolic profiles, clinically significant drug interactions are not expected between EVOTAZ and acetaminophen, atenolol, dapsone, fluconazole, trimethoprim/sulfamethoxazole, or azithromycin [see Clinical Pharmacology (12.3; Table 7) ].
Source: FDA drug label - atazanavir and cobicistat
Other Benzodiazepines : clorazepate diazepam estazolam flurazepam parenterally administered midazolam ↑ sedatives/hypnotics Parenterally administered midazolam: Coadministration should be done in a setting which ensures close clinical monitoring and appropriate medical management in case of respiratory depression and/or prolonged sedation.
Source: FDA drug label - atazanavir and cobicistat
Other HMG-CoA reductase inhibitors: atorvastatin, fluvastatin, pravastatin, rosuvastatin ↑ HMG-CoA reductase inhibitors Coadministration of EVOTAZ with atorvastatin is not recommended.
Source: FDA drug label - atazanavir and cobicistat
Kinase inhibitors: fostamatinib ↑ R406 active metabolite of fostamatinib Coadministration with fostamatinib may increase the plasma concentration of R406, the active metabolite of fostamatinib. Fostamatinib dose reduction may be required.
Source: FDA drug label - atazanavir and cobicistat
Tricyclic Antidepressants (TCAs) (e.g., amitriptyline, desipramine, imipramine, nortriptyline) ↑ TCAs Other Antidepressants (e.g., trazodone) ↑ trazodone Antifungals: ketoconazole, itraconazole ↑ atazanavir ↑ cobicistat ↑ ketoconazole ↑ itraconazole Specific dosing recommendations are not available for coadministration of EVOTAZ with either itraconazole or ketoconazole.
Source: FDA drug label - atazanavir and cobicistat
Tricyclic Antidepressants (TCAs) (e.g., amitriptyline, desipramine, imipramine, nortriptyline) ↑ TCAs Other Antidepressants (e.g., trazodone) ↑ trazodone Antifungals: ketoconazole, itraconazole ↑ atazanavir ↑ cobicistat ↑ ketoconazole ↑ itraconazole Specific dosing recommendations are not available for coadministration of EVOTAZ with either itraconazole or ketoconazole.
Source: FDA drug label - atazanavir and cobicistat
Corticosteroids: e.g., betamethasone budesonide ciclesonide dexamethasone fluticasone methylprednisolone mometasone triamcinolone ↓ atazanavir ↓ cobicistat ↑ corticosteroids Coadministration with oral dexamethasone or other systemic corticosteroids that induce CYP3A may result in loss of therapeutic effect and development of resistance to atazanavir.
Source: FDA drug label - atazanavir and cobicistat
Beta-Blockers: (e.g., metoprolol, carvedilol, timolol) ↔ atazanavir ↑ beta-blockers Clinical monitoring is recommended when beta-blockers that are metabolized by CYP2D6 are coadministered with EVOTAZ.
Source: FDA drug label - atazanavir and cobicistat
Calcium channel blockers: (e.g., amlodipine, diltiazem, felodipine, nifedipine, and verapamil) ↑ calcium channel blocker Clinical monitoring is recommended for coadministration with calcium channel blockers metabolized by CYP3A.
Source: FDA drug label - atazanavir and cobicistat
(e.g., dasatinib, nilotinib, vinblastine, vincristine) ↑ other anticancer agents A decrease in the dosage or an adjustment of the dosing interval of dasatinib or nilotinib may be necessary upon coadministration with EVOTAZ. Consult the dasatinib and nilotinib full prescribing information for dosing instructions.
Source: FDA drug label - atazanavir and cobicistat
Proton-pump inhibitors (PPI): (e.g., omeprazole) ↓ atazanavir In treatment-naive patients, administer EVOTAZ a minimum of 12 hours after administration of the PPI. The dose of the PPI should not exceed a dose comparable to omeprazole 20 mg daily.
