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Reyataz

REYATAZ

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Basic Informations

Reyataz is an HIV medication. It is in a category of HIV medicines called protease inhibitors (PIs). Reyataz prevents cells infected with HIV from producing new virus. This reduces the amount of virus in your body.

Reyataz, manufactured by Bristol-Myers Squibb, was approved for the treatment of HIV by the U.S. Food and Drug Administration (FDA) in 2003.

Reyataz must be used in combination with at least two other HIV drugs.

Drugs Interactions

Reyataz is broken down (metabolized) by the liver, like many medications used to treat HIV and AIDS. This means that Reyataz can interact with other medications. Reyataz can lower or raise the levels of other medications in the body. Similarly, other medications can lower or raise the levels of Reyataz in the body. While many interactions are not a problem, some can cause your medications to be less effective or increase the risk of side effects.

Tell your doctors and pharmacists about all medicines you take. This includes those you buy over-the-counter and herbal or natural remedies, such as St. John’s Wort. Bring all your medicines when you see a doctor, or make a list of their names, how much you take, and how often you take them. Your doctor can then tell you if you need to change the dosages of any of your medications.

The following medications should not be taken while you are being treated with Reyataz:

  • HIV protease inhibitors: Crixivan (indinavir)

  • Acid reflux/heartburn medications: Propulsid (cisapride)

  • Antibiotics: Rifadin (rifampin)

  • Cancer chemotherapeutics: Camptosar (irinotecan)

  • Antimigraine medications: Methergine, Methylergometrine (methylergonovine); Ergostat, Cafergot, Ercaf, Wigraine (ergotamine); Ergotrate, Methergine (ergonovine); or D.H.E. 45, Migranal (dihydroergotamine)

  • Antihistamines: Hismanal (astemizole) or Seldane (terfenadine)

  • Steroids: Flonase of Flovent (fluticasone)

  • Cholesterol-lowering drugs (statins): Zocor (simvastatin) and Mevacor (lovastatin)

  • Antipsychotics: Orap (pimozide)

  • Sedatives: Versed (midazolam) and Halcion (triazolam)

  • Herbal medications: St. John's wort

  • Enlarged prostate: Uroxatral (alfuzosin)

  • Pulmonary Hypertension: sildenafil, used as Revatio

If Reyataz is combined with low-dose Norvir, the following medications should also be avoided:

  • Antifungals: Vfend (voriconazole)

  • Heart medications: Cordarone (amiodarone), Tambocor (flecainide), Vascor (bepridil), Rythmol (propafenone), or Quinaglute/Quinidex (quinidine)

Anticonvulsants, such as Tegretol (carbamazepine), Luminal (phenobarbital), and Dilantin (phenytoin), may decrease the amount of Reyataz in the bloodstream. It might be necessary to increase your dose of Reyataz if you are taking any of these drugs.

HIV protease inhibitors can interact with Reyataz. We know that Norvir (ritonavir) increases the amount of Reyataz in the bloodstream. It is also likely that Kaletra which contains lopinavir and ritonavir, will also increase Reyataz levels in the bloodstream. Reyataz increases Invirase (saquinavir), and Lexiva (amprenavir) levels in the bloodstream. Crixivan (indinavir) should not be combined with Reyataz, as both drugs can cause increases in bilirubin levels. Aside from the Reyataz and Norvir combination, no other formal dosing recommendations have been made, but combining Reyataz with other protease inhibitors is not recommended.

HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs) can also interact with Reyataz. Sustiva (efavirenz) can decrease Reyataz levels in the bloodstream. Reyataz and Sustiva should therefore not be combined in people who are treatment experienced. People who have never taken antiretroviral therapy before may combine Reyataz and Sustiva, however, 100mg of Norvir should be added and the dose of Reyataz should be 400mg. Neither Viramune (nevirapine) nor Intelence (etravirine) should be used with Reyataz, given the likelihood of significant interactions. It is also likely that Rescriptor (delavirdine), a third NNRTI, will increase Reyataz levels in the bloodstream.

It is also important to be careful when using the nucleotide reverse transcriptase inhibitor (NRTI) Viread (tenofovir) with Reyataz. Viread can decrease Reyataz levels in the bloodstream and Reyataz can increase Viread levels in the bloodstream. If Viread is combined with Reyataz, then 300mg of Reyataz should be used with 100mg of Norvir (to increase Reyataz levels). To make sure that the increased Viread levels do not cause kidney damage (a possible side effect of Viread), blood tests to monitor kidney function should be performed regularly.

