Evotaz

Evotaz is a fixed-dose combination tablet containing 300mg of atazanavir and 150mg of cobicistat.

Atazanavir is an HIV protease inhibitor. Cobicistat is used to boost blood levels of atazanavir and has no antiviral activity of its own. These drugs reduce the amount of HIV in the body and prevent the development of AIDS-defining illnesses. Evotaz received marketing approval in the United States in January 2015 and in the European Union in July 2015.

The standard dose of Evotaz is one pink tablet taken once daily with food. Evotaz is approved for use in combination with two or more other antiretroviral drugs. Evotaz should not be initiated in patients with creatinine clearance less than 70 ml/min if any co-administered agent (e.g. emtricitabine, lamivudine, tenofovir disoproxil fumarate) requires dose adjustment based on creatinine clearance.

The use of cobicistat to boost blood levels of atazanavir means that drug interactions with other medications are somewhat different from those reported for atazanavir, due to the potential for interactions between both cobicistat and boosted atazanavir and other medications.

Evotaz should not be used in combination with HIV protease inhibitors or non-nucleoside reverse transcriptase inhibitors with the exception of rilpivirine. Evotaz should not be used with proton pump inhibitors and if taken with tenofovir, it should not be used with H2 receptor antagonists (e.g. famotidine). In people not taking tenofovir, Evotaz and famotidine should be taken together, with food, or at least ten hours apart.

Use of the following medicines is also contraindicated with Evotaz:

  • Simeprevir
  • Clarithromycin (unless no alternative)
  • Voriconazole
  • Colchicine in patients with renal or hepatic impairment
  • Rifabutin
  • Rifampicin
  • Alfuzosin
  • Anti-epileptic drugs
  • Antipsychotics
  • Amiodarone
  • Dronedarone
  • Quinidine
  • Systemic lidocaine
  • Bepredil
  • Bosentan
  • Fluticasone propionate
  • St John’s wort
  • Hormonal contraceptives oestrogen and progestin
  • Simvastatin, atorvastatin, lovastatin
  • Salemeterol
  • Ergot derivatives
  • Midazolam
  • Triazolam
  • Cisapride
  • Warfarin
  • Rivaroxaban

Refer to the entry on atazanavir for further information on potential drug interactions, efficacy and drug resistance.