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Atazanavir
Also known as: 198904-31-3, Latazanavir, Zrivada, Reyataz, Bms-232632, Cgp 73547
Molecular Formula
C38H52N6O7
Molecular Weight
704.9  g/mol
InChI Key
AXRYRYVKAWYZBR-GASGPIRDSA-N
FDA UNII
QZU4H47A3S

An azapeptide and HIV-PROTEASE INHIBITOR that is used in the treatment of HIV INFECTIONS and AIDS in combination with other ANTI-HIV AGENTS.
Atazanavir is a Protease Inhibitor. The mechanism of action of atazanavir is as a HIV Protease Inhibitor, and UGT1A1 Inhibitor, and UDP Glucuronosyltransferases Inhibitor, and Cytochrome P450 3A4 Inhibitor, and Cytochrome P450 3A Inhibitor, and Cytochrome P450 2C8 Inhibitor.
1 2D Structure

Atazanavir

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
methyl N-[(2S)-1-[2-[(2S,3S)-2-hydroxy-3-[[(2S)-2-(methoxycarbonylamino)-3,3-dimethylbutanoyl]amino]-4-phenylbutyl]-2-[(4-pyridin-2-ylphenyl)methyl]hydrazinyl]-3,3-dimethyl-1-oxobutan-2-yl]carbamate
2.1.2 InChI
InChI=1S/C38H52N6O7/c1-37(2,3)31(41-35(48)50-7)33(46)40-29(22-25-14-10-9-11-15-25)30(45)24-44(43-34(47)32(38(4,5)6)42-36(49)51-8)23-26-17-19-27(20-18-26)28-16-12-13-21-39-28/h9-21,29-32,45H,22-24H2,1-8H3,(H,40,46)(H,41,48)(H,42,49)(H,43,47)/t29-,30-,31+,32+/m0/s1
2.1.3 InChI Key
AXRYRYVKAWYZBR-GASGPIRDSA-N
2.1.4 Canonical SMILES
CC(C)(C)C(C(=O)NC(CC1=CC=CC=C1)C(CN(CC2=CC=C(C=C2)C3=CC=CC=N3)NC(=O)C(C(C)(C)C)NC(=O)OC)O)NC(=O)OC
2.1.5 Isomeric SMILES
CC(C)(C)[C@@H](C(=O)N[C@@H](CC1=CC=CC=C1)[C@H](CN(CC2=CC=C(C=C2)C3=CC=CC=N3)NC(=O)[C@H](C(C)(C)C)NC(=O)OC)O)NC(=O)OC
2.2 Other Identifiers
2.2.1 UNII
QZU4H47A3S
2.3 Synonyms
2.3.1 MeSH Synonyms

1. 232632, Bms

2. 3,12-bis(1,1-dimethylethyl)-8-hydroxy-4,11-dioxo-9-(phenylmethyl)-6-((4-(2-pyridinyl)phenyl)methyl)-2,5,6,10,13-pentaazatetradecanedioic Acid Dimethyl Ester

3. Atazanavir Sulfate

4. Bms 232632

5. Bms 232632 05

6. Bms-232632

7. Bms-232632-05

8. Bms232632

9. Bms23263205

10. Cgp 73547

11. Cgp 75136

12. Cgp 75176

13. Cgp 75355

14. Cgp-73547

15. Cgp-75136

16. Cgp-75176

17. Cgp-75355

18. Cgp73547

19. Cgp75136

20. Cgp75176

21. Cgp75355

22. Reyataz

2.3.2 Depositor-Supplied Synonyms

1. 198904-31-3

2. Latazanavir

3. Zrivada

4. Reyataz

5. Bms-232632

6. Cgp 73547

7. Bms 232632

8. Cgp-73547

9. Atazanavir (inn)

10. Atv

11. Reyataz (tn)

12. Chembl1163

13. Qzu4h47a3s

14. Methyl N-[(2s)-1-[2-[(2s,3s)-2-hydroxy-3-[[(2s)-2-(methoxycarbonylamino)-3,3-dimethylbutanoyl]amino]-4-phenylbutyl]-2-[(4-pyridin-2-ylphenyl)methyl]hydrazinyl]-3,3-dimethyl-1-oxobutan-2-yl]carbamate

