https://interactions.guidetherapeutiquevih.com/en/interaction-details?id=7211

Atazanavir

Lovastatin

Contraindicated.

No pharmaceutical opinion available for this interaction.

Mechanism

Atazanavir can inhibit the metabolism (CYP 3A4) and 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.

Comment
Reference
  • 1382
    Atazanavir (Reyataz), Bristol-Myers Squibb, Quebec, Canada, 26 octobre 2018.
  • 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.