No pharmaceutical opinion available for this interaction.
Darunavir / cobicistat can inhibit the metabolism (CYP 3A4) and increase the plasma concentration of Atorvastatin.
3A4 (major) and 2D6 (minor)
3A4 (potent) and 2D6 (weak), P-gp, MATE 1, BCRP, OATP1B1 and OATP1B3.
3A4 (major), 2C8 (minor): metabolised in acid derivatives 2-hydroxy-atorvastatin and 4-hydroxy-atorvastatin. These active metabolites are responsable of about 70% of the inhibitory activity of HMG-CoA reductase circulating. OATP1B1 and P-gp.
3A4 (weak), OATP1B1 and P-gp.
Possible increased risk of HMG CoA inhibitor toxicity.
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.
We do not recommend more than 20 mg per day (U.S. guidelines) and 40 mg per day (European guidelines).
Or choose an alternative.
Pravastatin or ezetimibe.
Symptoms of toxicity associated with hypolipidemic agents : gastrointestinal effects, fatigue and muscular weaknesses, myalgias, muscular cramps, myopathies, rhabdomyolysis and myoglobinuria leading to renal insufficiency.
|+ 290% (3.9x)|
|+ 319% (4.2x)|
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.