Atazanavir with Dapsone Interaction Details

Brand Names Associated with Atazanavir

Brand Names Associated with Dapsone

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Feb 29, 2024

Interaction Effect

An increased risk of hemolytic anemia and symptomatic hyperbilirubinemia

Interaction Summary

Coadministration of atazanavir, an inhibitor of CYP3A[1] and dapsone, a CYP3A4 substrate, may increase the risk of side effects of dapsone. Concomitant use of an atazanavir-based antiretroviral regimen and dapsone was associated with hemolysis and the development of hyperbilirubinemia resulting in icterus of the sclera in 2 case reports. In both cases symptoms resolved and laboratory parameters normalized following the discontinuation of dapsone [2]. If concomitant use is required, consider monitoring for signs and symptoms of hyperbilirubinemia and hemolysis; changes in therapy may be warranted.

Severity

Moderate

Onset

Unspecified

Evidence

Probable

How To Manage Interaction

Use caution when using atazanavir together with dapsone, as hemolytic anemia and hyperbilirubinemia with icteric sclerae have been reported during concurrent therapy[2]. If concomitant use is required, consider monitoring for signs and symptoms of hyperbilirubinemia and hemolysis; changes in therapy may be warranted.

Mechanism Of Interaction

Inhibition of CYP3A-mediated dapsone metabolism by atazanavir

Literature Reports

A) Hemolytic anemia and symptomatic hyperbilirubinemia with icteric sclera occurred in 2 HIV-infected patients treated with an atazanavir-containing antiretroviral regimens and concurrent dapsone for Pneumocystis pneumonia prevention. The first patient, a 38-year-old woman, developed persistent yellowing of the sclera shortly after initiation of dapsone. Viral hepatitis and glucose-6-phosphate dehydrogenase (G-6-PD) deficiency were ruled out, but blood tests revealed normocytic anemia (Hb 9.7 mg/dL), an unconjugated bilirubin level of 6.6 mg/dL, and evidence of hemolysis was noted later. The second patient, a 55–year-old man, developed icteric sclera 1 to 2 weeks after simultaneous initiation of an atazanavir-containing antiretroviral regimen and dapsone. Laboratory analysis revealed evidence of hemolysis, normocytic anemia (Hb 11.1 mg/dL), and an unconjugated bilirubin level of 6.3 mg/dL, and viral hepatitis and G-6-PD deficiency were ruled out. In both cases, icterus resolved and laboratory values normalized following the discontinuation of dapsone [2].

References

1 ) Product Information: REYATAZ(R) oral capsules, atazanavir sulfate oral capsules. Bristol-Myers Squibb (per Manufacturer), Princeton, NJ, 2012.

2 ) East J & Blanton LS : Symptomatic hyperbilirubinemia secondary to dapsone-induced hemolysis and atazanavir therapy. Antimicrob Agents Chemother 2012; 56(2):1081-1083.PubMed Abstract: http://www.ncbi.nlm.nih.gov/...

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.

Dapsone Overview

• Dapsone is used to treat leprosy and skin infections.

• This medication is sometimes prescribed for other uses; ask your doctor or pharmacist for more information.

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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:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

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.