ATAZANAVIR ZENTIVA 150 MG HARD CAPSULES - patient leaflet, side effects, dosage

1.what atazanavir is and what it is used for

Atazanavir is an antiviral (or antiretroviral) medicine. It is one of a group called protease inhibitors. These medicines control the Human Immunodeficiency Virus (HIV) infection by stopping a protein that the HIV needs for its multiplication. They work by reducing the amount of HIV in your body and this in turn, strengthens your immune system. In this way, atazanavir reduces the risk of developing illnesses linked to HIV infection. atazanavir capsules may be used by adults and children 6 years of age and older. Your doctor has prescribed this medicine for you because you are infected by the HIV that causes Acquired Immunodeficiency Syndrome (AIDS). It is normally used in combination with other anti-HIV medicines. Your doctor will discuss with you which combination of these medicines with atazanavir is best for you.

2.what you need to know before you take atazanavir

Do not take atazanavir

• if you are allergic to atazanavir or any of the other ingredients of this medicine (listed in section 6)
• if you have moderate to severe liver problems.

Your doctor will evaluate how severe your liver disease is before deciding whether you can take atazanavir

• if you are taking any of these medicines: (see also „Other medicines and atazanavir“):
• rifampicin (an antibiotic used to treat tuberculosis) astemizole or terfenadine (commonly used to treat allergy symptoms, these medicines may be available without prescription); cisapride (used to treat gastric reflux, sometimes called heartburn); pimozide (used to treat schizophrenia); quinidine or bepridil (used to correct heart rhythm); ergotamine, dihydroergotamine, ergonovine, methylergonovine (used to treat headaches); and alfuzosin (used to treat enlarged prostatic gland)
• quetiapine (used to treat schizophrenia, bipolar disorder and major depressive disorder); lurasidone (used to treat schizophrenia)
• medicines containing St. John’s wort (Hypericum perforatum, a herbal preparation)
• triazolam and oral (taken by mouth) midazolam (used to help you sleep and/or to relieve anxiety)
• simvastatin and lovastatin (used to lower blood cholesterol).
• grazoprevir-containing products, including elbasvir/grazo­previr fixed dose combination, and glecaprevir/pi­brentasvir fixed dose combination (used to treat chronic hepatitis C infection)

Do not take sildenafil with atazanavir when sildenafil is used for the treatment of pulmonary arterial hypertension. Sildenafil is also used for the treatment of erectile dysfunction. Tell your doctor if you are using sildenafil for the treatment of erectile dysfunction.

Tell your doctor at once if any of these apply to you.

Warnings and precautions

Atazanavir is not a cure for HIV infection. You may continue to develop infections or other illnesses linked to HIV infection. You can still pass on HIV when taking this medicine, although the risk is lowered by effective antiretroviral therapy. Discuss with your doctor the precautions needed to avoid infecting other people.

Some people will need special care before or whilst taking atazanavir. Talk to your doctor or pharmacist before taking atazanavir, and make sure your doctor knows:

• if you have hepatitis B or C
• if you develop signs or symptoms of gall stones (pain at the right side of your stomach)
• if you have type A or B haemophilia
• if you require haemodialysis

Atazanavir may affect how well your kidneys work.

Kidney stones have been reported in patients taking atazanavir. If you develop signs or symptoms of kidney stones (pain in your side, blood in your urine, pain when you urinate), please inform your doctor immediately.

In some patients with advanced HIV infection (AIDS) and a history of opportunistic infection, signs and symptoms of inflammation from previous infections may occur soon after anti-HIV treatment is started. It is believed that these symptoms are due to an improvement in the body’s immune response, enabling the body to fight infections that may have been present with no obvious symptoms. If you notice any symptoms of infection, please inform your doctor immediately. In addition to the opportunistic infections, autoimmune disorders (a condition that occurs when the immune system attacks healthy body tissue) may also occur after you start taking medicines for the treatment of your HIV infection. Autoimmune disorders may occur many months after the start of treatment. If you notice any symptoms of infection or other symptoms such as muscle weakness, weakness beginning in hands and feet and moving up towards the trunk of the body, palpitations, tremor or hyperactivity, please inform your doctor immediately to seek necessary treatment.

Some patients taking combination antiretroviral therapy may develop a bone disease called osteonecrosis (death of bone tissue caused by loss of blood supply to the bone). The length of combination antiretroviral therapy, corticosteroid use, alcohol consumption, severe immunosuppression, higher body mass index, among others, may be some of the many risk factors for developing this disease.