15. Chebi:37924

16. Ncgc00182552-01

17. Atazanavir [inn]

18. Atazanavir [inn:ban]

19. Dsstox_cid_28617

20. Dsstox_rid_82887

21. Dsstox_gsid_48691

22. (3s,8s,9s,12s)-3,12-bis(1,1-dimethylethyl)-8-hydroxy-4,11-dioxo-9-(phenylmethyl)-6-[[4-(2-pyridinyl)phenyl]methyl]-2,5,6,10,13-pentaazatetradecanedioic Acid Dimethyl Ester

23. Dr7

24. Methyl N-[1-[2-[2-hydroxy-3-[[2-(methoxycarbonylamino)-3,3-dimethylbutanoyl]amino]-4-phenylbutyl]-2-[(4-pyridin-2-ylphenyl)methyl]hydrazinyl]-3,3-dimethyl-1-oxobutan-2-yl]carbamate

25. Atazanavirum

26. Atazanavir Base

27. 1,14-dimethyl (3s,8s,9s,12s)-3,12-bis(1,1-dimethylethyl)-8-hydroxy-4,11-dioxo-9-(phenylmethyl)-6-[[4-(2-pyridinyl)phenyl]methyl]-2,5,6,10,13-pentaazatetradecanedioate

28. Methyl N-[(1s)-1-[[(1s,2s)-1-benzyl-2-hydroxy-3-[[[(2s)-2-(methoxycarbonylamino)-3,3-dimethyl-butanoyl]amino]-[[4-(2-pyridyl)phenyl]methyl]amino]propyl]carbamoyl]-2,2-dimethyl-propyl]carbamate

29. Methyl N-[(2s)-1-[[(2s,3s)-3-hydroxy-4-[[[(2s)-2-(methoxycarbonylamino)-3,3-dimethylbutanoyl]amino]-[(4-pyridin-2-ylphenyl)methyl]amino]-1-phenylbutan-2-yl]amino]-3,3-dimethyl-1-oxobutan-2-yl]carbamate

30. Cas-198904-31-3

31. Hsdb 7339

32. Unii-qzu4h47a3s

33. 2aqu

34. Reyataz(tm) (*1:1 Sulfate*)

35. (3s,8s,9s,12s)-3,12-bis(1,1-dimethylethyl)-8-hydroxy-4,11-dioxo-9-(phenylmethyl)-6-[[4-(2-pyridinyl)phenyl]methyl]-2,5, 6,10,13-pentaazatetradecanedioic Acid Dimethyl Ester

36. Atazanavir [mi]

37. Atazanavir [hsdb]

38. Atazanavir [vandf]

39. Atv & Aag

40. Atv & Hsa

41. Atazanavir [who-dd]

42. Schembl41696

43. Atazanavir,bisulfatesalt

44. Atazanavir, >=98% (hplc)

45. Dtxsid9048691

46. Atazanavir & Human Serum Albumin

47. Bdbm13934

48. Gtpl11138

49. Hms2089p22

50. Act06755

51. Amy31160

52. Zinc3941496

53. Tox21_113081

54. Mfcd08435966

55. Atazanavir & Alpha1-acid Glycoprotein

56. Akos025396423

57. Tox21_113081_1

58. Ccg-270390

59. Cs-0945

60. Db01072

61. Ncgc00182552-02

62. Ncgc00182552-03

63. Ncgc00182552-14

64. (2s)-n-(3-{[(2s)-2-(methoxycarbonylamino)-3,3-dimethylbutanoylamino][(4-(2-pyridyl)phenyl)methyl]amino}(1s,2s)-2-hydroxy-1-benzylpropyl)-2-(methoxycarbonylamino)-3,3-dimethylbutanamide

