Severe. These medicines may interact and cause very harmful effects and are usually not taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.
How the interaction occurs:
Proton pump inhibitors increase the pH (decrease the acidity) of your stomach. Atazanavir needs an acidic environment to be absorbed by your body.Proton pump inhibitors may speed up how quickly your body processes nelfinavir.
What might happen:
The amount of atazanavir or nelfinavir in your blood may decrease and they may not work as well against your HIV infection.
What you should do about this interaction:
Contact your healthcare professional (e.g. doctor or pharmacist) right away about using these medicines together. Your doctor may want to check the amount of atazanavir or nelfinavir in your blood, as well as your viral load. Your doctor may want to change your medicines.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.
1.Reyataz (atazanavir sulfate) US prescribing information. Bristol-Myers Squibb Company August, 2013.
2.Reyataz (atazanavir sulfate) Australian product information. Bristol-Myers Squibb Pharmaceuticals January 8, 2004.
3.Hirani VN, Raucy JL, Lasker JM. Conversion of the HIV protease inhibitor nelfinavir to a bioactive metabolite by human liver CYP2C19. Drug Metab Dispos 2004 Dec;32(12):1462-7.
4.Nexium (esomeprazole magnesium) US prescribing information. AstraZeneca Pharmaceuticals LP March, 2014.
5.Prilosec (omeprazole) US prescribing information. AstraZeneca Pharmaceuticals LP March, 2014.
6.Dexilant (dexlansoprazole) US prescribing information. Takeda Pharmaceuticals North America, Inc. September, 2012.
7.Prevacid (lansoprazole) US prescribing information. Takeda Pharmaceuticals America, Inc. September, 2012.
8.Protonix (pantoprazole sodium) US prescribing information. Wyeth Pharmaceuticals, Inc. December, 2013.
9.Viracept (nelfinavir mesylate) US prescribing information. Agouron Pharmaceuticals, Inc. May, 2013.
10.Baede-van Dijk PA, Hugen PW, Verweij-van Wissen CP, Koopmans PP, Burger DM, Hekster YA. Analysis of variation in plasma concentrations of nelfinavir and its active metabolite M8 in HIV-positive patients. AIDS 2001 May 25;15(8):991-8.
11.Nexium (esomeprazole) UK summary of product characteristics. AstraZeneca UK Limited April 25, 2008.
12.Tomilo DL, Smith PF, Ogundele AB, Difrancesco R, Berenson CS, Eberhardt E, Bednarczyk E, Morse GD. Inhibition of atazanavir oral absorption by lansoprazole gastric acid suppression in healthy volunteers. Pharmacotherapy 2006 Mar;26(3):341-6.
13.Kiser JJ, Lichtenstein KA, Anderson PL, Fletcher CV. Effects of esomeprazole on the pharmacokinetics of atazanavir and fosamprenavir in a patient with human immunodeficiency virus infection. Pharmacotherapy 2006 Apr;26(4):511-4.
14.Sekar VJ, Lefebvre E, De Paepe E, De Marez T, De Pauw M, Parys W, Hoetelmans RM. Pharmacokinetic Interaction between Darunavir Boosted with Ritonavir and Omeprazole or Ranitidine in Human Immunodeficiency Virus-Negative Healthy Volunteers. Antimicrob Agents Chemother 2007 Mar; 51(3):958-61.
15.Shelton MJ, Ford SL, Borland J, Lou Y, Wire MB, Min SS, Xue ZG, Yuen G. Coadministration of esomeprazole with fosamprenavir has no impact on steady-state plasma amprenavir pharmacokinetics. J Acquir Immune Defic Syndr 2006 May;42(1):61-7.
16.Fang AF, Damle BD, LaBadie RR, Crownover PH, Hewlett D Jr, Glue PW. Significant decrease in nelfinavir systemic exposure after omeprazole coadministration in healthy subjects. Pharmacotherapy 2008 Jan; 28(1):42-50.
17.Winston A, Back D, Fletcher C, Robinson L, Unsworth J, Tolowinska I, Schutz M, Pozniak AL, Gazzard B, Boffito M. Effect of omeprazole on the pharmacokinetics of saquinavir-500 mg formulation with ritonavir in healthy male and female volunteers. AIDS 2006 Jun 26;20(10):1401-6.
18.Goicoechea M, Best B, Capparelli E, Caperna J, Ballard C, Haubrich R. Therapeutic ritonavir-boosted atazanavir plasma concentration and concurrent omeprazole use. AIDS 2006 Oct 24;20(16):2127-8.
19.Furtek KJ, Crum NF, Olson PE, Wallace MR. Proton pump inhibitor therapy in atazanavir-treated patients: contraindicated?. J Acquir Immune Defic Syndr 2006 Mar;41(3):394-6.
20.Chan-Tack KM, Edozien A. Ritonavir-boosted atazanavir may be efficacious in HIV-infected patients concurrently receiving omeprazole. Clin Infect Dis 2006 May 1;42(9):1344.
21.Singh K, Dickinson L, Chaikan A, Back D, Fletcher C, Pozniak A, Moyle G, Nelson M, Gazzard B, Herath D, Boffito M. Pharmacokinetics and safety of saquinavir/ritonavir and omeprazole in HIV-infected subjects. Clin Pharmacol Ther 2008 Jun;83(6):867-72.
22.Tappouni HL, Rublein JC, Donovan BJ, Hollowell SB, Tien HC, Min SS, Theodore D, Rezk NL, Smith PC, Tallman MN, Raasch RH, Kashuba AD. Effect of omeprazole on the plasma concentrations of indinavir when administered alone and in combination with ritonavir. Am J Health Syst Pharm 2008 Mar 1;65(5):422-8.
23.Luber AD, Brower R, Kim D, Silverman R, Peloquin CA, Frank I. Steady-state pharmacokinetics of once-daily fosamprenavir/ritonavir and atazanavir/ritonavir alone and in combination with 20 mg omeprazole in healthy volunteers. HIV Med 2007 Oct;8(7):457-64.
24.Burger DM, Hugen PW, Kroon FP, Groeneveld P, Brinkman K, Foudraine NA, Sprenger H, Koopmans PP, Hekster YA. Pharmacokinetic interaction between the proton pump inhibitor omeprazole and the HIV protease inhibitor indinavir. AIDS 1998 Oct 22;12(15):2080-2.
25.Kosel BW, Storey SS, Collier AC. Lack of interaction between atazanavir and lansoprazole. AIDS 2005 Mar 24;19(6):637-8.
26.Klein CE, Chiu YL, Cai Y, Beck K, King KR, Causemaker SJ, Doan T, Esslinger HU, Podsadecki TJ, Hanna GJ. Effects of acid-reducing agents on the pharmacokinetics of lopinavir/ritonavir and ritonavir-boosted atazanavir. J Clin Pharmacol 2008 May;48(5):553-62.
27.Chiu YL, Klein CE, Woodward WC, King KR, Naylor C, Awni W, Brun S. Lack of effect of gastric acid-reducing agents on the pharmacokinetics of lopinavir/ritonavir in HIV-infected patients. AIDS Patient Care STDS 2007 Apr;21(4):247-51.
28.Phansalkar S, Desai AA, Bell D, Yoshida E, Doole J, Czochanski M, Middleton B, Bates DW. High-priority drug-drug interactions for use in electronic health records. J Am Med Inform Assoc 2012 Sep-Oct; 19(5):735-43.