Atazanavir: what it does, how to take it, and what to watch for

Atazanavir can make your skin or eyes look yellow — and that doesn’t always mean your liver is failing. That odd effect is one of the most common things people notice. Atazanavir is an HIV protease inhibitor used with other antiretrovirals to keep viral load low. Here’s a plain, practical guide that tells you how to use it safely and what to ask your doctor or pharmacist.

How it’s used and basic dosing

Atazanavir is never used alone. Doctors prescribe it as part of combination antiretroviral therapy (ART). For most adults the usual dose is 300 mg once daily with a booster: either ritonavir 100 mg or cobicistat 150 mg. Always follow the exact regimen your clinician gives you — doses can change for drug interactions or liver issues.

Take atazanavir with food. Food increases absorption and helps the drug work better. Don’t take it right with antacids or high-dose acid reducers — timing matters (see interactions).

Main side effects and monitoring

Most people tolerate atazanavir, but watch for these:

• Hyperbilirubinemia / jaundice: Atazanavir commonly raises indirect bilirubin. Your skin or the whites of your eyes may turn yellow. It’s usually harmless but can be distressing.
• GI upset: Nausea and diarrhea are common early on.
• Kidney and gallbladder issues: Rarely linked to kidney stones or gallbladder problems.
• Heart conduction: It can affect heart rhythm in people with existing block; an ECG may be recommended if you have heart disease.
• Liver safety: Check liver tests before and during treatment, especially if you have hepatitis B or C.

If you notice yellowing, dark urine, severe abdominal pain, fainting, or faint pulses — call your provider right away.

Resistance: missing doses lets the virus evolve. If treatment fails, genotypic testing guides the next regimen.

Key drug interactions — what to avoid or adjust

Atazanavir needs an acidic stomach to absorb. Proton pump inhibitors (omeprazole, esomeprazole) can lower its levels and are generally not recommended together. H2 blockers and antacids require careful timing or dose changes. Many common meds also interact — certain statins (simvastatin, lovastatin), some antiarrhythmics, and sedatives can be dangerous together. Always run any new drug, supplement, or OTC through your pharmacist.

Tips for everyday use

Take atazanavir with food and at the same time each day. Space antacids at least two hours before or one hour after. Keep all clinic follow-ups and blood tests. If you plan to buy meds online, use licensed pharmacies, require a prescription, and avoid unusually cheap offers.

Questions about interactions, pregnancy, or liver disease? Talk to your HIV provider or pharmacist — they’ll tailor advice to your situation.