EVOTAZ is a combination formulation of the HIV Protease Inhibitor (PI) atazanavir (300mg) and pharmacokinetic enhancer cobicistat (150mg). Atazanavir is active against both mutant and wild-type HIV-1. Cobicistat on its own has no antiviral activity. EVOTAZ is used in the treatment of HIV-1 infection in combination with other antiretroviral drugs, usually including low-dose ritonavir. Atazanavir is not active against HIV-2. It works by blocking HIV protease from its function in producing mature virions.
Dosing & Administration
EVOTAZ is indicated for the treatment of HIV-1 infection in adults and is used off-label in treatment-naïve adolescents in late puberty. EVOTAZ comes in a film-coated tablet and should be taken with food. Dosing instructions and considerations are given in detail in the product monograph.
EVOTAZ should not be used in patients with any degree of liver dysfunction. No dosage adjustments are necessary for patients with renal impairment, but EVOTAZ should not be used in patients requiring hemodialysis. As well, EVOTAZ should not be used in patients with a creatinine clearance less than 70 mL/min if they are also taking tenofovir disoproxil fumarate.
EVOTAZ is contraindicated in patients with hypersensitivity to the drug, and in patients with liver dysfunction. EVOTAZ is contraindicated for use with a number of medications and herbals listed in the product monograph.
EVOTAZ can cause serious liver and heart rhythm side effects. Other potential adverse effects include lactic acidosis syndrome, viral resistance, hepatotoxicity, elevated cholesterol, pancreatitis, rash, jaundice, renal calculi, hyperglycemia, and fat redistribution. A complete list of potential adverse effects is provided in the product monograph.
EVOTAZ should be used with caution in the presence of cardiac AV block, as atazanavir may prolong the PR interval or QTc in some patients. Patients with pre-existing cardiac abnormalities should be carefully screened prior to starting on EVOTAZ. EVOTAZ should be used with caution in hemophiliacs due to increased bleeding risk with atazanavir. Screening and monitoring guidelines are provided in the product monograph.
All patients who test positive for HIV infection should be screened for comorbid Hepatitis B virus (HBV) and Hepatitis C virus (HCV) infection. Co-infected patients should be started on an antiretroviral regimen targeting co-infected viruses, regardless of CD4 counts or viral loads. Current HIV treatment guidelines outline drug regimens and prescribing considerations.
EVOTAZ is associated with a large number of drug-drug interactions and contraindications, especially medications that are metabolized by CYP3A. A complete list is provided in the product monograph.
Pregnancy & Lactation
Highly active retroviral combination treatment should be used in all pregnant women. The safety of EVOTAZ in pregnancy has not been established. Current guidelines should be consulted when treating women in pregnancy. EVOTAZ is excreted in breast milk. The CDC recommends that all HIV positive women, treated or untreated, avoid breastfeeding to prevent vertical transmission of the virus.
There is no treatment that is specific for EVOTAZ overdose. Patients should be closely monitored and provided with supportive care. EVOTAZ is probably not removed by hemodialysis.
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