https://interactions.guidetherapeutiquevih.com/en/interaction-details?id=12599

Elvitegravir / Cobicistat

Pravastatin

Dosage adjustment may be necessary.

No pharmaceutical opinion available for this interaction.

Mechanism

Elvitegravir / Cobicistat may inhibit the transporters (OATP1B1 and OATP1B3) and increase the plasma concentration Pravastatin.

Elvitegravir / Cobicistat

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

–

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
  • 2985
    Elvitegravir/cobicistat/emtricitabine/tenofovir (Stribild), European public assessment report (EPAR) Product Information, London, United Kingdom, 5 août 2015.
  • 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.