The labeling for the protease inhibitor Reyataz (atazanavir sulfate, from Bristol-Myers Squibb) has been updated to include dose recommendations for HIV-infected pregnant women. In HIV combination therapy, treatment with the recommended adult dose of Reyataz 300mg, boosted with 100mg of ritonavir, achieved minimum plasma concentrations during the third trimester of pregnancy comparable to that observed historically in HIV-infected adults. During the postpartum period, atazanavir concentrations may be increased; therefore, while no dose adjustment is necessary, patients should be monitored for adverse events for two months after delivery.  

Pregnant women do not require a dose adjustment for Reyataz/ritonavir except in the case of treatment-experienced pregnant women during the second or third trimester when Reyataz is co-administered with either tenofovir or an H2-receptor antagonist. In that case, Reyataz 400mg plus ritonavir 100 mg once daily is recommended. There are insufficient data to recommend a Reyataz dose for use with both tenofovir and an H2-receptor antagonist in treatment-experienced pregnant women.

Reyataz is indicated in combination with other antiretroviral agents for treatment of HIV-1 infection in patients at least 6 years of age. It should be used during pregnancy only if the benefit outweighs the risk and the HIV-1 strains are susceptible to atazanavir. Reyataz should not be used without ritonavir in pregnant or postpartum women. Reyataz does not have an indication for prevention of maternal-fetal transmission of HIV-1 infection.

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