Signs of osteonecrosis are joint stiffness, aches and pains (especially of the hip, knee and shoulder) and difficulty in movement. If you notice any of these symptoms please inform your doctor.

Hyperbilirubi­naemia (an increase in the level of bilirubin in the blood) has occurred in patients receiving atazanavir. The signs may be a mild yellowing of the skin or eyes. If you notice any of these symptoms please inform your doctor.

Serious skin rash, including Stevens-Johnson syndrome , has been reported in patients taking atazanavir. If you develop a rash inform your doctor immediately.

If you notice a change in the way your heart beats (heart rhythm changes), please inform your doctor. Children receiving atazanavir may require their heart to be monitored. Your child’s doctor will decide this.

Children

Do not give this medicine to children younger than 3 months of age and weighing less than 5 kg. The use of atazanavir in children less than 3 months of age and weighing less than 5 kg has not been studied due to the risk of serious complications.

Other medicines and atazanavir

You must not take atazanavir with certain medicines. These are listed under „Do not take atazanavir“, at the start of section 2.

There are other medicines that may not mix with atazanavir. Tell your doctor if you are taking, have recently taken, or might take any other medicines. It is especially important to mention these:

• other medicines to treat HIV infection (e.g. indinavir, nevirapine and efavirenz)
• boceprevir and sofosbuvir/vel­patasvir/voxi­laprevir (used to treat hepatitis C)
• sildenafil, vardenafil, or tadalafil (used by men to treat impotence (erectile dysfunction))
• if you are taking an oral contraceptive („the Pill“) with atazanavir to prevent pregnancy, be sure to take it exactly as instructed by your doctor and not miss any doses
• any medicines used to treat diseases related to the acid in the stomach (e.g. antacids to be taken 1 hour before taking atazanavir or 2 hours after taking atazanavir, H2-blockers like famotidine and proton pump inhibitors like omeprazole)
• medicines to lower blood pressure, to slow heart rate, or to correct heart rhythm (amiodarone, diltiazem, systemic lidocaine, verapamil)
• atorvastatin, pravastatin, and fluvastatin (used to lower blood cholesterol)
• salmeterol (used to treat asthma)
• cyclosporin, tacrolimus, and sirolimus (medicines to decrease the effects of body's immune system)
• certain antibiotics (rifabutin, clarithromycin)
• ketoconazole, itraconazole, and voriconazole (antifungals)
• warfarin (an anticoagulant, used to reduce blood clots)
• carbamazepine, phenytoin, phenobarbital, lamotrigine (antiepileptics)
• irinotecan (used to treat cancer)
• sedative agents (e.g. midazolam administered by injection)
• buprenorphine (used to treat opioid addiction and pain).

Some medicines may interact with ritonavir, a medicine that is taken with atazanavir. It is important to tell your doctor if you are taking fluticasone or budesonide (given by nose or inhaled to treat allergic symptoms or asthma).

Atazanavir with food and drink

It is important that you take atazanavir with food (a meal or a substantial snack) as this helps the body absorb the medicine.

Pregnancy and breast-feeding

If you are pregnant or breast-feeding, think that you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine. Atazanavir, the active substance of this medicine, is excreted in human milk. Patients should not breast-feed while taking atazanavir. It is recommended that women infected with HIV do not breast-feed because the virus might be transmitted through the breast milk.

Driving and using machines

If you feel dizzy or lightheaded, do not drive or use machines and contact your doctor immediately.

Atazanavir contains lactose

If you have been told by your doctor that you have an intolerance to some sugars (e.g. lactose), contact your doctor before taking this medicinal product.

3.how to take atazanavir

Always take this medicine exactly as your doctor has told you. Check with your doctor if you are not sure. This way, you can be sure your medicine is fully effective and you reduce the risk of the virus developing resistance to the treatment.

The recommended adult dose of atazanavir capsules is 300 mg once daily with 100 mg ritonavir once daily and with food , in combination with other anti-HIV medicines. Your doctor may adjust the dose of atazanavir according to your anti-HIV therapy.

