[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Pharmacology](https://durgical.com/en/pharmacology/) › [HIV protease inhibitors (PIs)](https://durgical.com/en/pharmacology/classes/hiv-protease-inhibitors/) › Atazanavir

[Pharmacology](https://durgical.com/en/pharmacology/) · [HIV protease inhibitors (PIs)](https://durgical.com/en/pharmacology/classes/hiv-protease-inhibitors/)

# Atazanavir

A once-daily PI. It causes benign jaundice from indirect bilirubin and needs stomach acid, so antacids and acid suppressants affect it.

Updated 2026-11-01

- Class: [HIV protease inhibitors (PIs)](https://durgical.com/en/pharmacology/classes/hiv-protease-inhibitors/)
- Enzyme: HIV-1 protease
- ATC code: J05AE08
- WHO Model List of Essential Medicines

Also called: ATV

✂**HIV-1 protease**Atazanavir

ⓘ The figure shows atazanavir in the active site of wild-type HIV-1 protease.

**Target in 3D:** HIV-1 protease. PDB structure 3EL1 (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/3EL1) · Drag to rotate · pinch to zoom

## Mechanism of action

It fills the HIV protease active site and prevents virus maturation. It also inhibits human UGT1A1, the enzyme that conjugates bilirubin, so indirect bilirubin rises without liver damage.

- It binds the HIV protease active site
- Viral polyproteins stay uncut
- Virions come out immature

## Pharmacokinetics

**Absorption**
Taken with food; its solubility falls as gastric pH rises

**Metabolism**
Liver, by CYP3A; inhibits CYP3A and UGT1A1

## Indications

- HIV-1 infection, combined with other antiretrovirals, usually boosted with ritonavir [HIV infection and AIDS →](https://durgical.com/en/conditions/hiv-infection-and-aids/)

## Adverse effects

### Common

- Indirect hyperbilirubinaemia with jaundice or yellow eyes
- Nausea
- Rash

### Serious (rare, important)

- Kidney stones and gallstones
- PR prolongation (usually first-degree AV block)
- Severe skin reactions
- Hepatotoxicity

## Contraindications

- Drugs highly dependent on CYP3A or UGT1A1 with serious risk if raised
- Strong inducers such as rifampicin or St John's wort

## Key interactions

**Proton pump inhibitors, H2 blockers and antacids**
Lower atazanavir absorption; avoided or separated according to the label

**Tenofovir disoproxil**
Lowers atazanavir: boosted atazanavir is used

**Other PR-prolonging drugs**
Higher risk of AV block

## What is monitored

- Bilirubin (indirect) and liver tests
- ECG if there is conduction disease
- Symptoms of kidney stones or gallstones
- Lipids

## Administration and safety

- By mouth, with food
- Check the timing of antacids and acid suppressants relative to atazanavir
- Keep a full list of medicines and herbal products and review it with pharmacy before any new drug

## Nursing care

- Explain that yellow eyes or skin are usually benign but must be reported and transaminases checked
- Encourage good hydration and teach to recognise renal colic pain
- Ask about heartburn medicines

## Pregnancy and breastfeeding

Antiretroviral treatment in pregnancy protects the mother and lowers HIV transmission to the baby; the treating team chooses the regimen.

## Memory aid

'ATAZANAVIR: Amber eyes, Twinges of stones, Acid needed'.

## Test yourself

Think of the answer, then tap the question to see it.

## Why does atazanavir cause jaundice with normal transaminases?

It inhibits UGT1A1, which conjugates bilirubin: indirect bilirubin rises without liver injury.

## Why do proton pump inhibitors interact with atazanavir?

Atazanavir dissolves less when gastric pH rises, so less is absorbed.

## Which kidney complication is linked to atazanavir?

Nephrolithiasis (kidney stones).

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/atazanavir/)

## Related drugs

- [Ritonavir](https://durgical.com/en/pharmacology/ritonavir/)
- [Darunavir](https://durgical.com/en/pharmacology/darunavir/)

## Related conditions

- [HIV infection and AIDS](https://durgical.com/en/conditions/hiv-infection-and-aids/)

[← Back to the class: HIV protease inhibitors (PIs)](https://durgical.com/en/pharmacology/classes/hiv-protease-inhibitors/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - ATAZANAVIR capsule](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c98e40ec-8a2c-4f19-b1c3-c82f708c2490) (DailyMed (U.S. National Library of Medicine), 2025); [Atazanavir: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a603019.html) (MedlinePlus (U.S. National Library of Medicine), 2025); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=J05AE08) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/) (World Health Organization, 2025).

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Representative model, for educational purposes only.

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