Atients with HIV in the absence of potential or identified reducing the sensitivity to atazanavir is recommended to assign a combination of Reyataz 400 mg / ritonavir 100 mg omeprazole maximum dose of 20 mg once a day (or another drug from the group of proton pump inhibitors in appropriate dosage).
It is not recommended to assign omeprazole in a dose of 20 mg per day (or another drug from the group of proton pump inhibitors in appropriate dosage). blockers proviron libido H2 histamine receptors: concentration azatanavira in plasma was significantly reduced in the combined use of the drug once daily with famotidine 40 mg twice a day, which may reduce the therapeutic activity of the drug or to the development of resistance. When treating patients who have not received prior therapy, Reyataz 400 mg can be used once a day with food 2 hours before and at least 10 hours after application of blockers of H2-histamine receptors.
However, a single dose blockers, H2-histamine receptors total should not daily their intake should not exceed a dose corresponding to the dose of famotidine 20 mg and exceed a dose corresponding to 40 mg of famotidine. Alternatively, Reyataz 300 mg and ritonavir 100 mg may be used once a day in mealtime for 2 hours prior to and until at least 10 hours after application of the H2-blockers of histamine receptors in a single dose, comparable to the 40 mg famotidine. In the treatment of patients previously treated, a daily dose blockers, H2-histamine receptors should not exceed a dose corresponding to 40 mg of famotidine in such patients Reyataz 300 mg / ritonavir 100 mg should be applied once a day with food for 2 hours before and at least than 12 hours after application of the H2 blockers histamine receptors (once a day) at a dose corresponding to 40 mg of famotidine.
Alternatively, proviron libidoritonavir 100 mg may be used once a day with meals simultaneously blockers H2-histamine receptors for 2 hours prior to and until at least 10 hours after application blockers H2-histamine receptors in a dose not exceeding the dose which corresponds to 20 mg of famotidine. This dose may be taken once or twice a day. In the appointment of such combination to patients Reyataz / ritonavir and tenofovir with a blocker of H2-histamine receptors should be used dose: and ritonavir 100 mg once daily. Immunosuppressants (cyclosporin, tacrolimus, sirolimus): in the combined use of cyclosporine, tacrolimus, sirolimus, and drug may increase in the blood concentration of immunosuppressive drugs, so it is recommended to monitor their concentrations. antidepressants:Tritsiklicheskne antidepressants: a joint application of the drug Reyataz with three cyclic antidepressants occurrence of serious and / or life-threatening adverse reactions associated with antidepressants. It is recommended to monitor the concentrations of these drugs when combined with drug .
Trazodone: in the combined use of trazodone proviron libido with the drug or a combination ritonavir may increase concentrations of trazodone in the blood plasma. In a joint application of trazodone and ritonavir were reported occurrence of nausea, dizziness, decreased blood pressure and transient loss of consciousness. In a joint application with inhibitors of CYP3A4 trazodone, such as Reyataz should use lower doses of trazodone. Benzodiazepines: Mndazolam metabolized isoenzyme . Despite the fact that studies have been conducted, with the joint use of the drug and midazolam can expect a significant increase in the concentration of the latter.
The increase in the concentration of midazolam after oral administration would be much higher than with parenteral administration. Application of medication Reyataz together with midazolam oral contraindicated. Data on the simultaneous use of the drug Reyataz with midazolam in the form of injections are not available; on the basis of the simultaneous use of other HIV protease inhibitors with midazolam can assume a possible increase in the plasma concentrations of midazolam in 3-4 times. In a joint application of the drug Reyataz with injectable midazolam should be careful to monitor respiratory function and duration of sedation. In some cases, a correction mode.
Macrolide antibiotics: clarithromycin: when combined clarithromycin drug Reyataz concentration clarithromycin increases, which may cause lengthening QT-interval, so the antibiotic dose to be reduced by 50%. Oral Contraceptives: ethinylestradiol and norethisterone or norgestimate : when combined with the drug Reyataz concentration of ethinyl estradiol and norethisterone increase. The combined use of a combination of Reyataz / ritonavir with etnniestradiolom norgestamatom and reduces the average concentration of ethinyl estradiol and increases the average concentration of 17-deacetyl norgestimate, the active metabolite of norgestimate. In the case of joint use of oral contraceptives and the combination of Reyataz / ritonavir is recommended to use contraceptives containing ethinyl estradiol, at least 30 micrograms. If used with the contraceptive Reyataz without ritonavir, ethinyl estradiol content of oral contraceptives should not exceed 30 mg. Caution should be exercised, as the effect of increasing concentrations of progestogens has not known a joint application of the drug Reyataz and oral contraceptives; the risk of developing acne, dyslipidemia, and insulin resistance may increase. The combined use of the drug Reyataz or combinations Reyataz / ritonavir with other forms of hormonal contraceptives (contraceptive patch, contraceptive vaginal ring, injectable contraceptives) or oral contraceptives containing progestogens other than noretisterrona or norgestimate as well as preparations containing less than 25 mcg of ethinyl estradiol, has not been studied, so these methods of contraception should not be used in combination with the drug antimycobacterial drugs: rifabutin: Activity of rifabutin when combined with drug increases. At simultaneous reception of these drugs is recommended to decrease the dose of rifabutin up to 75% of the usual dose of 150 mg every other day or three times a week. Careful monitoring of adverse reactions in patients treated with rifabutin and or a combination of Reyataz / ritonavir; may require further dose adjustment of rifabutin. Drugs used in erectile dysfunction: Inhibitors of phosphodiesterase-5 (PDE-5) (sildenafil, tadalafil, vardenafil): the joint application of HIV protease inhibitors with inhibitors of phosphodiesterase-5 may be a significant increase in the concentration fosfodiesterazt-5 inhibitors and enhancement of their side effects. The recommended dose reduction: Viagra – 25 mg not more than once every 48 hours; Tadalafil – 10 mg not more than once every 72 hours; Vardenafil – 2.5 mg not more than once every 72 hours; . requires monitoring of adverse reactions Antifungals: ketoconazole, itraconazole, voriconazole: studied only with concomitant use of ketoconazole drug Reyataz without ritonavir; the concentration of atazanavir when using this combination significantly increased. ketoconazole and itraconazole can increase the concentration of atazanavir and ritonavir in the blood plasma. Caution should be exercised when using ketoconazole and itraconazole at daily doses greater than 200 mg together with a combination of Reyataz / ritonavir. Not recommended combined use of voriconazole with drugs Reyataz and ritonavir. Anticoagulants: Warfarin: due to increased activity of warfarin simultaneous use with the drug Reyataz may cause serious and / or life-threatening bleeding. It is recommended to monitor the international normalized ratio (MHO). Inhaled / nasal glucocorticoids (interaction with ritonavir): in the combined use of ritonavir with fluticasone propionate in healthy volunteers cortisol concentration decreased significantly. The combined use of a combination of Reyataz / ritonavir with fluticasone propionate may cause similar effects. In a joint application ritonavir and inhaled (or intranasal) formulations of fluticasone propionate noted the development of systemic side effects glyukokortnko steroids (Cushing’s syndrome, suppression of the adrenal cortex). Similar effects are possible when combined with other steroids glyukokortiko, a metabolite of CYP3A4 isoenzyme and ziruyuschihsya, eg, budesonide.