https://interactions.guidetherapeutiquevih.com/en/interaction-details?id=13617

Cobicistat

Atorvastatin

Dosage adjustment may be necessary.

No pharmaceutical opinion available for this interaction.

Mechanism

Cobicistat can inhibit the metabolism (CYP 3A4) and increase the plasma concentration of Atorvastatin.

Cobicistat

Pharmacodynamic effects

–

Recommendations

–

Alternative solution(s)

–

Atorvastatin

Pharmacodynamic effects

Increased risk of adverse effects.

Recommendations

Start therapy with the lowest dose and titrate to desired response while monitoring for safety.

In patients already under treatment, a reduction in dosage may be necessary.

No more than 10 mg daily is recommended when co-administered with atazanavir/cobicistat.

We do not recommend more than 20 mg per day (U.S. guidelines) and 40 mg per day (European guidelines).

Or choose an alternative.

Alternative solution(s)

Pravastatin or ezetimibe.

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

Ref #3360 : A study in two groups of 16 healthy patients studied co-administration of a single dose of 10 mg atorvastatin with darunavir/cobicistat 800/150 mg QD or atazanavir/cobicistat 300/150 mg QD. In the darunavir/cobicistat group, rosuvastatin AUC and Cmax increased by 3.9 and 4.2-fold, respectively, while in the atazanavir/cobicistat group atorvastatin AUC and Cmax increased by 9.2 and 18.9-fold, respectively. Therefore it is recommanded not to give more than 10 mg of atorvastatin daily when given with atazanavir/cobicistat. See atazanavir / cobicistat + atorvastatin and darunavir / cobicistat + atorvastatin.

We observe an increase in AUC of atorvastatin with lopinavir/ritonavir, saquinavir/ritonavir, tipranavir/ritonavir, fosamprenavir/ritonavir and nelfinavir.

Ref #1695: Case report of drug-induced rhabdomyolysis in a 34-year-old HIV-infected male with a history of liver disease and concomitant use of clarithromycin, atorvastatin, and lopinavir/ritonavir.

Reference
  • 2949
    Cobicistat (Tybost), European public assessment report (EPAR) Product Information, London, United Kingdom, 4 juin 2015.
  • 2790
    Atorvastatin (Lipitor), Pfizer, Quebec, Canada, 20 mars 2017.
  • 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.
  • 2984
    Hoetelmanss R, Lasure A, Koester A. The effect of TMC 114, a potent next-generation HIV protease inhibitor, with low dose ritonavir on atorvastatine pharmacokinetics. ICAAC. 2004. Abstract H-865.
  • 1695
    Mah Ming JB and Gill MJ. Drug-Induced Rhabdomyolysis after Concomitant Use of Clarithromycin, Atorvastatin, and Lopinavir/Ritonavir in a Patient with HIV. AIDS Patient Care and STDs 2003;17;207-210.