No pharmaceutical opinion available for this interaction.
Atazanavir / cobicistat can inhibit the metabolism (CYP 3A4) and increase the plasma concentration of Lovastatin.
Atazanavir : 3A4 and UGT1A1, 2C8 (weak to moderate) / Cobicistat : 3A4 (potent) and 2D6 (weak), P-gp, BCRP, OATP1B1 and OATP1B3
3A4 (major); P-gp
2C9 and 2D6, 3A4 (weak); P-gp
Possible increased risk of HMG CoA inhibitor toxicity.
Contraindicated. Use alternative.
See atorvastatin, rosuvastatin and pravastatin.
Symptoms of toxicity associated with hypolipidemic agents : gastrointestinal effects, fatigue and muscular weaknesses, myalgias, muscular cramps, myopathies, rhabdomyolysis and myoglobinuria leading to renal insufficiency.
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.
See saquinavir/ritonavir + simvastatin.