This section contains excerpted ¹ information on gene-based dosing recommendations. Neither this section nor other parts of this review contain the complete recommendations from the sources.

2023 Statement from the US Food and Drug Administration (FDA)

Contraindications

Atazanavir capsules are contraindicated… when coadministered with drugs that are highly dependent on CYP3A or UGT1A1 for clearance, and for which elevated plasma concentrations of the interacting drugs are associated with serious and/or life-threatening events […]

Drug interactions

Atazanavir is an inhibitor of CYP3A and UGT1A1. Coadministration of atazanavir and drugs primarily metabolized by CYP3A or UGT1A1 may result in increased plasma concentration of the other drug that could increase or prolong its therapeutic and adverse effects. […]

Atazanavir is a CYP3A4 substrate; therefore, drugs that induce CYP3A4 may decrease atazanavir plasma concentrations and reduce atazanavir's therapeutic effect.

Please review the complete therapeutic recommendations that are located here: (1)

2016 Statement from the Clinical Pharmacogenetics Implementation Consortium (CPIC)

For individuals carrying two UGT1A1 decreased function alleles (i.e., UGT1A1*28/*28, UGT1A1*28/*37, UGT1A1*37/*37, or rs887829 T/T), the likelihood of bilirubin-related atazanavir discontinuation is substantial. Before such individuals are prescribed atazanavir (boosted with either ritonavir or cobicistat), all such patients should be advised about the substantial likelihood of developing jaundice. Prescribing atazanavir to such individuals should generally be avoided unless the patient does not consider jaundice to be a concern, or there are other compelling reasons to prescribe atazanavir.

For individuals carrying fewer than two UGT1A1 decreased function alleles (i.e., *1/*28, *1/*37, *36/*28, *36/*37, rs887829 C/C or rs887829 C/T), the likelihood of bilirubin-related atazanavir discontinuation is low. This risk is extremely low for individuals carrying no UGT1A1 decreased function alleles (i.e., UGT1A1*1/*1, UGT1A1*1/*36, UGT1A1*36/*36, or rs887829 C/C). Among patients with extensive metabolizer UGT1A1 phenotypes it may not be necessary to discuss the possibility of jaundice with atazanavir. This decision about whether to discuss possible jaundice should be based on the clinical situation and provider judgment. If advice is offered, such discussion may note that the likelihood of developing jaundice that would require discontinuation of atazanavir is very low.

Please review the complete therapeutic recommendations that are located here: (4)

¹ The FDA labels specific drug formulations. In this excerpt, we have substituted the generic names for any specific drug labels. The FDA may not have labeled all formulations containing the generic drug. Where necessary, certain terms, genes and genetic variants may be corrected in accordance with nomenclature standards. We have provided the full name of abbreviations, shown in square brackets, where necessary.