65. 2,5,6,10,13-pentaazatetradecanedioic Acid, 3,12-bis(1,1-dimethylethyl)-8-hydroxy-4,11-dioxo-9-(phenylmethyl)-6-((4-(2-pyridinyl)phenyl)methyl)-, Dimethyl Ester, (3s-(3r*,8r*,9r*,12r*))-

66. Bs-16315

67. Dimethyl (3s,8s,9s,12s)-9-benzyl-3,12-di-tert-butyl-8-hydroxy-4,11-dioxo-6-[4-(2-pyridyl)benzyl]-2,5,6,10,13-pentaazatetradecanedioate

68. Hy-17367

69. Methyl N-[(1s)-1-{n'-[(2s,3s)-2-hydroxy-3-[(2s)-2-[(methoxycarbonyl)amino]-3,3-dimethylbutanamido]-4-phenylbutyl]-n'-{[4-(pyridin-2-yl)phenyl]methyl}hydrazinecarbonyl}-2,2-dimethylpropyl]carbamate

70. S4662

71. A25022

72. D07471

73. Ab01274792-01

74. Ab01274792-02

75. Ab01274792-03

76. Ab01274792_04

77. Q423467

78. Sr-01000930924

79. J-519602

80. Sr-01000930924-2

81. 6,10,13-pentaazatetradecanedioic Acid Dimethyl Ester

82. (3s,8s,9s,12s)-3,12-bis(1,1-dimethylethyl)-8-hydroxy-4,11-dioxo-9-(phenylmethyl)-6-[[4-(2-pyridinyl)phenyl]methyl]-2,5,

83. 2,5,6,10,13-pentaazatetradecanedioic Acid, 3-12-bis(1,1-dimethylethyl)-8-hydroxy-4,11-dioxo-9-(phenylmethyl)-6-((-4-(2-pyridinyl)phenyl)methyl)-, Dimethyl Ester, (3s,8s,9s,12s)-

84. Atazanavir;(2s)-n-(3-{[(2s)-2-(methoxycarbonylamino)-3,3-dimethylbutanoylamino][(4-(2-pyridyl)phenyl)methyl]amino}(1s,2s)-2-hydroxy-1-benzylpropyl)-2-(methoxycarbonylamino)-3,3-dimethylbutanamide

85. Dimethyl (3s,8s,9s,12s)-9-benzyl-3,12,di-tert-butyl-8-hydroxy-4,11-dioxo-6-(p-2-pyridylbenzyl)-2,5,6,10,13-pentaazatetradecanedioate

86. Methyl [(1s,4s,5s,10s)-4-benzyl-1,10-di-tert-butyl-5-hydroxy-2,9,12-trioxo-7-(4-pyridin-2-ylbenzyl)-13-oxa-3,7,8,11-tetraazatetradec-1-yl]carbamate (non-preferred Name)

87. Methyl N-[(1s)-1-[[(2s,3s)-3-hydroxy-4-[[[(2s)-2-(methoxycarbonylamino)-3,3-dimethyl-butanoyl]amino]-[(4-pyridin-2-ylphenyl)methyl]amino]-1-phenyl-butan-2-yl]carbamoyl]-2,2-dimethyl-propyl]carbamate

88. Methyl N-[(1s)-1-{[(2s,3s)-3-hydroxy-4-[(2s)-2-[(methoxycarbonyl)amino]-3,3-dimethyl-n''-{[4-(pyridin-2-yl)phenyl]methyl}butanehydrazido]-1-phenylbutan-2-yl]carbamoyl}-2,2-dimethylpropyl]carbamate

89. Methyl N-[(2s)-1-[[(2s,3s)-3-hydroxy-4-[[[(2s)-2-(methoxycarbonylamino)-3,3-dimethylbutanoyl]amino]-[(4-pyridin-2-ylphenyl)methyl]amino]-1-phenylbutan-2-yl]ami

