Atazanavir
===========

**PD Dialyzability**: Unlikely

Pharmacokinetic Parameters [1]_ [2]_ [3]_
-------------------------------------------

======= ======
/////// |pk|
======= ======
|pk1|   |v1|
|pk2|   |v2|
|pk3|   |v3|
|pk4|   |v4|
|pk5|   |v5|
|pk6|   |v6|
|pk7|   |v7|
======= ====== 

CAPD/CCPD Dosing: 
------------------

No dosing recommendation for PD population found in literature, However, given extensive hepatic metabolism, it is unlikely that dosage adjustment is required. Consider therapeutic drug monitoring given high interpatient variability [4]_. In HD patients, regardless of administration in relation to dialysis, atazanavir levels were 25-40% reduced in comparison to controls with normal renal function. However, only 2.1 % of the given dose was found to be cleared during HD [5]_. 

Literature Summary:
---------------------------

+----------+------------+----------------+--------------+---------------------+
| Title    | Patient    | Intervention   | Outcome      | Note                |
+==========+============+================+==============+=====================+
| |L1|     | * |L2|     | * |L3|         | * |L4|       | * |L5|              |
| [6]_     |            |                |              |                     |
+----------+------------+----------------+--------------+---------------------+

References
------------
.. [1] Foisy M, Tseng A, Marr T. Selected properties of atazanavir. Immunodeficiency Clinic [Internet]. 2015 Jan [cited 2018 Jan 14]. 1-11. Available from: www.hivclinic.ca 

.. [2] Wishart DS, Knox C, Guo AC, Shrivastava S, Hassanali M, Stothard P, et al. Drugbank: a comprehensive resource for in silico drug discovery and exploration. Nucleic Acids Res. 2006 Jan 1;34(Database issue):D668-672.

.. [3] Colombo S, Buclin T, Cavassini M, Décosterd LA, Telenti A, Biollaz J, et al. Population pharmacokinetics of atazanavir in patients with human immunodeficiency virus infection. Antimicrob Agents Chemother,2006;50(11):3801-8.

.. [4] Higgins N, Tseng A, Sheehan NL, la Porte CJL. Antiretroviral Therapeutic Drug Moniotring in Canada: Current Status and Recommendations for Clinical Practice. Can J Hosp Pharm 2009;62(6):500-509.

.. [5] Agarwala S, Eley T, Child M, Wang Y, Persson A, Filomoro D, et al. Pharmacokinetics of atazanavir in severely renally impaired subjects including those on hemodialysis [abstract 2]. 8th International Workshop On Clinical Pharmacology of HIV Therapy. Budapest, Hungary, April 16-18, 2007. 

.. [6] Izzedine H, Launay-Vacher V, Peytavin G, Valantin MA, Deray G. Atazanvir: a novel inhibitor of HIV protease in haemodialysis. Nephrol Dial Transplant 2005;20(4):852-853. 


.. |pk| replace:: Atazanavir
.. |pk1| replace:: Molecular Weight (Da)  
.. |pk2| replace:: Plasma Protein Binding (%)
.. |pk3| replace:: Volume of Distribution (L/Kg) 
.. |pk4| replace:: Hepatic Metabolism 
.. |pk5| replace:: Excreted Unchanged (%) 
.. |pk6| replace:: Half-Life; Normal Renal Function (hours)
.. |pk7| replace:: Half-Life; ESRD (hours) 
.. |v1| replace:: 704
.. |v2| replace:: 86
.. |v3| replace:: 88 L (Based on weight of 69-70 kg. Vd = 1.27 L/kg (calculated))
.. |v4| replace:: Extensive hepatic metabolism (CYP3A4)  
.. |v5| replace:: 7
.. |v6| replace:: 7
.. |v7| replace:: Unknown
.. |L1| replace:: Atazanavir: a novel inhibitor of HIV-protease in haemodialysis 
.. |L2| replace:: 48 year old African male undergoing HD diagnosed with severe acute renal failure secondary to nephropathy related to HIV.
.. |L3| replace:: Atazanavair 400 mg/day, lopinavir/ritonavir 532/132 mg/day, and efavirenz 60 mg/day x 2 weeks
.. |L4| replace:: In comparison to reference range, atazanavir AUC elevated when administered concurrently with efavirenz and ritonavir
.. |L5| replace:: No adverse effects observed.