Lack of interaction between atazanavir and lansoprazole
Abstract
The majority of antiretroviral drug interactions involve the cytochrome P450 enzyme system. However, interactions involving the impairment of absorption may also play an important role in antiretroviral efficacy. Atazanavir, a recently approved once daily protease inhibitor, is highly dependent on pH for adequate absorption. Therefore, it would be expected that medications which increase gastric pH, such as proton pump inhibitors and H2-receptor antagonists, would be contraindicated. The current recommendations are to avoid proton pump inhibitors and to separate the administration of atazanavir and H2-receptor antagonists by 12 h to minimize the effect on absorption [1]. The use of gastric acid inhibitors is a common therapy in the clinical care of HIV-infected individuals. To our knowledge, no studies have characterized this particular interaction. We describe the absence of interaction with the co-administration of atazanavir and lansoprazole. A 40-year-old HIV-infected man with extensive antiretroviral history and virological failure was switched to a regimen consisting of atazanavir (300 mg a day), ritonavir (100 mg a day), tenofovir (300 mg a day) and lamivudine (300 mg a day). His viral load before the initiation of this regimen was 37 200 RNA copies/ml and the CD4 lymphocyte count was 319 cells/mm3. He had also received the proton pump inhibitor, lansoprazole (30 mg twice a day) for gastroesophageal reflux disease and Barrett's esophagitis before initiating the…
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