Drug
Atazanavir-Cobicistat
Pronounced
"A-ta-ZAN-a-vir/koe-BIK-i-stat"
Drug Interactions
See also How to Use section.
Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.
Some products that may interact with this drug include: drospirenone/estradiol, elvitegravir, certain medications used to treat chronic hepatitis C (such as elbasvir/grazoprevir, glecaprevir/pibrentasvir), indinavir, orlistat, ritonavir.
This medication can slow down the removal of other medications from your body, which may affect how they work. Examples of affected drugs include certain alpha blockers (such as alfuzosin, silodosin), certain benzodiazepines (midazolam, triazolam), dronedarone, ergot alkaloids (such as dihydroergotamine, ergotamine), irinotecan, lurasidone, pimozide, ranolazine, rivaroxaban, salmeterol, certain drugs to treat erectile dysfunction-ED or pulmonary hypertension (avanafil, sildenafil), certain "statin" cholesterol drugs (lovastatin, simvastatin), among others.
Other medications can affect the removal of this medication from your body, which may affect how this medication works. Examples include apalutamide, lumacaftor, mitotane, certain HIV NNRTIs (such as efavirenz, etravirine, nevirapine), certain rifamycins (such as rifampin, rifapentine), certain drugs used to treat seizures (such as carbamazepine, phenobarbital, phenytoin, primidone), St. John's wort, among others.
Prescription and nonprescription drugs to treat heartburn, indigestion, or ulcers (including H2 blockers such as famotidine, proton pump inhibitors such as lansoprazole/omeprazole) reduce stomach acid and decrease the absorption of atazanavir. This may prevent atazanavir from working well. Ask your doctor or pharmacist how to use these medications safely.
This medication may decrease the effectiveness of hormonal birth control such as pills, patch, or ring. This could cause pregnancy. Discuss with your doctor or pharmacist if you should use reliable backup birth control methods while using this medication. Also tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your birth control is not working well.
Do not use this medication with other products that contain atazanavir or cobicistat.
Negative Interactions
2- Reduces Effectiveness
Atazanavir-Cobicistat
Khat
This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.
Khat (Catha edulis) is an herb found in East Africa and Yemen that has recently been imported into the United States. Studies have shown that chewing khat significantly reduces the absorption of ampicillin, which might reduce the effectiveness of the antibiotic. Therefore, people taking ampicillin should avoid herbal products that contain khat.
KhatAtazanavir-Cobicistat- Attel OA, Ali AA, Ali HM. Effect of khat chewing on the bioavailability of ampicillin and amoxicillin. J Antimicrob Chemother 1997;39:523-5.
- Reduces Effectiveness
Atazanavir-Cobicistat
St. John’s Wort
This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.
Studies have shown that taking indinavir together with St. John’s wort results in increased breakdown and dramatically reduced blood levels of indinavir. Therefore, people taking indinavir should not take St. John’s wort.
Indinavir is a protease inhibitor used to treat people with HIV infection. A pharmacological study gave indinavir to healthy volunteers for two days. On day 3, volunteers added 900 mg of St. John’s wort extract per day. At the end of the study, it was found that St. John’s wort led to a significant reduction in serum levels of indinavir. Until more is known, people taking indinavir or other antiretroviral drugs for HIV infection should avoid using St. John’s wort.
St. John’s WortAtazanavir-Cobicistat- Piscitelli SC, Burstein AH, Chaitt D, et al. Indinavir concentrations and St. John's wort. Lancet 2000;355:547-8 [letter].
- Moore LB, Goodwin B, Jones SA, et al. St. John's wort induces hepatic drug metabolism through activation of the pregnane X receptor. Proc Natl Acad Sci USA 2000;97:7500-2.
Supportive Interactions
4- Replenish Depleted Nutrients
Atazanavir-Cobicistat
Vitamin B12
This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.
Neomycin can decrease absorption or increase elimination of many nutrients, including calcium, carbohydrates, beta-carotene, fats, folic acid, iron, magnesium, potassium, sodium, and vitamin A, vitamin B12, vitamin D, and vitamin K. Surgery preparation with oral neomycin is unlikely to lead to deficiencies. It makes sense for people taking neomycin for more than a few days to also take a multivitamin-mineral supplement.