When taking Reyataz with Videx EC (didanosine), Reyataz should be taken with food two hours before or one hour after the Videx EC.

Reyataz can interact with some antidepressant medications. Reyataz can increase blood levels of tricyclic antidepressants, so caution should be taken if these drugs are used together and providers should monitor blood levels of the antidepressants. Reyataz can also increase blood levels of trazadone. The two drugs should be combined with caution, and lower dose of trazadone may be needed.

When Reyataz is combined with low-dose Norvir, it could increase blood levels of the antifungal drugs Nizoral (ketoconazole) and Sporanox (itraconazole). High doses of Nizoral and Sporanox should be used with caution if combined with Reyataz and Norvir.

Reyataz can interact with some medications used to treat TB, MAC and other bacterial infections. Rifadin (rifampin) should not be used with Reyataz. Reyataz can increase Mycobutin (rifabutin) levels (the Mycobutin dose should be reduced to 150mg every other day or three times a week). Reyataz can increase Biaxin (clarithromycin) levels in the bloodstream (the Biaxin dose should be reduced by half or an alternative antibiotic should be tried).

Reyataz can increase the blood levels of hormonal contraceptives and the two drugs should combined with caution. If an oral contraceptive is combined with Reyataz and Norvir, the oral contraceptive should contain at least 35 mcg of ethinyl estradiol. If Reyataz is taken without ritonavir, the oral contraceptive should contain no more than 30 mcg of ethinyl estradiol. Other hormonal contraceptives (such as the contraceptive patch, contraceptive vaginal ring, or injectable contraceptives) or oral contraceptives containing progestagens other than norethindrone or norgestimate, or less than 25 mcg of ethinyl estradiol, have not been studied with Reyataz; therefore, alternative methods of non-hormonal contraception are recommended.

Cholesterol-lowering drugs, also known as "statins," can interact with Reyataz. There are two statins that should not be used with Reyataz: Zocor (simvastatin) and Mevacor (lovastatin). Levels of these two drugs can become significantly increased in the bloodstream if they are combined with Reyataz, which increases the risk of side effects. The two statins that are considered to be the safest in combination with Reyataz are Pravachol (pravastatin) and Lescol (fluvastatin). It is also possible to take Reyataz with Lipitor (atorvastatin) or Crestor (rosuvastatin), although Reyataz can increase Lipitor and Crestor levels in the bloodstream. If Lipitor is prescribed, it's best to begin treatment with the lowest possible dose of the drug and then increase the dose if necessary.

Caution is needed when combining Reyataz with proton pump inhibitors (PPI) --used to treat heartburn and acid reflux--examples of which include include Propulsid (cisaprid), Nexium (esomeprazole), Prevacid (lansoprazole), Prilosec (omeprazole) and Protonix (pantoprazole). This is because Reyataz requires stomach acid to be absorbed properly by the body. Because PPIs greatly reduce stomach acid, they can decrease the amount of Reyataz that gets absorbed into the blood stream.

For HIV-positive people new to HIV treatment using 300mg Reyataz combined with 100mg Norvir, PPIs must be taken 12 hours before taking Reyataz, and the PPI dose must not exceed the equivalent of 20mg of Prilosec.

HIV-positive people new to HIV treatment who are using the 400mg dose of Reyataz (without Norvir) can not take PPIs. HIV-positive people who have tried and failed other treatments in the past are also cautioned against using PPIs

Caution is also needed with another type of stomach acid-reducing medication known as H2-receptor antagonists. Examples of H2-receptor antagonists include: Tagamet (cimetidine), Pepcid (famotidine), Axid (nizatidine), and Zantac (ranitidine). These medications must be used very carefully with Reyataz because they can decrease the amount of Reyataz absorbed into the bloodstream.

For HIV-positive people new to HIV treatment using 300mg Reyataz combined with 100mg Norvir, H2-receptor antagonists must be taken at the same time as Reyataz and food and/or at least ten hours after, and the dose must not exceed the equivalent of 40mg, twice daily, of Pepcid. For patients unable to tolerate Norvir, Reyataz 400 mg once daily with food should be taken at least two hours before and at least 10 hours after the H2-receptor antagonist. For these patients, no single dose of the H2-receptor antagonist should exceed the equivalent of 20 mg of Pepcid.

