Minocycline and Atazanavir: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Atazanavir
Minocycline
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
Decreased atazanavir exposure and plasma concentrations
Interaction Deep Dive
In a pharmacokinetic study in 12 HIV-positive patients, coadministration of atazanavir with minocycline led to significant decreases in atazanavir exposure and plasma concentrations1. Although additional studies are warranted to determine the effect on treatment response, caution is advised if atazanavir and minocycline are coadministered.
Why it happens (mechanism)
Unknown
Literature reports
1 report — tap to read
a) In a study involving 12 HIV-positive adults (median age, 43.5 years), coadministration of minocycline and atazanavir resulted in decreased atazanavir exposure and plasma concentrations. Patients were on a stable antiretroviral regimen containing atazanavir 300 mg/ritonavir 100 mg for at least 4 weeks prior to study enrollment. On days 2 through 15, patients received atazanavir/ritonavir plus minocycline 100 mg twice daily, and on days 16 though 30, atazanavir/ritonavir plus minocycline 100 mg twice daily with valproic acid 250 mg twice daily. Compared to administration of atazanavir/ritonavir alone, coadministration of minocycline reduced atazanavir AUC by 33% (p=0.014), Cmin by 50% (p=0.022), and Cmax by 25% (p=0.024). The geometric mean ratio (95% confidence interval (CI)) for AUC, Cmin, and Cmax of atazanavir with and without minocycline were 0.67 (0.5 to 0.9), 0.5 (0.28 to 0.89), and 0.75 (0.58 to 0.95), respectively. The geometric mean ratio (95% CI) for AUC, Cmin, and Cmax of atazanavir with or without minocycline plus valproic acid were 0.68 (0.43 to 1.06), 0.5 (0.24 to 1.06), and 0.66 (0.41 to 1.06), respectively. Comparison of coadministration with minocycline alone versus minocycline plus valproic acid did not reveal a significant difference in atazanavir pharmacokinetics. Ritonavir pharmacokinetics were unaffected by addition of either minocycline or minocycline plus valproic acid 1.
Common questions
Can I take Minocycline and Atazanavir together?
Decreased atazanavir exposure and plasma concentrations Always confirm with your pharmacist or prescriber before making any change.
How serious is the Minocycline and Atazanavir interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Minocycline or Atazanavir 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 (1)
- DiCenzo R, Peterson DR, Cruttenden K, et al: Effects of minocycline and valproic acid coadministration on atazanavir plasma concentrations in human immunodeficiency virus-infected adults receiving atazanavir-ritonavir. Antimicrob Agents Chemother 2008; 52(9):3035-3039. DOI
Keep reading about Atazanavir
Keep reading about Minocycline
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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