Darunavir / ritonavir

Lovastatin

Contraindicated.

No pharmaceutical opinion available for this interaction.

Mechanism

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

Darunavir / ritonavir

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
  • 2107
    Darunavir (Prezista), Janssen, Ontario, Canada, 23 mai 2018.
  • 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.