Atazanavir with Betrixaban Interaction Details
Brand Names Associated with Atazanavir
- Atazanavir
- ATZ
- Reyataz®
Brand Names Associated with Betrixaban
- Betrixaban
- Bevyxxa®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Feb 29, 2024
Interaction Effect
Increased betrixaban exposure and an increased risk of bleeding
Interaction Summary
Coadministration of atazanavir with ritonavir, a strong CYP3A4/P-gp inhibitor, and betrixaban (Direct-acting oral anticoagulant) may result in increased exposure of betrixaban, which could lead to in an increased risk of bleeding[1]. Due to potentially increased bleeding risk, dosing recommendations for coadministration of betrixaban with a P-gp inhibitor such as atazanavir/cobicistat depends on DOAC indication and renal function [2]. Reduce dose of betrixaban in patients receiving or starting P-gp inhibitors. Monitor patients closely, and promptly evaluate any signs or symptoms of blood loss in these patients. The recommended dose of betrixaban in these patients is an initial single dose of 80 mg, followed by 40 mg once daily for 35 to 42 days. Avoid use of betrixaban in patients with severe renal impairment receiving concomitant P-gp inhibitors [3].
Severity
Major
Onset
Unspecified
Evidence
Theoretical
How To Manage Interaction
Coadministration of atazanavir with ritonavir, a strong CYP3A4/P-gp inhibitor, and betrixaban (Direct-acting oral anticoagulant) may result in increased exposure of betrixaban, which could lead to in an increased risk of bleeding[1]. Due to potentially increased bleeding risk, dosing recommendations for coadministration of betrixaban with a P-gp inhibitor such as atazanavir/cobicistat depends on DOAC indication and renal function [2]. Reduce dose of betrixaban in patients receiving or starting P-gp inhibitors. Monitor patients closely, and promptly evaluate any signs or symptoms of blood loss in these patients. The recommended dose of betrixaban in these patients is an initial single dose of 80 mg, followed by 40 mg once daily for 35 to 42 days. Avoid use of betrixaban in patients with severe renal impairment receiving concomitant P-gp inhibitors [3].
Mechanism Of Interaction
Inhibition of P-gp-mediated efflux transport of betrixaban
References
1 ) Product Information: REYATAZ(R) oral capsules, oral powder, atazanavir oral capsules, oral powder. Bristol-Myers Squibb Company (per FDA), Princeton, NJ, 2020.
2 ) Product Information: EVOTAZ(R) oral tablets, atazanavir cobicistat oral tablets. Bristol-Myers Squibb Company (per FDA), Princeton, NJ, 2023.
3 ) Product Information: BEVYXXA(R) oral capsules, betrixaban oral capsules. Portola Pharmaceuticals Inc (per FDA), South San Francisco, CA, 2020.
Atazanavir Overview
-
Atazanavir is used along with other medications to treat human immunodeficiency virus (HIV) infection in adults and children who are at least 3 months of age and weigh at least 22 lb (10 kg). Atazanavir is in a class of medications called protease inhibitors. It works by decreasing the amount of HIV in the blood. Although atazanavir does not cure HIV, it may decrease your chance of developing acquired immunodeficiency syndrome (AIDS) and HIV-related illnesses such as serious infections or cancer. Atazanavir must be given with other medications that treat HIV infection to completely treat the infection. Taking these medications along with practicing safer sex and making other lifestyle changes may decrease the risk of transmitting the HIV virus to other people.
Betrixaban Overview
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Betrixaban is used to prevent deep vein thrombosis (DVT; a blood clot, usually in the leg) and pulmonary embolism (PE; a blood clot in the lung) in people who are hospitalized for serious illnesses and are at risk of developing a clot due to decreased ability to move around or other risk factors. Betrixaban is in a class of medications called factor Xa inhibitors. It works by blocking the action of a certain natural substance that helps blood clots to form.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.