2.4 Create Date
2005-06-24
3 Chemical and Physical Properties
Molecular Weight 704.9 g/mol
Molecular Formula C38H52N6O7
XLogP35.6
Hydrogen Bond Donor Count5
Hydrogen Bond Acceptor Count9
Rotatable Bond Count18
Exact Mass704.38974802 g/mol
Monoisotopic Mass704.38974802 g/mol
Topological Polar Surface Area171 Ų
Heavy Atom Count51
Formal Charge0
Complexity1110
Isotope Atom Count0
Defined Atom Stereocenter Count4
Undefined Atom Stereocenter Count0
Defined Bond Stereocenter Count0
Undefined Bond Stereocenter Count0
Covalently Bonded Unit Count1
4 Drug and Medication Information
4.1 Drug Information
1 of 2  
Drug NameReyataz
PubMed HealthAtazanavir (By mouth)
Drug ClassesAntiretroviral Agent, Antiviral
Drug LabelREYATAZ (atazanavir sulfate) is an azapeptide inhibitor of HIV-1 protease.The chemical name for atazanavir sulfate is (3S,8S,9S,12S)-3,12-Bis(1,1-dimethylethyl)-8-hydroxy-4,11-dioxo-9-(phenylmethyl)-6-[[4-(2-pyridinyl)phenyl]methyl]-2,5,6,10,13-pen...
Active IngredientAtazanavir sulfate
Dosage FormCapsule; Powder
RouteOral
Strengtheq 50mg base/packet; eq 150mg base; eq 200mg base; eq 300mg base
Market StatusPrescription
CompanyBristol Myers Squibb

2 of 2  
Drug NameReyataz
PubMed HealthAtazanavir (By mouth)
Drug ClassesAntiretroviral Agent, Antiviral
Drug LabelREYATAZ (atazanavir sulfate) is an azapeptide inhibitor of HIV-1 protease.The chemical name for atazanavir sulfate is (3S,8S,9S,12S)-3,12-Bis(1,1-dimethylethyl)-8-hydroxy-4,11-dioxo-9-(phenylmethyl)-6-[[4-(2-pyridinyl)phenyl]methyl]-2,5,6,10,13-pen...
Active IngredientAtazanavir sulfate
Dosage FormCapsule; Powder
RouteOral
Strengtheq 50mg base/packet; eq 150mg base; eq 200mg base; eq 300mg base
Market StatusPrescription
CompanyBristol Myers Squibb

4.2 Therapeutic Uses

Atazanavir sulfate is indicated in combination with other antiretroviral agents for the treatment of HIV-1 infection. The use of atazanavir sulfate may be considered in antiretroviral-treatment experienced adults with HIV strains that are expected to be susceptible to atazanavir sulfate by genotypic and phenotypic testing. /Included in US product labeling/

Thomson.Micromedex. Drug Information for the Health Care Professional. 25th ed. Volume 1. Plus Updates. Content Reviewed by the United States Pharmacopeial Convention, Inc. Greenwood Village, CO. 2005., p. 457


4.3 Drug Warning

Lactic acidosis syndrome, sometimes fatal, and symptomatic hyperlactatemia have been reported in patients receiving atazanavir in conjunction with nucleoside reverse transcriptase inhibitors (NRTIs). Therapy with NRTIs is known to be associated with an increased risk of lactic acidosis syndrome; female gender and obesity also are known risk factors for this syndrome. Whether atazanavir contributes to the risk of lactic acidosis syndrome remains to be established.

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 629


Hyperglycemia (potentially persistent), new-onset diabetes mellitus, or exacerbation of preexisting diabetes mellitus has been reported in patients receiving HIV protease inhibitors. May require initiation of antidiabetic therapy (e.g., insulin, oral antidiabetic agents) or dosage adjustment for existing diabetes; diabetic ketoacidosis can occur.

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 629


Abnormalities in AV conduction, including prolongation of the PR interval, have occurred in individuals receiving atazanavir. Cardiac conduction abnormalities generally are limited to first-degree AV block; prolongation of the QTc interval observed in HIV-infected patients receiving atazanavir have not been directly attributed to the drug. Asymptomatic first-degree AV block was observed in 5.9 or 3-10.4% of patients in clinical trials receiving regimens that included atazanavir or comparator antiretrovirals (lopinavir/ritonavir, nelfinavir, efavirenz), respectively; second- or third-degree block was not observed. Atazanavir should be used with caution in patients with cardiac conduction abnormalities (e.g., marked first-degree AV block; second- or third-degree AV block) because of lack of clinical experience.

