https://interactions.guidetherapeutiquevih.com/en/interaction-details?id=9842
https://interactions.guidetherapeutiquevih.com/en/interaction-details?id=9842
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.
–
–
–
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.
–
| Reference number |
|---|
| # patients |
| HIV |
| Dose |
| Frequency |
| Cmax |
| AUC |
| Cmin |
| 3417 |
|---|
| 16 |
| - |
| 150/150 mg * |
| QD |
| - 9% |
| - 8% |
| - 12% |
| 3417 |
|---|
| 16 |
| - |
| 10 mg |
| x 1 |
| + 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.