Atazanavir and Cobicistat
Atazanavir and cobicistat is a two-drug combination used alongside other antiretroviral medicines to treat HIV-1 infection in adults and children weighing at least 35 kg.
🧬 Where this information comes from Click to expand
The clinical label records used on this page are FDA-filed Structured Product Labeling (SPL) retrieved through openFDA. We identified 1 clinical label set within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. Forms, routes, brands, labelers, strengths, and NDC product-record counts are built separately from matching FDA National Drug Code Directory records. The linked DailyMed document is a representative official source for verification, not the page’s only clinical source. View the linked label on DailyMed →
📖 Atazanavir and Cobicistat: Patient Information Guide
A plain-language walkthrough of Atazanavir and Cobicistat — what it treats, how it works, how it’s taken, side effects, warnings and interactions. Tap any section to expand it.
🎯What it's used for▾
Atazanavir and cobicistat, available as the brand Evotaz, is approved to treat HIV-1 (human immunodeficiency virus type 1) infection. It must always be used as part of a combination antiretroviral regimen — not as a standalone treatment.
- Evotaz is approved for HIV-1 infection in adult patients
- Evotaz is approved for HIV-1 infection in pediatric patients weighing at least 35 kg
- In treatment-experienced patients (those who have taken HIV medicines before), Evotaz should only be used after assessing how much resistance to protease inhibitors the virus has developed
⚙️How it works▾
Evotaz contains two ingredients working together. Atazanavir is an HIV-1 protease inhibitor — it blocks a key enzyme (protease) that the virus needs to assemble new, functional copies of itself. Without this step, HIV cannot produce infectious particles. Cobicistat is a CYP3A inhibitor, meaning it slows the liver enzyme that would otherwise break atazanavir down too quickly. By boosting atazanavir levels in the blood, cobicistat helps the antiviral component work effectively.
Because cobicistat blocks the same liver pathway that metabolizes many other drugs, there is a significant potential for drug interactions — making a complete medication review essential before and during treatment.
💊How it's taken▾
Evotaz is taken as one tablet by mouth, once a day, with food. Taking it with food improves absorption of both ingredients. It must always be combined with other antiretroviral agents as directed by your prescriber.
- Take at the same time each day to keep drug levels steady
- If you take antacids, H2 blockers (like famotidine), or proton pump inhibitors (like omeprazole), these may need to be taken at a different time or may need dose adjustments — check with your prescriber or pharmacist
- Evotaz is not recommended during pregnancy or for patients with any degree of liver impairment
🤒Side effects — in detail▾
The most common side effects with Evotaz (atazanavir coadministered with cobicistat) are:
- Jaundice (yellowing of skin or eyes) — very common due to elevated bilirubin; usually harmless and reversible, but tell your doctor
- Skin rash — ranges from mild to severe; stop the medication and seek care if the rash is severe
- Ocular icterus (yellowing of the whites of the eyes)
- Nausea
- Diarrhea
- Headache
- Fatigue
- Elevated creatinine on lab tests — often a drug effect on kidney filtration markers, not actual kidney damage, but requires monitoring
Serious reactions that require prompt medical attention include severe skin reactions (such as Stevens-Johnson syndrome), significant kidney problems especially when combined with tenofovir DF, and heart conduction changes. Contact your care team right away if you notice any of these.
⚠️Warnings & precautions▾
- Heart conduction (PR interval prolongation): Atazanavir slows the heart's electrical system. This is usually mild and without symptoms, but patients with pre-existing heart conduction problems may need ECG monitoring.
- Severe skin reactions: Stevens-Johnson syndrome, DRESS syndrome, and other serious rashes have been reported. Discontinue Evotaz immediately if a severe rash appears.
- Kidney problems: Cobicistat affects creatinine lab values without always harming actual kidney function — but real kidney damage, including acute kidney failure and Fanconi syndrome (a kidney tubule disorder), can occur, especially with tenofovir DF. Kidney stones have also been reported.