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 629


Because atazanavir is a competitive inhibitor of uridine diphosphate-glucuronosyltransferase (UGT) 1A1 (an enzyme that catalyzes the glucuronidation of bilirubin), reversible asymptomatic elevations in indirect (unconjugated) bilirubin occur in most patients receiving the drug. Total bilirubin concentrations at least 2.6 times the upper limit of normal have been reported in 35-47% of patients receiving the drug in clinical trials; long-term safety data are not available for patients experiencing persistent elevations in total bilirubin exceeding 5 times the upper limit of normal. Increases in serum AST (SGOT) and/or ALT (SGPT) concentrations that occur with hyperbilirubinemia should be evaluated for etiologies other than hyperbilirubinemia. If jaundice or scleral icterus that result from bilirubin elevations cause cosmetic concerns, alternative antiretroviral therapy can be considered; reduction of atazanavir dosage not recommended (efficacy data not available for reduced dosages).

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 629


For more Drug Warnings (Complete) data for ATAZANAVIR (17 total), please visit the HSDB record page.


4.4 Drug Indication

Atazanavir is indicated in combination with other antiretroviral agents for the treatment of HIV-1 infection in adults and pediatric patients 3 months of age and older weighing at least 5kg. Atazanavir is also indicated in combination with [cobicistat] and other antiretrovirals for the treatment of HIV-1 infection in adults and pediatric patients weighing at least 35kg.


FDA Label


Atazanavir Mylan, co-administered with low dose ritonavir, is indicated for the treatment of HIV 1 infected adults and paediatric patients 6 years of age and older in combination with other antiretroviral medicinal products.

Based on available virological and clinical data from adult patients, no benefit is expected in patients with strains resistant to multiple protease inhibitors ( 4 PI mutations). There are very limited data available from children aged 6 to less than 18 years.

The choice of Atazanavir Mylan in treatment experienced adult and paediatric patients should be based on individual viral resistance testing and the patients treatment history.


Reyataz capsules, co-administered with low dose ritonavir, are indicated for the treatment of HIV-1 infected adults and paediatric patients 6 years of age and older in combination with other antiretroviral medicinal products (see section 4. 2).

Based on available virological and clinical data from adult patients, no benefit is expected in patients with strains resistant to multiple protease inhibitors ( 4 PI mutations).

The choice of Reyataz in treatment experienced adult and paediatric patients should be based on individual viral resistance testing and the patients treatment history (see sections 4. 4 and 5. 1).

Reyataz oral powder, co-administered with low dose ritonavir, is indicated in combination with other antiretroviral medicinal products for the treatment of HIV-1 infected paediatric patients at least 3 months of age and weighing at least 5 kg (see section 4. 2).

Based on available virological and clinical data from adult patients, no benefit is expected in patients with strains resistant to multiple protease inhibitors ( 4 PI mutations). The choice of Reyataz in treatment experienced adult and paediatric patients should be based on individual viral resistance testing and the patients treatment history (see sections 4. 4 and 5. 1).


Atazanavir Krka capsules, co-administered with low dose ritonavir, are indicated for the treatment of HIV-1 infected adults and paediatric patients 6 years of age and older in combination with other antiretroviral medicinal products.

Based on available virological and clinical data from adult patients, no benefit is expected in patients with strains resistant to multiple protease inhibitors ( 4 PI mutations).

The choice of Atazanavir Krka in treatment experienced adult and paediatric patients should be based on individual viral resistance testing and the patients treatment history.