Source: FDA drug label - atazanavir and cobicistat
Other HMG-CoA reductase inhibitors: atorvastatin, fluvastatin, pravastatin, rosuvastatin ↑ HMG-CoA reductase inhibitors Coadministration of EVOTAZ with atorvastatin is not recommended.
Source: FDA drug label - atazanavir and cobicistat
Corticosteroids: e.g., betamethasone budesonide ciclesonide dexamethasone fluticasone methylprednisolone mometasone triamcinolone ↓ atazanavir ↓ cobicistat ↑ corticosteroids Coadministration with oral dexamethasone or other systemic corticosteroids that induce CYP3A may result in loss of therapeutic effect and development of resistance to atazanavir. Alternative corticosteroids including beclomethasone, prednisone, and prednisolone (whose PK and/or PD are less affected by strong CYP3A inhibitors relative to other studied steroids) should be considered, particularly for long-term use.
Source: FDA drug label - atazanavir and cobicistat
Other HMG-CoA reductase inhibitors: atorvastatin, fluvastatin, pravastatin, rosuvastatin ↑ HMG-CoA reductase inhibitors Coadministration of EVOTAZ with atorvastatin is not recommended. Dosage recommendations with rosuvastatin are as follows. Rosuvastatin dose should not exceed 10 mg/day.
Source: FDA drug label - atazanavir and cobicistat
Hepatitis C Antiviral Agents sofosbuvir/velpatasvir/ voxilaprevir ↑ voxilaprevir Coadministration with EVOTAZ is not recommended.
Source: FDA drug label - atazanavir and cobicistat
7.4 Drugs with No Observed or Predicted Interactions with the Components of EVOTAZ Based on known metabolic profiles, clinically significant drug interactions are not expected between EVOTAZ and acetaminophen, atenolol, dapsone, fluconazole, trimethoprim/sulfamethoxazole, or azithromycin [see Clinical Pharmacology (12.3; Table 7) ].
Source: FDA drug label - atazanavir and cobicistat
Antibacterials (macrolide or ketolide antibiotics): clarithromycin erythromycin telithromycin ↑ atazanavir ↑ cobicistat ↑ clarithromycin ↑ erythromycin ↑ telithromycin Consider alternative antibiotics.
Source: FDA drug label - atazanavir and cobicistat
tenofovir disoproxil fumarate ↓ atazanavir ↑ tenofovir Patients receiving EVOTAZ and tenofovir should be monitored for tenofovir-associated adverse reactions [see Warnings and Precautions (5.4) ] . H 2 ‑Receptor antagonists (H 2 RA ) : (e.g., famotidine) ↓ atazanavir Coadministration of EVOTAZ with tenofovir DF and an H 2 RA in treatment-experienced patients is not recommended.
Source: FDA drug label - atazanavir and cobicistat
Beta-Blockers: (e.g., metoprolol, carvedilol, timolol) ↔ atazanavir ↑ beta-blockers Clinical monitoring is recommended when beta-blockers that are metabolized by CYP2D6 are coadministered with EVOTAZ.
Source: FDA drug label - atazanavir and cobicistat
Corticosteroids: e.g., betamethasone budesonide ciclesonide dexamethasone fluticasone methylprednisolone mometasone triamcinolone ↓ atazanavir ↓ cobicistat ↑ corticosteroids Coadministration with oral dexamethasone or other systemic corticosteroids that induce CYP3A may result in loss of therapeutic effect and development of resistance to atazanavir.
Source: FDA drug label - atazanavir and cobicistat
Hepatitis C Antiviral Agents sofosbuvir/velpatasvir/ voxilaprevir ↑ voxilaprevir Coadministration with EVOTAZ is not recommended.
Source: FDA drug label - atazanavir and cobicistat
voriconazole effects unknown Coadministration with voriconazole is not recommended unless the benefit/risk assessment justifies the use of voriconazole.
Source: FDA drug label - atazanavir and cobicistat
Hepatitis C Antiviral Agents sofosbuvir/velpatasvir/ voxilaprevir ↑ voxilaprevir Coadministration with EVOTAZ is not recommended.
Source: FDA drug label - atazanavir and cobicistat