https://interactions.guidetherapeutiquevih.com/en/interaction-details?id=12597

Ritonavir

Pravastatin

Dosage adjustment may be necessary.

No pharmaceutical opinion available for this interaction.

Mechanism

Ritonavir may inhibit the transporters (OATP1B1 and OATP1B3) and increase the plasma concentration Pravastatin.

Ritonavir

Pharmacodynamic effects

–

Recommendations

–

Alternative solution(s)

–

Pravastatin

Pharmacodynamic effects

Possible increased risk of HMG CoA inhibitor toxicity.

Recommendations

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.

Alternative solution(s)

–

Monitor

Symptoms of toxicity associated with hypolipidemic agents : gastrointestinal effects, fatigue and muscular weaknesses, myalgias, muscular cramps, myopathies, rhabdomyolysis and myoglobinuria leading to renal insufficiency.

Tests

AST

ALT

CK

Myoglobin

Lipidic profile

Pharmacokinetic parameters

–

Comment

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.

Reference
  • 2793
    Pravastatin (Pravachol), Bristol-Myers Squibb Canada, Québec, Canada, 18 octobre 2017.
  • 2787
    Jacobson TA. Comparative Pharmacokinetic Interaction Profiles of Pravastatin, Simvastatin and Atorvastatin When Coadministered Whit Cytochrome P450 Inhibitors. Am J Cardiol 2004; 94 : 1140-1146.
  • 1492
    Moyle GJ, Buss NE, and Gazzard B. Pravastatin 40-mg qd Does not Alter Protease Inhibitor (PI) Exposure or Virological Efficacy over 24 Weeks Therapy. 9th Conference on Retroviruses and Opportunistic Infections. Seattle, Washington. February 2002. Abstract 446-W
  • 2983
    Chauvin B, Drouot S, Barrail-Tran A and Taburet AM. Drug-Drug Interactions between HMG-coA reductase inhibitors (Statins) and Antiretroviral Protease Inhibitors. Clin Pharmacokinet 2013; 52: 815-831.
  • 2129
    Sekar VJ, Spinosa-Guzman S, Marien K, et al. Interaction between the new HIV protease inhibitor darunavir (TMC114) and the lipid-lowering agent pravastatin. 8th International Workshop on Clinical Pharmacology of HIV Therapy, 16-18 April 2007, Budapest, Hungary. Abstract 54.
  • 2380
    Aquilante, C. Kiser, J. Anderson, P. et al. DRV/R, pravastatin and pharmacogenetics: Influence of SL01B1 polymorphisms on pharmacokinetic variability in the drug-drug interaction between darunavir/ritonavir and pravastatin. Drug Interaction & Pharmacology Presentations at the 50th Interscience Conference on Antimicrobial Agents and Chemotherapy, Boston, September 2010. Abstract A1 2007
  • 3391
    Suttels V, Florence E, Leys J, et al. A 68-year old male presenting with rhabdomyolysis-associated acute kidney injury following concomitant use of elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate and pravastatin/fenofibrate: a case report. J Med Case Rep, 2015, 9: 190.