Discontinue treatment if severe rash/reactions develop. SJS, erythema multiforme, & toxic skin eruptions including DRESS; anaphylaxis. Prolongs the PR interval. Increased risk for developing further transaminase elevations or hepatic decompensation in patients w/ underlying hepatitis B or C viral infections or marked elevations in transaminases. New-onset DM, exacerbation of preexisting DM, & hyperglycemia (persisted in some cases when therapy is discontinued) in HIV-infected patients. Diabetic ketoacidosis. May develop an inflammatory response to indolent or residual opportunistic infections (eg,
Mycobacterium avium infection, cytomegalovirus,
Pneumocystis jirovecii pneumonia, or TB) during the initial phase of treatment. Autoimmune disorders (eg, Graves' disease, polymyositis, & Guillain-Barré syndrome). Fat redistribution/accumulation including central obesity, dorsocervical fat enlargement (buffalo hump), peripheral/facial wasting, breast enlargement, & cushingoid appearance. Increased bleeding, including spontaneous skin hematomas & hemarthrosis in patients w/ hemophilia type A & B. Resistance/cross resistance. Pregnancy (risk of lactic acidosis syndrome & hyperbilirubinemia). Do not use during lactation. Atazanavir: Preexisting conduction system disease (eg, marked 1st degree AV block or 2nd or 3rd degree AV block). Hyperbilirubinemia. Consider alternative therapy if jaundice or scleral icterus associated w/ bilirubin elevations present concerns for patients. Ritonavir: Allergic reactions including urticaria, mild skin eruptions, bronchospasm, & angioedema. Increased risk for developing cardiac conduction abnormalities in patients w/ underlying structural heart disease, preexisting conduction system abnormalities, ischemic heart disease, cardiomyopathies. Preexisting liver diseases, liver enzyme abnormalities, or hepatitis; hepatic dysfunction in patients w/ multiple concomitant medications &/or w/ advanced AIDS. Monitor increase in AST/ALT especially during the 1st 3 mth of treatment. Increased risk of elevated triglycerides & pancreatitis in patients w/ advanced HIV disease; discontinue therapy if signs or symptoms of pancreatitis occur. Should not be taken by patients w/ galactose intolerance, total lactase deficiency or glucose-galactose malabsorption. Co-administration w/ drugs that prolong PR interval (including Ca channel blockers, β-adrenergic blockers), particularly those metabolized by CYP3A. Perform triglyceride & cholesterol testing prior to initiating therapy & at periodic intervals during therapy. Increased triglycerides, cholesterol, SGOT (AST), SGPT (ALT), GGT, CPK, & uric acid. May reduce the efficacy of combined hormonal contraceptive, use alternative contraceptive method or additional barrier method of contraception.
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