https://interactions.guidetherapeutiquevih.com/en/interaction-details?id=13312

Darunavir / cobicistat

Lovastatin

Contraindicated.

No pharmaceutical opinion available for this interaction.

Mechanism

Darunavir / cobicistat can inhibit the metabolism (CYP 3A4) and increase the plasma concentration of Lovastatin.

Darunavir / cobicistat

Pharmacodynamic effects

–

Recommendations

–

Alternative solution(s)

Antiretrovirals that do not inhibit or induce CYP3A4, such as bictegravir, dolutegravir, or doravirine.

Lovastatin

Pharmacodynamic effects

Possible increased risk of HMG CoA inhibitor toxicity.

Recommendations

Contraindicated. Use alternative.

Alternative solution(s)

See atorvastatin, rosuvastatin and pravastatin.

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

Due to the significant first-pass effect of lovastatin and simvastatin in the liver via CYP3A4, coadministration of these drugs with PIs is contraindicated. Cases of rhabdomyolysis have been reported.

A pharmacokinetic study with simvastatin 40 mg QD and saquinavir/ritonavir 400/400 mg BID demonstrated a 30-fold increase in simvastatin AUC.

Comment
Reference
  • 3071
    Darunavir/cobicistat (Prezcobix), Janssen, Ontario, Canada, 7 avril 2017.
  • 3437
    Darunavir/cobicistat/emtricitabine/tenofovir alafenamide (Symtuza), Janssen Inc, Ontario, Canada, 3 octobre 2018.