Drug interactions
Atazanavir + Bosentan
Severity: Major
Atazanavir and Bosentan: major interaction.
Last updated Sources: US FDA label
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Atazanavir inhibits CYP3A4 and raises bosentan concentrations substantially, increasing the risk of hepatotoxicity, edema and hypotension. Bosentan may also lower unboosted atazanavir concentrations.
What this interaction means in plain words
Atazanavir and Bosentan can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Atazanavir belongs to Anti Virals; Bosentan belongs to Miscellaneous.
Why it happens
CYP3A4 inhibition by atazanavir reduces bosentan clearance, while bosentan induction may lower atazanavir levels.
What to do
If coadministered, start bosentan at a reduced dose or frequency in patients already stable on a boosted protease inhibitor, and monitor liver tests and blood pressure. Use ritonavir-boosted atazanavir rather than unboosted atazanavir.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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References
Other interactions of Bosentan
- Bosentan + Cyclosporin Contraindicated
- Bosentan + Glibenclamide Contraindicated
- Bosentan + Glyburide-metformin Contraindicated
- Bosentan + Lonafarnib Contraindicated
- Bosentan + Sparsentan Contraindicated
- Artemether / lumefantrine + Bosentan Major
Other interactions of Atazanavir
- Alfuzosin + Atazanavir Contraindicated
- Atazanavir + Avanafil Contraindicated
- Atazanavir + Dronedarone Contraindicated
- Atazanavir + Eletriptan Contraindicated
- Atazanavir + Eplerenone Contraindicated
- Atazanavir + Ergotamine Contraindicated
Frequently asked questions
Can I take Atazanavir with Bosentan?
MediHelp rates the interaction as major. Atazanavir and Bosentan can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Atazanavir inhibits CYP3A4 and raises bosentan concentrations substantially, increasing the risk of hepatotoxicity, edema and hypotension. Bosentan may also lower unboosted atazanavir concentrations.
How serious is the interaction between Atazanavir and Bosentan?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: If coadministered, start bosentan at a reduced dose or frequency in patients already stable on a boosted protease inhibitor, and monitor liver tests and blood pressure. Use ritonavir-boosted atazanavir rather than unboosted atazanavir.
What other medicines interact with Bosentan?
MediHelp also lists interactions of Bosentan with, for example, Cyclosporin, Glibenclamide, Glyburide-metformin. The full list is on the Bosentan page.
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