For children (6 to less than 18 years of age), your child's doctor will decide the right dose based on your child's weight. The dose of atazanavir capsules for children is calculated by body weight and is taken once daily with food and 100 mg ritonavir as shown below:

Body weight (kg)	Atazanavir dose (mg) once daily	Ritonavir dose* (mg) once daily
15 to less than 35	200	100
at least 35	300	100
*Ritonavir capsules, tablets or oral solution may be used.

The availability of other formulations available for use in children at least 3 months old and weighing at least 5 kg should be checked. Switching to atazanavir capsules is encouraged as soon as patients are able to consistently swallow capsules.

A change in dose may occur when switching between oral powder and capsules. Your doctor will decide the right dose based on your child’s weight.

There are no dosing recommendations for atazanavir in paediatric patients less than 3 months of age.

Take atazanavir capsules with food (a meal or a substantial snack). Swallow the capsules whole.

Do not open the capsules.

If you take more atazanavir than you should

Yellowing of the skin and/or eyes (jaundice) and irregular heart beat (QTc prolongation) may occur if you or your child take too much of atazanavir. If you accidentally take more atazanavir capsules than your doctor recommended, contact your HIV doctor at once or contact the nearest hospital for advice.

If you forget to take atazanavir

If you miss a dose, take the missed dose as soon as possible with food and then take your next scheduled dose at its regular time. If it is almost time for your next dose, do not take the missed dose. Wait and take the next dose at its regular time. Do not take a double dose to make up for a forgotten dose.

If you stop taking atazanavir

Do not stop taking atazanavir before talking to your doctor.

If you have any further questions on the use of this medicine, ask your doctor.

4.possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. When treating HIV infection, it is not always easy to identify what side effects are caused by atazanavir, by the other medicines you are taking, or by the HIV infection itself. Tell your doctor if you notice anything unusual about your health.

During HIV therapy there may be an increase in weight and in levels of blood lipids and glucose. This is partly linked to restored health and life style, and in the case of blood lipids, sometimes to the HIV medicines themselves. Your doctor will test for these changes.

Tell your doctor immediately if you develop any of the following serious side effects:

• Skin rash, itching that may occasionally be severe has been reported. The rash usually disappears within 2 weeks without any change to your atazanavir treatment. Severe rash may be developed in association with other symptoms which could be serious. Stop taking atazanavir and talk to your doctor immediately if you develop a severe rash or a rash with flu-like illness symptoms, blisters, fever, mouth sores, muscle or joint pain, swelling in the face, inflammation of the eye which causes redness (conjunctivitis), painful, warm, or red lumps (nodules).
• Yellowing of your skin or the white part of your eyes caused by high levels of bilirubin in your blood has been frequently reported. This side effect is usually not dangerous in adults and infants older than 3 months of age; but it might be a symptom of a serious problem. If your skin or the white part of your eyes turns yellow, talk to your doctor immediately.
• Changes in the way your heart beats (heart rhythm change) may occasionally happen. Talk to your doctor immediately if you get dizzy, lightheaded or if you suddenly faint. These could be symptoms of a serious heart problem.
• Liver problems may occur infrequently. Your doctor should do blood tests prior you start atazanavir and during treatment. If you have liver problems, including hepatitis B or C infection, you may experience a worsening of your liver problems. Talk to your doctor immediately if you get dark (tea-colored) urine, itching, yellowing of your skin or the white part of your eyes, pain around the stomach, pale coloured stools or nausea.
• Gallbladder problems uncommonly happen in people taking atazanavir. Symptoms of gallbladder problems may include pain in the right or middle upper stomach area, nausea, vomiting, fever or yellowing your skin or the white part of your eyes.
• Atazanavir may affect how well your kidneys work.
• Kidney stones uncommonly happen in people taking atazanavir. Talk to your doctor immediately if you get symptoms of kidney stones which may include, pain in your low back or low stomach area, blood in your urine or pain when you urinate.