- Chronic kidney disease: Long-term use of atazanavir has been associated with chronic kidney disease, including inflammation caused by drug crystals depositing in kidney tissue.
- Liver toxicity: Patients with hepatitis B or C are at increased risk of liver enzyme elevations or liver failure. Evotaz is not recommended for anyone with liver impairment.
- Hyperbilirubinemia: Most patients will have elevated bilirubin, which can cause visible yellowing. This reverses when the drug is stopped, but liver enzymes should be monitored alongside bilirubin elevations.
- Drug interactions: Evotaz boosts and is affected by many medications. Serious or life-threatening interactions are possible — some drugs are completely contraindicated.
- Not recommended in pregnancy: Drug levels fall too low in the second and third trimesters to be effective, and an alternative regimen is recommended.
🔀What it interacts with▾
Evotaz has a large number of drug interactions because both atazanavir and cobicistat affect key liver enzymes that process many medications. Always tell your prescriber and pharmacist about everything you take.
- Rifampin, St. John's wort, carbamazepine, phenobarbital, phenytoin: Contraindicated — these lower Evotaz levels so much that the drug stops working and resistance can develop
- Lovastatin, simvastatin: Contraindicated — Evotaz raises their levels to dangerous heights, increasing risk of serious muscle damage
- Lurasidone, pimozide, triazolam, oral midazolam: Contraindicated — risk of life-threatening reactions
- Dronedarone, ranolazine: Contraindicated — risk of serious heart reactions
- Sildenafil (for pulmonary arterial hypertension): Contraindicated at that indication
- Antacids, H2 blockers, proton pump inhibitors: Lower atazanavir absorption — timing adjustments are needed
- Tenofovir DF: Increases risk of kidney damage — close monitoring required; combination not recommended if kidney function is below a certain threshold
- Blood thinners (warfarin, apixaban, rivaroxaban, dabigatran): Evotaz can raise their levels, increasing bleeding risk — monitoring and possible dose changes needed
- Hormonal contraceptives containing drospirenone/ethinyl estradiol: Contraindicated — use non-hormonal birth control instead
- Other HIV protease inhibitors, ritonavir, elvitegravir: Not recommended in combination with Evotaz
This is not a complete list of interactions. Always talk with your doctor or pharmacist before starting, stopping, or changing any medication.
📋Before taking it▾
- Liver disease: Evotaz is not recommended for anyone with any degree of liver impairment, including hepatitis B or C — liver tests should be done before and during treatment
- Kidney disease: Kidney lab tests are required before starting and throughout treatment; Evotaz is not recommended for treatment-experienced patients with end-stage kidney disease on hemodialysis
- Pregnancy: Evotaz is not recommended during pregnancy — drug levels drop too low in the second and third trimesters to be effective; switch to an alternative if you become pregnant
- Breastfeeding: Do not breastfeed — HIV can pass through breast milk, and the drug's safety for nursing infants is not established
- Children under 35 kg or under 3 months: Evotaz is not approved for these patients; atazanavir specifically is not recommended in infants under 3 months due to risk of kernicterus (severe jaundice affecting the brain)
- Heart conduction problems: Tell your doctor about any history of heart block or abnormal heart rhythms — ECG monitoring may be needed
- Hemophilia: Spontaneous bleeding has been reported with HIV protease inhibitors — extra clotting factor may be needed
- Older adults: Should be monitored more carefully due to higher rates of kidney, liver, and cardiac issues with age
- All medications and supplements: A full medication review is essential before starting — the interaction list is extensive
🚑If you take too much▾
There is no specific antidote for an Evotaz overdose. Because atazanavir is heavily processed by the liver and both ingredients bind tightly to blood proteins, dialysis is unlikely to remove them effectively. One reported case of a large atazanavir overdose caused PR interval prolongation and a heart conduction change (bifascicular block) that resolved on its own without treatment.
If an overdose is suspected, seek emergency medical care immediately. Treatment is supportive — vital signs and heart function (ECG) should be monitored.
