Date of report: 27 Feb 2020
Reported case interaction between
 Atazanavir and Naringin

FLS Science

Drugs suspected to be involved in the DDI

Drug A
Atazanavir (Victim)
Daily Dose
300 (mg)
Dose adjustment performed
No
Administration Route
Oral
Start date
Unknown
End date
Unknown
Drug B
Naringin (Perpetrator)
Daily Dose
Unknown
Dose adjustment performed
No
Administration Route
Oral
Start date
Unknown
End date
Unknown

Complete list of drugs taken by the patient

Antiretroviral treatment
Emtricitabine/Tenofovir-DF
Atazanavir (unboosted)
Complete list of all comedications taken by the patient, included that involved in the DDI
Naringin-copntaining CAM, sinetrol, fluoxetine, pseudoephedrine

Clinical case description

Gender
Female
Age
40
eGFR (mL/min)
>60
Liver function impairment
No
Description
Patient failing antiretroviral therapy with atazanavir plus tenofovir/emtricitabine (mean HIV RNA: 149 copies/mL). He referred that he had recently started using a naringin‐containing supplement, claimed to be a fat‐burning accelerator. TDM revealed suboptimal atazanavir concentration during concomitant treatment with naringin that increased after discontinuation (85 versus 719 ng/mL). This case has been published by Cattaneo D, et al. in Obesity (Silver Spring). 2018 Aug;26(8):1251-1252.

Outcome

Loss of efficacy

Drug Interaction Probability Scale (DIPS)

Score
7 - Probable

Editorial Comment

Weight-loss drugs should be used with caution in HIV-infected patients treated with antiretroviral drugs because of the risk of virologic failure. Naringin is a flavanone‐7‐O‐glycoside that inhibits the activity of carrier proteins (p‐glycoprotein and organic‐anion‐transporting polypeptide), ultimately resulting in impaired drug absorption (Shirasaka Y, Li Y, Shibue Y, et al. Concentration‐dependent effect of naringin on intestinal absorption of beta(1)‐adrenoceptor antagonist talinolol mediated by p‐glycoprotein and organic anion transporting polypeptide (OATP). Pharm Res 2009; 26: 560‐ 567.)