No pharmaceutical opinion available for this interaction.
Elvitegravir / Cobicistat may possibly inhibit the metabolism (CYP 3A4) and consequently increase the plasma concentration of Atorvastatin.
Elvitegravir / Cobicistat may inhibit hepatic transports OATP1B1/B3 and BCRP and increase plasma concentration of Atorvastatin.
Elvitegravir 3A4 and then UGT1A1/3; Cobicistat 3A4 (major) and 2D6 (minor)
Elvitegravir : 2C9 (moderate)
Cobicistat : 3A4 and 2D6 (potent), P-gp, MATE 1, BCRP, OATP1B1 and OATP1B3
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.
|150/150 mg *|
|+ 132% (2.3x)|
|+ 160% (2.6x)|
Ref #3417 : * Administered as a fixed-dose tablet also containing emtricitabine/tenofovir alafenamide (TAF) 200/10 mg.
Increases in atorvastatin concentrations are smaller than those observed with lopinavir/ritonavir.
We observe an increase in AUC of atorvastatin with lopinavir/ritonavir, saquinavir/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.