QT time prolongation
Adverse drug events
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Atazanavir (ATV) is usually used with other substances to treat and prevent HIV infection. It is taken orally as a capsule. Atazanavir has been on the market since 2003. Atazanavir is a second generation protease inhibitor. It prevents the virus from multiplying by blocking the necessary viral HIV protease. Immature, non-contagious viruses develop and the viral load decreases. Atazanavir only needs to be taken once a day. The tolerance is comparatively good, gastrointestinal complaints and changes in blood lipids occur less frequently than with other protease inhibitors. Common undesirable effects include yellowing of the whites of the eyes (sclerenic terus) or of the skin due to increased bilirubin levels in the blood.
The warnings are checked for the combination of several active substances. For the individual substances, please consult the relevant specialist information.
Since only atazanavir was entered without any further substances, no pharmacokinetic interaction can be detected.
The pharmacokinetic parameters of the average population are used as the starting point for calculating the individual changes in exposure due to the interactions.
Atazanavir has a mean oral bioavailability [ F ] of 68%, which is why the maximum plasma levels [Cmax] tend to change with an interaction. The terminal half-life [ t12 ] is 6.5 hours and constant plasma levels [ Css ] are reached after approximately 26 hours. The protein binding [ Pb ] is moderately strong at 86%. The metabolism mainly takes place via CYP3A4 and the active transport takes place in particular via PGP.
|Serotonergic Effects a||0||Ø|
Rating: According to our knowledge, atazanavir does not increase serotonergic activity.
|Kiesel & Durán b||0||Ø|
Rating: According to our knowledge, atazanavir does not increase anticholinergic activity.
QT time prolongation
Recommendation: Please make sure that influenceable risk factors are minimized. Electrolyte imbalances such as low levels of calcium, potassium and magnesium should be compensated for. The lowest effective dose of atazanavir should be used.
Rating: Atazanavir can potentially prolong the QT time and if there are risk factors, arrhythmias of the type torsades de pointes can occur.
General adverse effects
|Side effects||∑ frequency||ata|
|Elevated ALT||6.0 %||6.0|
|Atrioventricular block||5.5 %||5.5|
|Abdominal pain||4.0 %||4.0|
Fever (2%): atazanavir
Cholelithiasis (1.4%): atazanavir
Erythema multiforme: atazanavir
Stevens johnson syndrome: atazanavir
Diabetes mellitus: atazanavir
Hypersensitivity reaction: atazanavir
Immune reconstitution syndrome: atazanavir
Based on your answers and scientific information, we assess the individual risk of undesirable side effects. These recommendations are intended to advise professionals and are not a substitute for consultation with a doctor. In the restricted test version (alpha), the risk of all substances has not yet been conclusively assessed.
Abstract: No Abstract available
Abstract: BACKGROUND: Atazanavir (ATV), an HIV protease inhibitor (PI) that may be preferred for the treatment of HIV-infected patients with cardiovascular comorbidities because of its favourable effects on plasma lipids, has been associated with cardiac rhythm disturbances. OBJECTIVE: To quantify the effect of ATV on corrected QT (QTc) and QTc dispersion (QTd), markers of the potential for cardiac dysrhythmia, in patients switching from other PIs to ATV. METHODS: In this prospective, single-centre, open-label study, 12-lead electrocardiograms were performed for subjects at baseline, 2 h after the first dose of ATV, and 1 month after initiation of ATV. RESULTS: Twenty-one patients (19 received ritonavir-boosted ATV) completed the study. There was a trend towards an increase in the QTc at 2 h after the first dose [mean+/-standard deviation 3.19+/-8.0 ms; 95% confidence interval (CI) -0.47 to 6.85 ms; P=0.084]. There was no difference between QTc values at baseline and at 1 month (-1.5+/-8.75 ms; 95% CI -5.50 to 2.46; P=0.43). There was a nonsignificant decrease in the QTd between baseline and 2 h (-5.1+/-15.19 ms; 95% CI -13.22 to 2.96; P=0.197) and between baseline and 1 month (-0.61+/-15.04 ms; 95% CI -8.1 to 6.87; P=0.865). A significant increase in the PR interval (7.4+/-10.7 ms; 95% CI 2.5 to 12.25 ms; P=0.005) was observed at 1 month. CONCLUSIONS: The use of ATV did not result in increases in the QTc interval or QTd. However, PR interval monitoring may be warranted in patients with underlying heart block or those treated with atrioventricular nodal blocking agents.