Vitamin B12Atazanavir-Cobicistat- Roe DA. Drug-Induced Nutritional Deficiencies, 2d ed. Westport, CT: Avi Publishing, 1985, 157-8 [review].
- Holt GA. Food & Drug Interactions. Chicago: Precept Press,1998, 183.
- Replenish Depleted Nutrients
Atazanavir-Cobicistat
Vitamin K
This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.
Several cases of excessive bleeding have been reported in people who take antibiotics. This side effect may be the result of reduced vitamin K activity and/or reduced vitamin K production by bacteria in the colon. One study showed that people who had taken broad-spectrum antibiotics had lower liver concentrations of vitamin K2 (menaquinone), though vitamin K1 (phylloquinone) levels remained normal. Several antibiotics appear to exert a strong effect on vitamin K activity, while others may not have any effect. Therefore, one should refer to a specific antibiotic for information on whether it interacts with vitamin K. Doctors of natural medicine sometimes recommend vitamin K supplementation to people taking antibiotics. Additional research is needed to determine whether the amount of vitamin K1 found in some multivitamins is sufficient to prevent antibiotic-induced bleeding. Moreover, most multivitamins do not contain vitamin K.
Vitamin KAtazanavir-Cobicistat- Suzuki K, Fukushima T, Meguro K, et al. Intracranial hemorrhage in an infant owing to vitamin K deficiency despite prophylaxis. Childs Nerv Syst 1999;15:292-4.
- Huilgol VR, Markus SL, Vakil NB. Antibiotic-induced iatrogenic hemobilia. Am J Gastroenterol 1997;92:706-7.
- Bandrowsky T, Vorono AA, Borris TJ, Marcantoni HW. Amoxicllin-related postextraction bleeding in an anticoagulated patient with tranexamic acid rinses. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1996;82:610-2.
- Kaiser CW, McAuliffe JD, Barth RJ, Lynch JA. Hypoprothrombinemia and hemorrhage in a surgical patient treated with cefotetan. Arch Surg 1991;126:524-5.
- Conly J, Stein K. Reduction of vitamin K2 concentration in human liver associated with the use of broad spectrum antimicrobials. Clin Invest Med 1994;17:531-9.
- Support Medicine
Atazanavir-Cobicistat
Probiotics
This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.
In one study, taking 500 mg of Saccharomyces boulardii twice daily enhanced the effectiveness of the antibiotic vancomycin in preventing recurrent clostridium infection. Therefore, people taking antibiotics who later develop diarrhea might benefit from supplementing with saccharomyces organisms.ProbioticsAtazanavir-Cobicistat- Surawicz CM, Elmer GW, Speelman P, et al. Prevention of antibiotic-associated diarrhea by Saccharomyces boulardii: A prospective study. Gastroenterol 1989;96:981-8.
- Reduce Side Effects
Atazanavir-Cobicistat
Probiotics
This interaction is based on this drug belonging to a drug class. While this drug may differ from the text and references below, drugs within this class work in a similar way and this interaction is applicable to drugs within the same class.
A common side effect of antibiotics is diarrhea, which may be caused by the elimination of beneficial bacteria normally found in the colon. Controlled studies have shown that taking probiotic microorganisms—such as Lactobacillus casei, Lactobacillus acidophilus, Bifidobacterium longum, or Saccharomyces boulardii—helps prevent antibiotic-induced diarrhea.
The diarrhea experienced by some people who take antibiotics also might be due to an overgrowth of the bacterium Clostridium difficile, which causes a disease known as pseudomembranous colitis. Controlled studies have shown that supplementation with harmless yeast—such as Saccharomyces boulardii or Saccharomyces cerevisiae (baker’s or brewer’s yeast)—helps prevent recurrence of this infection.
Treatment with antibiotics also commonly leads to an overgrowth of yeast (Candida albicans) in the vagina (candida vaginitis) and the intestines (sometimes referred to as “dysbiosis”). Controlled studies have shown that Lactobacillus acidophilus might prevent candida vaginitis.
ProbioticsAtazanavir-Cobicistat- Elmer GW, Surawicz CM, McFarland LV. Biotherapeutic agents. A neglected modality for the treatment and prevention of selected intestinal and vaginal infections. JAMA 1996;275:870-6 [review].
- Schellenberg D, Bonington A, Champion CM, et al. Treatment of Clostridium difficile diarrhoea with brewer's yeast. Lancet 1994;343:171-2.