No pharmaceutical opinion available for this interaction.
Atazanavir / cobicistat can inhibit the CYP 3A4 and P-gp and increase the plasma concentration of Ticagrelor.
Atazanavir / cobicistat can inhibit the metabolism (CYP 3A4) and decrease the active metabolite formation of Ticagrelor.
Atazanavir : 3A4 and UGT1A1, 2C8 (weak to moderate) / Cobicistat : 3A4 (potent) and 2D6 (weak), P-gp, BCRP, OATP1B1 and OATP1B3
3A4 and 3A5: Active metabolite that is similar in activity to ticagrelor; P-gp
3A4 (weak), P-gp (weak)
Possible increase of adverse effects.
Possible decrease of clinical efficacy.
Contraindicated. Use alternative.
Adverse effects of ticagrelor: Bleeding (epistaxis, gastrointestinal/cutaneous hemorrhage), bruising, dyspnea, headache, dizziness, gastrointestinal effects (nausea, vomiting, dyspepsia, diarrhea or constipation), bradycardia.
Ref #3164 : An in vitro study with healthy volunteers showed that ketoconazole, a potent inhibitor of CYP3A4, increased ticagrelor AUC by more than 7.3-fold and Cmax by 2.4-fold and decreased the active metabolite AUC and Cmax by 56% and 89%, respectively.