5 Pharmacology and Biochemistry
5.1 Pharmacology

Atazanavir (ATV) is an azapeptide HIV-1 protease inhibitor (PI) with activity against Human Immunodeficiency Virus Type 1 (HIV-1). HIV-1 protease is an enzyme required for the proteolytic cleavage of the viral polyprotein precursors into the individual functional proteins found in infectious HIV-1. Atazanavir binds to the protease active site and inhibits the activity of the enzyme. This inhibition prevents cleavage of the viral polyproteins resulting in the formation of immature non-infectious viral particles. Protease inhibitors are almost always used in combination with at least two other anti-HIV drugs. Atazanivir is pharmacologically related but structurally different from other protease inhibitors and other currently available antiretrovirals.


5.2 MeSH Pharmacological Classification

HIV Protease Inhibitors

Inhibitors of HIV PROTEASE, an enzyme required for production of proteins needed for viral assembly. (See all compounds classified as HIV Protease Inhibitors.)


5.3 FDA Pharmacological Classification
5.3.1 Active Moiety
ATAZANAVIR
5.3.2 FDA UNII
QZU4H47A3S
5.3.3 Pharmacological Classes
Cytochrome P450 3A Inhibitors [MoA]; Cytochrome P450 3A4 Inhibitors [MoA]; HIV Protease Inhibitors [MoA]; Protease Inhibitor [EPC]; UDP Glucuronosyltransferases Inhibitors [MoA]; UGT1A1 Inhibitors [MoA]; Cytochrome P450 2C8 Inhibitors [MoA]
5.4 ATC Code

J05AE08


J05AE08


J05AE08


J - Antiinfectives for systemic use

J05 - Antivirals for systemic use

J05A - Direct acting antivirals

J05AE - Protease inhibitors

J05AE08 - Atazanavir


5.5 Absorption, Distribution and Excretion

Absorption

Atazanavir is rapidly absorbed with a Tmax of approximately 2.5 hours. Administration of atazanavir with food enhances bioavailability and reduces pharmacokinetic variability. Oral bioavailability is 60-68%.


Atazanavir is rapidly absorbed with a Tmax of approximately 2.5 hours. Atazanavir demonstrates nonlinear pharmacokinetics with greater than dose-proportional increases in AUC and Cmax values over the dose range of 200-800 mg once daily. Steady-state is achieved between Days 4 and 8, with an accumulation of approximately 2.3-fold.

Physicians Desk Reference. 59th ed. Thomson PDR. Montvale, NJ 2005., p. 1061


Administration of /atazanavir/ with food enhances bioavailability and reduces pharmacokinetic variability. Administration of a single dose of /atazanavir/ with a light meal (357 kcal, 8.2 g fat, 10.6 g protein) resulted in a 70% increase in AUC and 57% increase in Cmax relative to the fasting state. Administration of a single dose of /atazanavir/ with a high-fat meal (721 kcal, 37.3 g fat, 29.4 g protein) resulted in a mean increase in AUC of 35% with no change in Cmax relative to the fasting state. Administration of /atazanavir/ with either a light meal or high-fat meal decreased the coefficient of variation of AUC and Cmax by approximately one half compared to the fasting state.

Physicians Desk Reference. 59th ed. Thomson PDR. Montvale, NJ 2005., p. 1061


Peak plasma concentration: Healthy subjects: 5199 ng/mL on day 29 following a 400 mg daily dose with a light meal. HIV-infected patients: 2298 ng/mL on day 29 following a 400 mg daily dose with a light meal.

Thomson.Micromedex. Drug Information for the Health Care Professional. 25th ed. Volume 1. Plus Updates. Content Reviewed by the United States Pharmacopeial Convention, Inc. Greenwood Village, CO. 2005., p. 457


Time to peak concentration: HIV-infected patients: 2 hours.

Thomson.Micromedex. Drug Information for the Health Care Professional. 25th ed. Volume 1. Plus Updates. Content Reviewed by the United States Pharmacopeial Convention, Inc. Greenwood Village, CO. 2005., p. 457


For more Absorption, Distribution and Excretion (Complete) data for ATAZANAVIR (8 total), please visit the HSDB record page.


