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The Precautionary and Prohibited Medications Database

Maintained by a collaboration of the University at Buffalo Pharmacology Specialty Laboratory and Frontier Science & Technology Research Foundation

 
Medications Atazanavir and Etoposide
Designation Precautionary
Last updated 14-Aug-2018
Interaction History
Effect on concentration Atazanavir: No change

Etoposide: Increase
Pharmacologic effect Atazanavir: N/A

Etoposide: N/A
Pharmacologic effect applies to drugs in the same class Atazanavir:

Etoposide:
Pharmacologic effect description Atazanavir:

Etoposide:
Potential pharmacokinetic effect Atazanavir: N/A

Etoposide: N/A
Potential pharmacokinetic effect applies to drugs in the same class Atazanavir:

Etoposide:
Potential pharmacokinetic mechanism Atazanavir:

Etoposide:

Summary

While boosted protease inhibitors are not expected to have their concentrations altered by concomitant administration of etoposide, levels of etoposide may be increased.

Sources

MDR-and CYP3A4-mediated drug–drug interactions.

Study Design
Interaction studies comparing the pharmacokinetics of etoposide and atazanavir have not been conducted, and theoretical interactions are based upon what is known of the metabolic pathways of these medications.  
Study Results
Etoposide is partly metabolized by CYP3A4 to reactive catechol metabolites, though several other pathways of metabolism exist, including glucuronidation by UGT1A1.  
Study Conclusions
O-demethylation of etoposide occurs through the cytochrome P450 pathway. Ritonavir boosted protease inhibitors could potentially increase etoposide exposure. Close monitoring of etoposide induced toxicity is recommended.  
References
Pal D, Mitra AK. Mdr-and cyp3a4-mediated drug–drug interactions. Journal Of Neuroimmune Pharmacology. 2006; 3: 323-329.  

Study information updated: 14-Aug-2018