Atazanavir and Alfuzosin: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Atazanavir
Alfuzosin
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased alfuzosin exposure and an increased risk of QT interval prolongation
Interaction Deep Dive
Although the interaction between alfuzosin, a CYP3A4 substrate, and atazanavir, a potent CYP3A4 inhibitor, has not been studied, the interaction between alfuzosin and ketoconazole, another potent CYP3A4 inhibitor, resulted in 2- to 3-fold increases in alfuzosin Cmax and AUC values1. Concomitant use may also increase the risk of QT interval prolongation due to additive effect. Therefore, concomitant use of alfuzosin and atazanavir is contraindicated due to the potential for significant increases in alfuzosin plasma concentrations, which could result in hypotension 32.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated alfuzosin metabolism by atazanavir; additive QT interval prolongation
Literature reports
1 report — tap to read
a) Although the interaction between alfuzosin, a CYP3A4 substrate, and atazanavir, a potent CYP3A4 inhibitor, has not been studied, there have been two studies in which repeated doses of ketoconazole, another potent CYP3A4 inhibitor, and alfuzosin resulted in increased alfuzosin Cmax and AUC values. In one study, alfuzosin Cmax and AUC were increased by 2.3- and 3.2-fold, respectively, when patients received repeated ketoconazole doses of 400 mg/day followed by a single 10 mg alfuzosin dose. In another study, alfuzosin Cmax and AUC were increased by 2.1- and 2.5-fold when patients received repeated ketoconazole doses of 200 mg/day followed by a single 10 mg alfuzosin dose 1.
Common questions
Can I take Atazanavir and Alfuzosin together?
Increased alfuzosin exposure and an increased risk of QT interval prolongation Always confirm with your pharmacist or prescriber before making any change.
How serious is the Atazanavir and Alfuzosin interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
Questions for your pharmacist
- Does my dose of Atazanavir or Alfuzosin need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (3)
- Product Information: UROXATRAL(R) extended release oral tablets, alfuzosin hcl extended release oral tablets. Sanofi-Aventis, Bridgewater, NJ, 2010.
- Product Information: EVOTAZ(R) oral tablets, atazanavir cobicistat oral tablets. Bristol-Myers Squibb Company (per FDA), Princeton, NJ, 2023. DailyMed
- Product Information: REYATAZ(R) oral capsules, oral powder, atazanavir oral capsules, oral powder. Bristol-Myers Squibb Company (per FDA), Princeton, NJ, 2023. DailyMed
Keep reading about Atazanavir
Keep reading about Alfuzosin
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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