No pharmaceutical opinion available for this interaction.
Lopinavir / ritonavir may possibly inhibit the metabolism (CYP 3A4) and consequently increase the plasma concentration of Atorvastatin.
3A4 (major), 13 identified metabolites, 5 of these metabolites are linked to the metabolism of ritonavir, transporters: MRP1, MRP2, OATP1A2, OATP1B1, P-gp
2C19 (strong), 1A2, 2C9 (moderate) UGT (moderate)
3A4 and 2D6 (strong), transporters: BCRP, MRP2, OATP1A2, OATP1B1, OATP1B3, OATP2B1, P-gp
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 a 10 mg dose once daily, and increase with caution depending on patient clinical response and tolerance.
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.
Lopinavir/ritonavir substantially reduced o-OH-atorvastatin Cmax and AUC, substantially increased p-OH-atorvastatin AUC and Cmax, and increased HMG-CoA reductase inhibitory activity Cmax and AUC by 4.5 and 2.5 fold, respectively.
We also observe an increase in AUC of atorvastatin with saquinavir/ritonavir, darunavir/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.