HIV-positive people who have tried and failed other treatments may take H2-antagonists at the same time as Norvir-boosted Reyataz and food and/or at least ten hours after, and the dose must not exceed the equivalence of 20mg, twice daily, of Pepcid. Also, treatment-experienced individuals taking H2 -receptor antagonists along with Viread (tenofovir) or Truvada (tenofovir plus emtricitabine) must increase the dose of Reyataz to 400mg.

Antacids and medications with a buffered coating may reduce blood levels of Reyataz. Reyataz should be taken two hours before or one hour after such medications.

There is a class of drugs, known as PDE-5 inhibitors that are used to treat both erectile dysfunction and pulmonary arterial hypertension. Their brand names differ, depending on their use. Prezista/Norvir can significantly increase blood levels of these drugs.

When used to treat erectile dysfunction, it is best to use a lower dose of Viagra (sildenafil), Levitra (vardenafil) and Cialis (tadalafil) in order to reduce the risk of side effects. When used to treat pulmonary arterial hypertension, the dose of tadalafil (Adcirca) must be reduced if combined with Prezista/Norvir. Revatio (sildenafil) and Prezista/Norvir should not be used together.
Reyataz can increase blood levels of a type of heart medication known as calcium channel blockers. If Reyataz is combined with diltiazem (Cardizem, Dilacor, Tiazac), the diltiazem dose should be decreased by 50 percent. Filodipine (Plendil), nifedipine (Adalat, Nifedical, and Procardia), nicardipine (Cardene), and verapamil (Veralan and Covera) should be used with caution in people taking Reyataz, and providers may wish to conduct an electrocardiogram to check on your heart rhythm.

Reyataz can increase blood levels of an asthma medication called Serevent (salmeterol), a drug that is used to open the air passages in the lungs during an asthma attack. This can result in heart rhythm problems. Use of the two drugs together is not recommended.

Reyataz can increase blood levels of immune suppressing drugs such as Cyclosporine (cyclosporin A), Rapamune (sirolimus), and Prograf (tacrolimus) that are used after a person has had transplant surgery. Blood level monitoring of the immune suppressors is recommended.

Reyataz can increase blood levels of cochicine, which is used to treat gout. Lower doses of colchicine are recommended, and the two drugs should not be used together in people with liver or kidney impairment.

Herbal products can also interact with Reyataz. St. John's wort should not be used with Reyataz, since it can greatly reduce the amount of Reyataz in the bloodstream. HIV-positive people should also be cautious about using garlic supplements or milk thistle with Reyataz—test tube studies suggest that both herbal products can interact with the same liver enzyme system (cytochrome P450 3A4) responsible for metabolizing Reyataz. This may alter the amount of Reyataz in the bloodstream. These and other herbal products should be used with caution, until further studies are conducted.

Some drugs have what is called a "narrow therapeutic window," meaning that the drug may be ineffective or cause side effects when the dose of the drug changes only a small amount. Drugs metabolized by the liver enzyme known as CY2C8 that have a narrow therapeutic window should be used with caution in people taking Reyataz. Examples of these kinds of drugs include the cancer chemotherapy Taxol (paclitaxel) and Prandin (repaglinide), which is used to control blood sugar.

Side Effects

Reyataz can increase levels of bilirubin, a pigment found in the liver. Increased bilirubin can cause the skin, nails, and the whites of the eyes to appear yellowish-brown. Increased bilirubin can also be a sign of liver damage. However, in people who have taken Reyataz in clinical trials, an increase in bilirubin has not been associated with any other signs of liver damage. Reyataz should not be combined with Crixivan, another protease inhibitor that can cause increased bilirubin levels.

There have been reports of patients developing painful kidney stones while on HIV drug regimens containing Reyataz. While little is known about the frequency of the kidney stones, or if certain risk factors are involved, increasing fluid intake while taking Reyataz may help decrease the risk of this possible side effect.

Changes in the way your heart beats may occur when taking Reyataz. If you get dizzy or lightheaded these could be symptoms of a heart problem.

Other possible side effects of Reyataz include headaches, pain/tingling in the arms and legs, nausea, diarrhea, abdominal discomfort, and rash.

Reyataz may not increase fat levels in the blood like other protease inhibitors. When used with Norvir, however, increased in total cholesterol, "bad" LDL cholesterol and triglycerides may be seen.

It is still not known if Reyataz can cause lipodystrophy's body-shape changes, such as an increase in fat around the gut or a loss of fat in the arms, legs, or face. It is also not known if HIV-positive people who continue taking Reyataz for a long period of time (e.g., longer than one year) will be able to keep their cholesterol and triglyceride levels low.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.