No pharmaceutical opinion available for this interaction.
Ritonavir may inhibit the transporters (OATP1B1 and OATP1B3) and increase the plasma concentration Pravastatin.
3A4 and 2D6 (major), 1A2 and 2B6 (minor), 5 metabolites, one of which has a weak concentration of an active metabolite (M-2), transporters: MRP1, MRP2, P-gp
2B6, 2C8, 2C9, 1A2, 2C19 (moderate) UGT (moderate)
3A4 (potent) and 2D6 (moderate), transporters: BCRP, OATP1A2, OATP1B1, OATP1B3, MRP1, MRP2, OCT1, OCT2, P-gp
OATP1B1 and OATP1B3
Possible increased risk of HMG CoA inhibitor toxicity.
Use this combination with caution.
Start with a small dosage. Monitor closely for signs and symptoms of toxicity and adjust dosage as a function of efficacy and tolerance.
Symptoms of toxicity associated with hypolipidemic agents : gastrointestinal effects, fatigue and muscular weaknesses, myalgias, muscular cramps, myopathies, rhabdomyolysis and myoglobinuria leading to renal insufficiency.
The coadministration is generally well tolerated. Start with a low dose of pravastatin because a wide individual variability was reported.
Ref #2380 : Co-administration of pravastatin with darunavir/ritonavir increased pravastatin AUC by 21%.
Réf #2129 : However, in another study with darunavir/ritonavir, an average increase in pravastatin SSC of 81% was observed with increases of up to 5-fold in some subjects.
Réf #3391 : Case report of rhabdomyolysis in a patient on elvitegravir/cobicistat and pravastatin/fenofibrate.