The Reyataz (atazanavir) package insert was revised to include information regarding the administration of atazanavir and/or atazanavir/ritonavir with food, proton pump inhibitors, H₂ receptor antagonists, acetaminophen, and fluconazole. Additionally, dosing information in patients with renal impairment was included.

Please refer to http://img.thebody.com/fda/2008/reyataz_prescribing.pdf for complete labeling. Below are highlights of the major recent changes.

The Dosage and Administration section and Precautions: Drug Interaction Table 11 were updated to include drug interaction information regarding the use of Reyataz and proton pump inhibitors and H₂-receptor antagonists.

The dose recommendations for therapy-naïve patients receiving H₂-receptor antagonists or proton pump inhibitors are the following:

• H₂-receptor antagonist: The H₂-receptor antagonist dose should not exceed a 40 mg dose equivalent of famotidine twice daily. Reyataz 300 mg and ritonavir 100 mg should be administered simultaneously with, and/or at least 10 hours after, the dose of the H₂-receptor antagonist.
• proton-pump inhibitors: The proton-pump inhibitor dose should not exceed a 20 mg dose equivalent of omeprazole and must be taken approximately 12 hours prior to the Reyataz 300 mg and ritonavir 100 mg dose.

The dose recommendations for therapy-experienced patients receiving H₂-receptor antagonists or proton pump inhibitors are the following:

• Whenever an H₂-receptor antagonist is given to a patient receiving Reyataz with ritonavir, the H₂-receptor antagonist dose should not exceed a dose equivalent to famotidine 20 mg twice daily, and the Reyataz and ritonavir doses should be administered simultaneously with, and/or at least 10 hours after, the dose of the H₂-receptor antagonist.
  • Reyataz 300 mg (one 300-mg capsule or two 150-mg capsules) with ritonavir 100 mg once daily (all as a single dose with food) if taken with an H₂-receptor antagonist.
  • Reyataz 400 mg (two 200-mg capsules) with ritonavir 100 mg once daily (all as a single dose with food) if taken with both tenofovir and an H₂-receptor antagonist.
• Proton-pump inhibitors should not be used in treatment-experienced patients receiving Reyataz.

In addition, the Dosage and Administration section was updated to provide dosing information in patients with renal impairment as follows:

For patients with renal impairment, including those with severe renal impairment who are not managed with hemodialysis, no dose adjustment is required for Reyataz. Treatment-naive patients with end stage renal disease managed with hemodialysis should receive Reyataz 300 mg with ritonavir 100 mg. Reyataz should not be administered to HIV-treatment experienced patients with end stage renal disease managed with hemodialysis.

No dose adjustments are needed when Reyataz is co-administered with acetaminophen or fluconazole.

The Clinical Pharmacology section was updated to include the following information:

• results of a food effect study with Reyataz 300 mg with ritonavir 100 mg with a light meal and high fat meal (see Clinical Pharmacology: Food Effect).
• results of a study in adult subjects with severe renal impairment, including those on hemodialysis is presented (see Clinical Pharmacology: Special Populations: Impaired Renal Function).
• results of drug-drug interaction studies with acetaminophen famotidine, fluconazole, and omperazole (See Clinical Pharmacology: Table 4: Drug Interactions: Pharmacokinetic Parameters for Atazanavir in the Presence of C administered Drugs and Table 5: Drug Interactions: Pharmacokinetic Parameters for Coadministered Drugs in the Presence of Reyataz.