Other side effects reported for patients treated with atazanavir are as follows:

Common (may affect up to 1 in 10 people):

• headache
• vomiting, diarrhoea, abdominal pain (stomach pain or discomfort), nausea, dyspepsia (indigestion)
• fatigue (extreme tiredness)

Uncommon (may affect up to 1 in 100 people):

• peripheral neuropathy (numbness, weakness, tingling or pain in the arms and legs)
• hypersensitivity (allergic reaction)
• asthenia (unusual tiredness or weakness)
• weight loss, weight gain, anorexia (loss of appetite), appetite increased
• depression, anxiety, sleep disorders
• disorientation, amnesia (loss of memory), dizziness, somnolence (sleepiness), abnormal dreams
• syncope (fainting), hypertension (high blood pressure)
• dyspnoea (shortness of breath)
• pancreatitis (inflammation of the pancreas), gastritis (inflammation of the stomach), stomatitis aphthous (mouth ulcers and cold sores), dysgeusia (impairment of the sense of taste), flatulence (wind), dry mouth, abdominal distension
• angioedema (severe swelling of the skin and other tissues most often the lips or the eyes)
• alopecia (unusual hair loss or thinning), pruritus (itching)
• muscle atrophy (muscle shrinkage), arthralgia (joint pain), myalgia (aching muscles)
• interstitial nephritis (kidney inflammation), haematuria (blood in the urine), proteinuria (excess protein in the urine), pollakiuria (increased frequency of urination)
• gynaecomastia (breast enlargement in men)
• chest pain, malaise (generally feeling unwell), fever
• insomnia (difficulty sleeping)

Rare (may affect up to 1 in 1,000 people):

• gait disturbance (abnormal manner of walking)
• oedema (swelling)
• hepatosplenomegaly (enlargement of the liver and spleen)
• myopathy (aching muscles, muscle tenderness of weakness, not caused by exercise)
• kidney pain

Reporting of side effects

If you get any side effects, talk to your doctor or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: or search for MHRA Yellow Card in the Google Play or Apple App Store.

By reporting side effects you can help provide more information on the safety of this medicine.

5.how to store atazanavir

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the label, carton or blister. The expiry date refers to the last day of that month.

Bottle pack with 60 capsules: Use within 60 days after first opening.

Bottle pack with 30 capsules: Use within 30 days after first opening.

Do not store above 30°C.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6.contents of the pack and other information

What atazanavir contains

Atazanavir 150mg

• The active substance is atazanavir. Each capsule contains 150 mg of atazanavir (as sulphate).
• The other ingredients are lactose monohydrate, crospovidone (type B) and magnesium stearate. The capsule shell contains titanium dioxide (E171), gelatine, indigo carmine (E132).

Atazanavir 200 mg

• The active substance is atazanavir. Each capsule contains 200 mg of atazanavir (as sulphate).
• The other ingredients are lactose monohydrate, crospovidone (type B) and magnesium stearate. The capsule shell contains titanium dioxide (E171), gelatine, indigo carmine (E132).

Atazanavir 300 mg

• The active substance is atazanavir. Each capsule contains 300 mg of atazanavir (as sulphate).
• The other ingredients are lactose monohydrate, crospovidone (type B) and magnesium stearate. The capsule shell contains titanium dioxide (E171), gelatine, indigo carmine (E132), red iron oxide (E172), black iron oxide (E172), yellow iron oxide (E172).

What atazanavir looks like and contents of the pack

Each capsule of atazanavir 150 mg contains 150 mg of atazanavir.

Pale yellow to slightly brownish granular powder filled capsule with opaque blue cap and greenish-blue body.

Each capsule of Atazanavir 200 mg contains 200 mg of Atazanavir.

Pale yellow to slightly brownish granular powder filled capsule with opaque blue cap and opaque blue body.

Each capsule of Atazanavir 300 mg contains 300 mg of Atazanavir.

Pale yellow to slightly brownish granular powder filled capsule with opaque red cap and opaque blue body.

Atazanavir 150 mg hard capsules are supplied in bottles of 60 capsules.

Atazanavir 150 mg hard capsules are also supplied in blister packs of 60 capsules.

Atazanavir 200 mg hard capsules are supplied in bottles of 60 capsules.

Atazanavir 200 mg hard capsules are also supplied in blister packs of 60 capsules.

Atazanavir 300 mg hard capsules are supplied in bottles of 30 or 60 capsules. Either one bottle of 30 or 60 capsules or three bottles of 30 hard capsules are provided in one carton.

Atazanavir 300 mg hard capsules are also supplied in blister packs of 30 or 60 capsules.

Not all pack sizes may be marketed in all countries.

The Marketing Authorisation Holder is

Zentiva Pharma UK Limited, 12 New Fetter Lane, London, EC4A 1JP, UK

The Manufacturer is

Zentiva, k. s., U kabelovny 130, Praha 10, Dolm Mecholupy, Czech Republic

This leaflet was last updated in February 2020

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19.06.2020 6:50:52