Atazanavir

Lovastatin

Contraindicated.

No pharmaceutical opinion available for this interaction.

Mechanism

Atazanavir may possibly inhibit the metabolism (CYP 3A4) and consequently increase the plasma concentration of Lovastatin.

Atazanavir

Pharmacodynamic effects

Recommendations

Alternative solution(s)

Lovastatin

Pharmacodynamic effects

Possible increased risk of HMG CoA inhibitor toxicity.

Recommendations

Contraindicated. Use alternative.

Alternative solution(s)

See atorvastatin, rosuvastatin and pravastatin.

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

AST

ALT

CK

Myoglobin

Pharmacokinetic parameters

Comment

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.

Reference
  • 1382
    Atazanavir (Reyataz), Bristol-Myers Squibb, Quebec, Canada, 23 nov. 2017.
  • 1489
    Dube MP, Stein JH, Aberg JA, et al. Guidelines for the evaluation and management of dyslipidemia in human immunodeficiency virus (HIV)-infected adults receiving antiretroviral therapy: recommendations of the HIV Medical Association of the Infectious Disease Society of America and the Adult AIDS Clinical Trials Group. Clin Infect Dis 2003 Sep 1;37(5):613-627.
  • 1936
    Penzak SR, Chuck SK, and Stajich GV. Safety and efficacy of HMG-CoA reductase inhibitors for treatment of hyperlipidemia in patients with HIV infection. Pharmacother 2000; 20(9):1066-1071.
  • 2792
    Lovastatin (Mevacor), Merck, Quebec, Canada, 2011.
  • 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.