📡Pharmacodynamics — effects in the body▾
Atazanavir can prolong the PR interval on an ECG (a measure of how long it takes for an electrical impulse to travel through part of the heart). In clinical studies, this was generally mild and without symptoms, most often causing first-degree AV block. Neither atazanavir nor cobicistat meaningfully prolonged a different heart measure (QTc interval) at usual doses.
Cobicistat causes an apparent decrease in estimated kidney filtration rate (eGFR) by blocking how creatinine is secreted by kidney tubules — without actually reducing true kidney function. This is a drug effect on a lab value, not kidney damage, though real kidney injury can still occur and monitoring is essential.
🔬Pharmacokinetics — how your body processes it▾
Both atazanavir and cobicistat reach peak blood levels about 2 hours after taking Evotaz. Food increases the absorption of both ingredients, which is why taking it with a meal is important. Atazanavir has a half-life of about 7 hours, and cobicistat about 3.5 hours — both are broken down primarily by a liver enzyme called CYP3A.
Cobicistat is almost entirely eliminated in the feces (about 86%), with very little leaving through the urine. Atazanavir is heavily metabolized by the liver. In adolescents weighing at least 35 kg, atazanavir levels were somewhat higher than in adults but not enough to require a different dose. Liver impairment significantly affects how atazanavir is processed, which is why Evotaz is not recommended for anyone with liver disease.
📦How to store it▾
Store EVOTAZ tablets at 25°C (77°F); excursions permitted between 15°C and 30°C (59°F and 86°F) .
📄 Written from Atazanavir and Cobicistat’s FDA-approved label information, summarized in plain language with AI, and reviewed by our pharmacy team before publication. Every point is grounded in that labeling — nothing is invented. How we use AI →
Supplements & herbs that interact with Atazanavir and Cobicistat
152 supplements and herbal products have documented interactions with Atazanavir and Cobicistat in the licensed clinical database we use. Most are manageable — but your pharmacist should know about everything you take, including vitamins and herbals.
- Major · 3
- Moderate · 107
- Minor · 42
Educational information from a licensed clinical database (Natural Medicines) — see our data sources & update cadence. Not medical advice: an interaction being documented does not mean it will happen to you; do not start or stop medications or supplements without professional guidance.
🩺 Pharmacist Counseling Corner
Quick, plain-English answers to the questions patients ask most about Atazanavir and Cobicistat — the kind of thing our pharmacy team would talk through with you at the counter.
What exactly is Evotaz and why do I need to take other HIV medicines with it? ▾
Why am I turning yellow — is that dangerous? ▾
How important is it really to take Evotaz with food? ▾
I take a lot of other medications — do I really need to worry about interactions? ▾
What should I watch for with my kidneys while on Evotaz? ▾
Can I take Evotaz if I'm pregnant or trying to get pregnant? ▾
Is Atazanavir and Cobicistat available over the counter? ▾
When was Atazanavir and Cobicistat first available? ▾
Who makes Atazanavir and Cobicistat? ▾
💬 Answers drafted from Atazanavir and Cobicistat’s FDA-approved label information, summarized in plain language with AI, and reviewed by our pharmacy team before publication. Grounded in that labeling — nothing is made up. How we use AI →
🧰 Keep exploring
💊 How Atazanavir and Cobicistat comes
Atazanavir and Cobicistat is available in 1 form. Different forms and brands can have different approved uses, doses, schedules, and directions. Follow the instructions for your exact product, and do not switch forms without guidance from your prescriber or pharmacist.
Tablet
How this form is used
- Evotaz is used to treat HIV-1 infection in adults and in pediatric patients weighing at least 35 kg, always in combination with other antiretroviral medicines
- Evotaz use in treatment-experienced patients should be guided by the number of protease inhibitor resistance mutations the virus has developed
- Evotaz is taken as one tablet by mouth, once daily, with food
- Evotaz should not be taken during pregnancy; if you become pregnant while on Evotaz, talk to your prescriber about switching regimens
- If you take antacids or acid-reducing medicines, Evotaz may need to be taken at a different time — ask your pharmacist for specific guidance
- Evotaz is not recommended for patients with any degree of liver impairment or for treatment-experienced patients with end-stage kidney disease on hemodialysis
📊 Atazanavir and Cobicistat across the U.S. market
How Atazanavir and Cobicistat appears in the FDA’s National Drug Code Directory — including its dosage forms, strengths, brand names, manufacturers, and FDA-listed product records. These are directory records, not sales or prescription volume.
