No pharmaceutical opinion available for this interaction.
Ritonavir may possibly inhibit the metabolism (CYP 3A4) and consequently increase the plasma concentration of Lovastatin.
3A4 and 2D6 (major), 1A2 and 2B6 (minor), 5 metabolites, one of which has a weak concentration of an active metabolite (M-2), transporters: MRP1, MRP2, P-gp
2B6, 2C8, 2C9, 1A2, 2C19 (moderate) UGT (moderate)
3A4 (potent) and 2D6 (moderate), transporters: BCRP, OATP1A2, OATP1B1, OATP1B3, MRP1, MRP2, OCT1, OCT2, P-gp
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.
|+ >3 x|
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.