Reyataz (Atazanavir)

BEFORE you use REYATAZ, talk to your doctor or pharmacist:

• If you suffer from liver disease because the dose of REYATAZ may need to be reduced.
• If you are intolerant to lactose because REYATAZ capsules contain small quantities of lactose. These small quantities are unlikely to induce specific symptoms of intolerance.
• If you are pregnant or planning to become pregnant, or breast-feeding.
• If you have a heart problem.

Discuss the use of REYATAZ with your doctor because some conditions may require special attention before or while taking this medicine. In particular because:

• There have been changes in the way the heart beats (heart rhythm changes). Call your healthcare provider right away if you get dizzy or lightheaded. These could be symptoms of a heart problem.
• There is a possibility of increased bleeding if you have a type A or B haemophilia.
• There have been reports of increased sugar in the blood and development or worsening of diabetes mellitus when using protease inhibitors.
• Changes in body fat have been seen in some patients taking antiretroviral therapy. These changes may include increased amount of fat in the upper back and neck, breasts and around the trunk. Loss of fat from the legs, arms and face may also happen. The cause or long-term health effects of these conditions are not known at this time.
• There have been reports of kidney stones. If you develop signs or symptoms of kidney stones (pain in your side, blood in your urine, pain when you urinate) call your healthcare provider right away.
• REYATAZ should not be used in combination with quetiapine. Serious and/or life-threatening reactions, including severe sedation and coma, have been reported for use of HIV protease inhibitors together with quetiapine. If coadministration is necessary, your doctor may need to monitor and adjust the dose of quetiapine.

Can I take REYATAZ during pregnancy and breast-feeding?

• Pregnancy: It is not known if REYATAZ can harm your unborn baby.
• Pregnant women have experienced serious side effects when taking REYATAZ with other HIV medicines called nucleoside analogues. You and your healthcare provider will need to decide if REYATAZ is right for you. If you use REYATAZ while you are pregnant, talk to your healthcare provider about the Antiretroviral Pregnancy Registry.
• Breast-feeding: If you are breastfeeding, do not take REYATAZ unless specifically directed by your doctor. This is to avoid transmission of HIV to your infant thorough breast milk.

There have been reports of a condition called lactic acidosis syndrome (excess of lactic acid in the blood) with the use of REYATAZ in combination with other medicines used to treat HIV infection. This serious side effect has occasionally been fatal. Lactic acidosis occurs more often in women, particularly if very overweight. Frequent nausea, vomiting and stomach pain might indicate the development of lactic acidosis.

Ask your doctor for advice if you get pregnant or think you are pregnant or if you want to breast-feed.

Can REYATAZ be used in children?

REYATAZ capsules can be used in children 6 years of age and older. Dosing recommendations are not available for children from 3 months to less than 6 years of age. REYATAZ should not be used in babies under the age of 3 months.

Like all medicines, REYATAZ can have side effects.

When treating HIV infection, it is not always easy to tell what side effects are caused by REYATAZ, by the other medicines you take, or by the HIV infection itself. For this reason, it is important that you inform your doctor of any change in your health.

Some of the most common side effects of REYATAZ taken with other anti-HIV medicines include nausea, headache, rash, abdominal pain, and yellowing of the skin or whites of the eyes.

REYATAZ can cause the following side effects:

• Yellowing of the skin or eyes. These effects may be due to increases in bilirubin levels in the blood. Call your healthcare provider if your skin or the white part of your eyes turn yellow. Although these effects may not be damaging to your liver, skin, or eyes, it is important to tell your healthcare provider promptly if they occur.
• If you have liver disease including hepatitis B or C, your liver disease may get worse when you take anti-HIV medicines likeREYATAZ.
• Rash. Rash (redness and itching) sometimes occurs in patients taking REYATAZ, most often in the first few weeks after the medicine is started. Tell your healthcare provider if rash occurs. If severe rash occurs or if severe rash with swelling of the face or tongue occur, seek immediate medical attention.
• Diabetes and high blood sugar (hyperglycemia) sometimes happen in patients taking protease inhibitor medicines likeREYATAZ. Some patients had diabetes before taking protease inhibitors while others did not. Some patients may need changes in their diabetes medicine.
• A change in the way your heart beats (heart rhythm change). Call your healthcare provider right away if you get dizzy or lightheaded. These could be symptoms of a heart problem.
• Gallbladder disorders (which may include gallstones and gallbladder inflammation) and includes symptoms such as severe abdominal pain, nausea, vomiting, itching, jaundice (yellowing of the skin and eyes), pale stool and dark urine. If these symptoms occur, contact your doctor immediately.
• Your immune system may get stronger when you start taking HIV medicines. It may begin to fight infections that have been hidden in your body for a long time or your immune system could react against your own body (autoimmune disease). Examples are Graves' disease (which affects the thyroid gland), Guillain-Barré syndrome (which affects the nervous system) or polymyositis (which affects the muscles). Autoimmune disease may develop at any time, sometimes months after the start of HIV therapy). Sometimes symptoms can be severe, so if you develop high temperature (fever), joint or muscle pain, redness, rash, swelling, or fatigue or any new symptoms contact your doctor straight away.

Other side effects may occur with REYATAZ. Ask your doctor or pharmacist for more information about side effects. Inform your doctor promptly about these or any other symptoms. If the condition persists or worsens, seek medical attention.

If you notice any side effects not mentioned in this leaflet, please inform your doctor or pharmacist.

This summary does not include everything there is to know about REYATAZ. If you have questions or concerns, or want more information about REYATAZ, your physician and pharmacist have the complete prescribing information upon which this leaflet was based. You may want to read it and discuss it with your doctor or other healthcare professional. Remember, no written summary can replace careful discussion with your doctor.

REYATAZ may interact with other drugs, including those you take without a prescription. You must tell your doctor or pharmacist about all drugs, including prescription and non-prescription drugs, herbal products and supplements and street drugs, you are taking or planning to take before you take REYATAZ. REYATAZ should be taken in combination with other antiretroviral agents. Clinical trials have found that combination antiviral therapy is more effective than one drug alone at reducing the amount of HIV in the blood and at reducing the development of resistance.

REYATAZ should not be taken with indinavir (CRIXIVAN) as both REYATAZ and CRIXIVAN sometimes cause increased levels of bilirubin in the blood. (Increased levels of bilirubin can cause yellowing of the skin and the white part of the eyes).

If you are taking didanosine (VIDEX) buffered tablets or antacids, take REYATAZ with a meal one hour after or more than two hours before you take these medicines. Taking them together causes lower amounts of REYATAZ in the blood making it less effective.

The following medicines may require your healthcare provider to either monitor your therapy more closely or to change the dose or dose schedule of either REYATAZ or the other medicine:

• The anticoagulant warfarin (COUMADIN).
• Corticosteroids, given by nose or inhaled, such as fluticasone propionate (FLONASE or FLOVENT). Your doctor may choose not to keep you on fluticasone, especially if you are also taking ritonavir (KALETRA, NORVIR).
• Medicines to prevent organ transplant rejection: cyclosporine (SANDIMMUNE, NEORAL), tacrolimus (PROGRAF) and sirolimus (RAPAMUNE).
• Medicines for abnormal heart rhythm: lidocaine and quinidine (also known as BIQUIN), amiodarone (CORDARONE).
• The antidepressant trazodone.
• Tricyclic antidepressant such as amitriptyline (ELAVIL), desipramine, imipramine (TOFRANIL).
• Rifabutin (MYCOBUTIN)
• Calcium channel blockers such as diltiazem (CARDIZEM or TIAZAC), felodipine (PLENDIL), verapamil (COVERA-HS or ISOPTIN SR).
• Oral contraceptives; REYATAZ may affect the safety and effectiveness of hormonal contraceptives such as birth control pills. Talk to your healthcare provider about choosing an effective method of contraception. Hormonal contraceptives do not prevent the spread of HIV to others.
• Stomach acid reducing agents (eg, famotidine, also known as PEPCID AC).
• Proton-pump inhibitors used for indigestion, heart burn or ulcers (ex. omeprazole, also known as LOSEC).
• The antifungals ketoconazole (NIZORAL) and itraconazole (SPORANOX) if you are taking REYATAZ with ritonavir.
• Voriconazole (VFEND), used to treat fungal infections: your doctor should monitor your therapy more closely for voriconazole-associated adverse events.
• Efavirenz.
• Midazolam (when injected).
• Atorvastatin (LIPITOR); there is an increased chance of serious side effects if you take REYATAZ with this cholesterol-lowering medicine.
• Sildenafil (VIAGRA) or tadalafil (CIALIS) used for erectile dysfunction: before you take sildenafil or tadalafil with REYATAZ, talk to your doctor about possible drug interactions and side effects. Your doctor may lower your dose of sildenafil or tadalafil if you are taking REYATAZ. Vardenafil should not be coadministered with REYATAZ. If you take sildenafil or tadalafil and REYATAZ together, you may be at increased risk of side effects of sildenafil or tadalafil such as low blood pressure, visual changes, and penile erection lasting more than 4 hours. If you experience any of these side effects you should seek immediate medical assistance.
• Coadministration of REYATAZ and tadalafil (ADCIRCA) for the treatment of pulmonary hypertension is not recommended.
• REYATAZ should not be coadministered with SEREVENT DISKUS (salmeterol) and/or ADVAIR (salmeterol with fluticasone) used to treat asthma, emphysema/chronic obstructive pulmonary disease also known as COPD.
• Bosentan (TRACLEER) when used to treat pulmonary arterial hypertension.
• Medicine to treat opioid dependence: buprenorphine (SUBOXONE).
• The antibiotic clarithromycin (BIAXIN).
• Colchicine, used to prevent or to treat gout.
• Antiepileptic medicines such as TEGRETOL (carbamazepine), DILANTIN (phenytoin), or phenobarbital, or LAMICTAL (lamotrigine).
• Quetiapine (SEROQUEL), used to treat schizophrenia and bipolar disorder.

Other medicines may interact with REYATAZ. Remember to tell your healthcare provider all the medicines (prescription, non-prescription) and herbal supplements you are taking or planning to take.

Usual dose:

For adults, who have never taken anti-HIV medicines before, the recommended dose of REYATAZ is:

• 300 mg (one 300 mg capsule or two 150 mg capsules) once daily taken with ritonavir 100 mg once daily taken with food.
• OR
• 400 mg (two 200 mg capsules), or as prescribed by physician, once a day with food (without ritonavir).

For adults who have taken anti-HIV medicines in the past, the usual dose is:

• 300 mg (one 300 mg capsule or two 150 mg capsules) once daily taken with ritonavir 100 mg once daily taken with food.

For children from 6 to 18 years of age, the recommended dose is based on weight. Your child's physician will provide you with the correct dosing instructions. Do not exceed the adult dose.

It is important that you take REYATAZ with food to achieve higher, more consistent REYATAZ levels. REYATAZ capsules should not be opened, they should be swallowed whole with water.

REYATAZ must be taken every day exactly as your doctor prescribes because it gives you the best chance to slow down resistance to the medicine. Therefore do not change or stop your daily dose of REYATAZ without first asking your doctor.

REYATAZ should always be taken with other antiretrovirals.

REYATAZ should be taken at about the same time each day with a meal.

If a side effect prevents you from taking REYATAZ as directed, tell your doctor right away.

Always keep REYATAZ on hand so you don't run out. When you travel or need to stay in the hospital, make sure you will have enough REYATAZ to last until you can get a new supply.

Overdose:

In case of drug overdose, contact a healthcare practitioner, hospital emergency department or regional poison control centre, even if there are no symptoms.

Missed dose:

It is important to take the daily dose prescribed by your doctor to ensure that you get maximum benefit. If you forget to take a dose, take the dose you missed as soon as possible with some food, and then return to your normal schedule. However, if a dose is skipped, do not double the next dose. Continue as normal with your next dose.