Share of FDA-listed product records by manufacturer — FDA National Drug Code Directory. Record counts are not sales or prescription volume.
📈 How widely Atazanavir and Cobicistat is used
A general measure of how commonly Atazanavir and Cobicistat is prescribed, based on Medicaid — one of the largest public drug programs. The figure below is prescriptions filled in Q1–Q4 2025, summed across every form and brand of the drug.
Think of this as a proxy for how widely Atazanavir and Cobicistat is used, drawn from freely available public data. Medicaid is just one program — these numbers don’t include Medicare, other government coverage, or commercial and cash-pay prescriptions, so real-world use is higher than what’s shown here.
How commonly is Atazanavir and Cobicistat prescribed? Of the 1,594 medications we measure, Atazanavir and Cobicistat ranks #1,234 by Medicaid prescriptions — more than 23% of them.
Utilization by Atazanavir and Cobicistat product
Pick a product to see its own Medicaid numbers. Each chip is one clinical product — a specific strength & dosage form as defined by RxNorm — with brand-name and generic versions combined.
atazanavir 300 MG / cobicistat 150 MG Oral Tablet
Summed across the 1 of 2 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 1601654
Shares are of the Medicaid prescriptions shown here. Product grouping follows RxNorm (the National Library of Medicine’s drug terminology), so “one product” means one strength & dosage form regardless of manufacturer. Dollar figures are gross Medicaid reimbursement before mandatory rebates — rebates (often large, especially for brand-name drugs) are confidential, so actual net cost to Medicaid is lower than shown.
Source: Medicaid State Drug Utilization Data (CMS), aggregated by generic ingredient — summed across every NDC (all brands, strengths, salt forms and dosage forms) of Atazanavir and Cobicistat, and across all states and both fee-for-service and managed-care claims. A general popularity signal; it excludes Medicare, commercial insurance and cash prescriptions, so it is not total U.S. use. Based on the 1 of 2 listed Atazanavir and Cobicistat NDCs with Medicaid activity.
🔍 Compare Atazanavir and Cobicistat products
A representative set of FDA-listed product records for Atazanavir and Cobicistat — across manufacturers, strengths, and dosage forms, grouped by form with each product’s manufacturer and how the FDA approved it. The same medicine may be made and packaged by different companies, so a single drug can have many directory entries. (It’s also why a refill can look different — a new shape, color, or box — even though it contains the same medication.)
| Strength | Route | Manufacturer / Labeler | Category ⓘ | Details |
|---|---|---|---|---|
| 💊Tablet | ||||
| ATAZANAVIR SULFATE 300 mg/1; COBICISTAT 150 mg | Oral | E.R. Squibb & Sons, L.L.C. | NDA | View NDC → |
| 300; 150 mg/1; mg | Oral | E.R. Squibb & Sons, L.L.C. × 2 listings | NDA | View NDC → |
| ATAZANAVIR SULFATE 300 mg/1; COBICISTAT 150 mg | — | Patheon Inc. | DRUG FOR FURTHER PROCESSING | View NDC → |
Showing 4 of 4 products — FDA National Drug Code Directory. See every product, package size and price: browse all 4 Atazanavir and Cobicistat NDCs →
📈 What people report — real-world data (FDA FAERS)
After a medicine reaches the market, patients, doctors and drugmakers can send the FDA reports of problems they think may be linked to it. Here’s what’s been reported for Atazanavir and Cobicistat — a signal of what to watch for, not proof the drug caused it.