Abstract: We report, to our knowledge, the first documented case of torsades de pointes associated with atazanavir therapy. This case serves to highlight the need to monitor patients receiving atazanavir therapy who have risk factors for QT interval prolongation, such as female sex, bradycardia, electrolyte abnormalities, congestive heart failure, and a baseline prolonged QT interval.
Abstract: We aimed to determine the prevalence of a prolonged QTc interval in HIV-infected patients and its related factors through an observational study of a cohort of asymptomatic HIV-infected outpatients. All patients underwent a standard 12-lead electrocardiogram and a transthoracic echocardiogram. Prolonged QTc was considered if it was >440 ms in men and >450 ms in women. Epidemiological, clinical, and laboratory data were collected and the patients completed a questionnaire about cardiovascular risk factors. The analysis of the potential risk factors for prolonged QTc was done by multivariate logistic regression. The study included 194 patients, 84% men, with a mean age of 46.3 years. The mean duration of HIV infection was 122.6 months and 27.8% had AIDS. Antiretroviral therapy was being taken by 185 (96.4%) patients, and 92.4% of them had an undetectable viral load. The mean CD4 lymphocyte count was 553/mm(3). A total of 24 (12.4%) patients had a prolonged QTc interval, with a mean QTc of 456 ms. The factors associated with a prolonged QTc were hyperlipidemia (OR 3.7, 95% CI: 1.3-10.3; p=0.01) and diastolic dysfunction (OR 6.7, 95% CI: 2.4-18.3; p=0.0001), while the use of atazanavir was associated with a lower likelihood of having a prolonged QTc (OR 0.11, 95% CI: 0.02-0.5; p=0.008). A prolonged QTc syndrome was not uncommon in this cohort of asymptomatic HIV-infected patients with good immunovirological control. It was associated with hyperlipidemia and diastolic dysfunction. The use of atazanavir, compared with other protease inhibitors, was associated with a lower likelihood of having a prolonged QTc.
Abstract: Transporters in proximal renal tubules contribute to the disposition of numerous drugs. Furthermore, the molecular mechanisms of tubular secretion have been progressively elucidated during the past decades. Organic anions tend to be secreted by the transport proteins OAT1, OAT3 and OATP4C1 on the basolateral side of tubular cells, and multidrug resistance protein (MRP) 2, MRP4, OATP1A2 and breast cancer resistance protein (BCRP) on the apical side. Organic cations are secreted by organic cation transporter (OCT) 2 on the basolateral side, and multidrug and toxic compound extrusion (MATE) proteins MATE1, MATE2/2-K, P-glycoprotein, organic cation and carnitine transporter (OCTN) 1 and OCTN2 on the apical side. Significant drug-drug interactions (DDIs) may affect any of these transporters, altering the clearance and, consequently, the efficacy and/or toxicity of substrate drugs. Interactions at the level of basolateral transporters typically decrease the clearance of the victim drug, causing higher systemic exposure. Interactions at the apical level can also lower drug clearance, but may be associated with higher renal toxicity, due to intracellular accumulation. Whereas the importance of glomerular filtration in drug disposition is largely appreciated among clinicians, DDIs involving renal transporters are less well recognized. This review summarizes current knowledge on the roles, quantitative importance and clinical relevance of these transporters in drug therapy. It proposes an approach based on substrate-inhibitor associations for predicting potential tubular-based DDIs and preventing their adverse consequences. We provide a comprehensive list of known drug interactions with renally-expressed transporters. While many of these interactions have limited clinical consequences, some involving high-risk drugs (e.g. methotrexate) definitely deserve the attention of prescribers.