5.6 Metabolism/Metabolites

Atazanavir is extensively metabolized in humans, primarily by the liver. The major biotransformation pathways of atazanavir in humans consisted of monooxygenation and dioxygenation. Other minor biotransformation pathways for atazanavir or its metabolites consisted of glucuronidation, N-dealkylation, hydrolysis, and oxygenation with dehydrogenation. In vitro studies using human liver microsomes suggested that atazanavir is metabolized by CYP3A.


Atazanavir is extensively metabolized in humans. The major biotransformation pathways of atazanavir in humans consisted of monooxygenation and (atazanavir sulfate) dioxygenation. Other minor biotransformation pathways for atazanavir or its metabolites consisted of glucuronidation, N-dealkylation, hydrolysis, and oxygenation with dehydrogenation. Two minor metabolites of atazanavir in plasma have been characterized. Neither metabolite demonstrated in vitro antiviral activity. In vitro studies using human liver microsomes suggested that atazanavir is metabolized by CYP3A.

Physicians Desk Reference. 59th ed. Thomson PDR. Montvale, NJ 2005., p. 1062


5.7 Biological Half-Life

Elimination half-life in adults (healthy and HIV infected) is approximately 7 hours (following a 400 mg daily dose with a light meal). Elimination half-life in hepatically impaired is 12.1 hours (following a single 400 mg dose).


The mean half-life of atazanavir in hepatically impaired subjects was 12.1 hours compared with 6.4 hours in healthy volunteers. ...

Physicians Desk Reference. 59th ed. Thomson PDR. Montvale, NJ 2005., p. 1062


The mean elimination half-life of atazanavir in healthy volunteers (n=214) and HIV-infected adult patients (n=13) was approximately 7 hours at steady state following a dose of 400 mg daily with a light meal.

Physicians Desk Reference. 59th ed. Thomson PDR. Montvale, NJ 2005., p. 1062


5.8 Mechanism of Action

Atazanavir selectively inhibits the virus-specific processing of viral Gag and Gag-Pol polyproteins in HIV-1 infected cells by binding to the active site of HIV-1 protease, thus preventing the formation of mature virions. Atazanavir is not active against HIV-2.


Atazanavir is an azapeptide HIV-1 protease inhibitor. The compound selectively inhibits the virus-specific processing of viral Gag and Gag-Pol polyproteins in HIV-1 infected cells, thus preventing formation of mature virions.

Physicians Desk Reference. 59th ed. Thomson PDR. Montvale, NJ 2005., p. 1060


BMS-232632 is an azapeptide human immunodeficiency virus type 1 (HIV-1) protease (Prt) inhibitor that exhibits potent anti-HIV activity with a 50% effective concentration (EC(50)) of 2.6 to 5.3 nM and an EC(90) of 9 to 15 nM in cell culture. Proof-of-principle studies indicate that BMS-232632 blocks the cleavage of viral precursor proteins in HIV-infected cells, proving that it functions as an HIV Prt inhibitor. Comparative studies showed that BMS-232632 is generally more potent than the five currently approved HIV-1 Prt inhibitors. Furthermore, BMS-232632 is highly selective for HIV-1 Prt and exhibits cytotoxicity only at concentrations 6,500- to 23, 000-fold higher than that required for anti-HIV activity. To assess the potential of this inhibitor when used in combination with other antiretrovirals, BMS-232632 was evaluated for anti-HIV activity in two-drug combination studies. Combinations of BMS-232632 with either stavudine, didanosine, lamivudine, zidovudine, nelfinavir, indinavir, ritonavir, saquinavir, or amprenavir in HIV-infected peripheral blood mononuclear cells yielded additive to moderately synergistic antiviral effects. Importantly, combinations of drug pairs did not result in antagonistic anti-HIV activity or enhanced cytotoxic effects at the highest concentrations used for antiviral evaluation. Our results suggest that BMS-232632 may be an effective HIV-1 inhibitor that may be utilized in a variety of different drug combinations.

PMID:10898681 Full text: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC90019 Robinson BS et al; Antimicrob Agents Chemother 44 (8): 2093-9 (2000)


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