Source: openFDA, from the FDA Adverse Event Reporting System (FAERS). These are voluntary reports — they don’t prove the drug caused the effect, and counts reflect how often something was reported, not how often it actually happens. Reports also often name the very problem the medicine is taken for — a common reason to file one is that the drug didn’t help — so for a pain reliever you may see “pain” high on the list; that points to why the report was filed, not to the drug causing the symptom. This counts every report that lists Atazanavir and Cobicistat in any role, so the total runs higher than the FDA’s official dashboard, which counts only cases where the drug is the suspect. For the authoritative figures, see the FDA FAERS Public Dashboard. Always talk to your pharmacist or doctor.
🏛️ The road to your pharmacy
How Atazanavir and Cobicistat went from FDA review to the pharmacy shelf — the key milestones in its regulatory journey.
Source: Drugs@FDA.
🚨 Recall history
A recall is when a specific batch of a medicine is pulled from the market — usually a manufacturing issue, not a problem with the drug itself. Class I is most serious, Class III least.
Source: openFDA drug enforcement (recall) reports.
RxNorm Concept Web — From Ingredient to Every Form and Strength
This page starts with one exact multiple-ingredient concept (MIN). The branches below show its dose-form concepts (SCDF), then the available clinical drug and strength concepts (SCD). A product with a different ingredient combination belongs on a different page.
RxCUI 1601653 1 dose form · 1 strength
-
Dose form (SCDF) Oral Tablet RxCUI 1601652In current FDA listingsClinical drug / strength (SCD) atazanavir 300 MG / cobicistat 150 MGRxCUI 1601654
Look up RxCUI 1601653 in the RxCUI Atlas →
RxNorm is the U.S. National Library of Medicine’s normalized drug vocabulary. Its concept hierarchy can include forms that are not currently marketed; the status on each branch compares that concept with current FDA listings. RxCUIs identify vocabulary concepts, not individual packages or manufacturers.
📦 Supply & shortage status
Whether Atazanavir and Cobicistat is in short supply in the U.S. right now, plus any shortage history the FDA has on record. A shortage usually reflects a manufacturing or demand issue — not a safety problem with the drug.
Source: openFDA, from the FDA Drug Shortages database.
🏷️ Sold under these brand names
🏭 Manufacturers & labelers
RxNorm drug class
Atazanavir and Cobicistat belongs to the Cytochrome P450 3A Inhibitor class.
Classified by RxNorm RxClass — the U.S. National Library of Medicine's standardized drug-classification service (Established Pharmacologic Class from the FDA, the ATC drug family from the WHO, and mechanism of action). Reference only, not medical advice.
🔬 Where this comes from
Core label, product, RxNorm, safety, and utilization data on this page come from the sources identified below. AI-written, editorial, and licensed sections are labeled separately.
How we combine label and product data
HelloPharmacist combines public FDA and NLM records; we don’t author the underlying clinical facts. We identified 1 FDA-filed SPL label set within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. The representative label is the starting point for the displayed reference monograph; the 12 largest stored in-scope SPL records, which may include that representative, are compared section by section, and the longest available version of each section is retained. Forms, routes, brands, labelers, product-listed strengths, and product-record counts are aggregated separately from ingredient-matched FDA NDC Directory records; package records listed above are associated with the linked SPL; and the normalized concept hierarchy comes from NLM RxNorm.
For canonical ingredient pages, bounded product-attributed indication and administration excerpts may be added to the AI evidence, and the generator is instructed to preserve available product, brand, route, and form qualifiers instead of treating one label as universal. Where a section is identified as AI-written, its plain-language text is generated from bounded label evidence. New draft drug pages remain in the admin review queue before first publication. E.R. Squibb & Sons, L.L.C. is the representative DailyMed label linked for verification and dates; it is not the sole source used for the page.
This is general education, not medical advice — always consult your doctor or pharmacist about your medications and any medical condition. For the exact wording of the linked representative label, view that label on DailyMed; some displayed composite sections may come from other in-scope SPL labels. Learn how we use AI and our data sources & update cadence.