Trade name : Synthivan
Active ingredient : Atazanavir & Ritonavir
Strength availability : 300mg & 100mg
Manufactured by : Cipla
Package : 30 tablets in a container
Category : Anti retroviral agents
Synthivan belongs to anti-retroviral agent which includes active ingredients like Atazanavir sulfate and Ritonavir. Both components having anti-retroviral activity and it is protease inhibitors. Protease enzyme which is Specific for cell maturation and proliferation. Synthivan is not a curable but it decrease the progression of the infection.
Synthivan tablet is a fixed dose combination which indicated for the treatment of HIV type I infected associated with AIDS. Synthivan is used only for reducing the progression of HIV virus maturation and replications It is not cure or prevents the infectious condition
Atazanavir sulfate, belongs to azapeptide HIV-1 protease inhibitor, which show activity against HIV virus type I Normally protease enzyme is specific for proteolytic cleavage of viral polyprotein into functional proteins present in infectious HIV-1. This atazanavir bounds to the active site of the protease enzyme and prohibits its activity. This inhibition causes to prevent the different of viral polyprotein; it concludes formation of immature cells and turns to non-infectious cells Ritonavir, it is a peptidomimetic HIV protease inhibitor. Low dose of Ritonavir acts as pharmacokinetic booster of concomitantly used other anti-retroviral drug Atazanavir, it increase the plasma concentration of Atazanavir concurrently
Synthivan tablet should be taken with food The recommended dose of Synthivan based on the medical history of the patients Synthivan is a prescription medicine; it is administered under the guidance of medical practitioner The recommended dose of Synthivan for adult patients: One tablet should be taken orally with meals as a single dose.
Combination therapy : One tablet should be taking once daily with food, if Synthivan is combined with any medicines like; Tenofovir H2 receptor antagonist: The dose of H2 receptor antagonist like famotidine should not exceed 40mg two times a day. Synthivan tablet is administered concurrently with or 10 hours after the dose of famotidine. Proton pump inhibitor: Omeprazole, a proton pump inhibitor it should not exceed to 20mg. Omeprazole should be administered in 12 hours prior to the dose of Synthivan tablet
Dose recommendation for therapy experienced patients :
If H2 receptor antagonist co administered with Synthivan tablet, dose of famotidine should not exceed to 20mg twice daily. Synthivan should be taken with food if co administered with famotidine Synthivan should not be taken, if both tenofovir and H2 receptor antagonist has been taken together. Proton pump inhibitor drugs should not taken, if treatment experienced patient taking Synthivan tablets Efavirenz should not concomitant with Synthivan tablet; it leads to decrease the Synthivan exposure
Absorption: Atazanavir is fastly absorbed , high plasma concentration is 2.5 hours.
If Synthivan is taken with food, Oral bioavailability is 60-68%
Distribution: Atazanavir is highly bound to human serum protein nearly 86%. It bounds to alpha-1-acid glycoprotein and albumin (89% and 86%) respectively.
The major biotransformation pathways like; Monooxygenation Dioxygenation Synthivan is highly metabolized in liver. It is metabolized by CYP3A.
The route of elimination is not known clearly The Synthivan in healthy persons terminal half life is 7 hours.
Some drug interaction may have chance to get; Severe skin reactions, Hyperbilirubinaemia, hepatoxicity, chronic kidney disease If patient suggested for concomitant therapy, care should be taken to reduce life threatening conditions Combination of ritonavir with some other drugs like sedative, hypnotics, anti-arrhythmia may leads to severe life threatening adverse reactions.
Atazanavir is a CYP3A4 substrate, drug which induce CYP3A4 may cause to reduce the serum concentration and therapeutic effects of the atazanavir. Concomitant use of Didanosine with Synthivan tablets leads to decrease the atazanavir exposure Interaction of Tenofovir with Synthivan: decrease the AUC and Cmin of atazanavir and increase the plasma concentration of tenofovir While Atazanavir combined with efavirenz: decrease the exposure of atazanavir Some list of medicines; Saquinavir, antacids, amiodarone, lidocaine, quinidine, carbamazepine, phenytoin, phenobarbitol etc
Patients are highly contraindicated to the components that present in the Synthivan tablet While Synthivan co administered with drugs which are highly dependent on CYP3A leads to increasing plasma concentration of interacting drugs causes life threatening conditions Synthivan concomitant with strongly CYP3A inducers may causes loss of efficacy of atazanavir List of medicines that are contraindicated; Alfuzosin, rifampicin, Irinotecan, Lurasidone, Pimozide, Midazolam, st. johns wort, lovastatin, simvastatin, sildenafil, indinavir, nevirapine,
if patient fail to administer the dose, advice them to take within a time. Or the missed dose should be swap and follow the regular drug schedule.
The serious effects that caused by Atazanavir :
Cardiac conduction abnormalities
Chronic kidney disease
Nephrolithiasis and cholelithiasis
Hepatic function abnormalities