Atazanavir: What it does and how to use it safely

Atazanavir is an HIV protease inhibitor used to keep the virus under control. It’s often given with a booster (ritonavir or cobicistat) to work better. You may have heard it can turn your skin or eyes yellow — that can happen, but it doesn’t always mean serious liver damage. Still, knowing how it works, what to expect, and which drugs to avoid will make treatment safer and easier.

How atazanavir works and common dosing

Atazanavir blocks a viral enzyme called protease so HIV can’t make new infectious copies of itself. Typical dosing is 300 mg once daily with ritonavir 100 mg, or 300 mg once daily with cobicistat as a booster. Sometimes doctors use 400 mg once daily without a booster, but that’s less common. Take it with food — food improves absorption and helps the drug work better.

Common side effects and what to watch for

The most noticeable effect is increased bilirubin, which can cause yellowing of the eyes or skin. That’s usually harmless but can look alarming. Other common issues include nausea, headache, stomach upset, and rash. Rare but important problems include prolonged PR interval on an ECG (which can affect heart rhythm) and kidney stones in some people. If you notice severe jaundice, dark urine, severe abdominal pain, fainting, or a new fast heartbeat, contact your clinician right away.

Doctors usually check liver tests, bilirubin, kidney function, and sometimes an ECG after starting therapy. If you have a history of heart block, kidney stones, or severe liver disease, mention that before starting atazanavir.

Key drug interactions and simple rules

Atazanavir interacts with many drugs because it affects liver enzymes. Big ones to remember: avoid proton pump inhibitors (PPIs) like omeprazole unless your doctor adjusts the dose, and separate antacids by at least 2 hours. Rifampin and St. John’s Wort lower atazanavir to unsafe levels and should not be used together. Some statins (simvastatin, lovastatin) are unsafe with atazanavir; safer options like atorvastatin need dose checks. Tell your provider about all prescription meds, OTC drugs, and supplements.

Practical tips: take atazanavir with food, keep a list of your medicines, avoid starting herbal products without checking, and set reminders so you don’t miss doses — missed doses can let the virus rebound and increase resistance risk.

If you’re pregnant, breastfeeding, or trying to become pregnant, talk to your HIV specialist — they’ll pick the safest regimen and monitor you closely. For any new symptoms or if you suspect a drug interaction, call your clinic rather than stopping the drug on your own.

Want a quick checklist to bring to your next visit? Note your full medication list, ask about baseline labs (bilirubin, liver enzymes, kidney function), ask if an ECG is recommended, and confirm food and antacid timing. That keeps your treatment working and lowers surprises along the way.