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Recommendations for Coadministration of PIs and NNRTIs with Statin Medications

for Health Care Providers

Recommendations for Coadministration of PIs and NNRTIs with Statin Medications

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OK to coadminister Generally safe to begin treatment with usual starting dosage

caution Caution; start with low dosage, monitor effects

do not coadminister Coadministration is contraindicated

do not coadminister No data

AtorvastatinFluvastatinLovastatinPitavastatinPravastatinRosuvastatinSimvastatin
Protease Inhibitors
Atazanavircautioncautiondo not coadministerOK to coadminister

(unboosted)

caution

(ritonavir boosted)

cautiondo not coadminister

Rosuvastatin AUC ? 213% and Cmax ? 600%

do not coadminister
Darunavir/
ritonavir
cautioncautiondo not coadministerOK to coadministercaution

Pravastatin AUC ? 81%-500%

cautiondo not coadminister
Fosamprenavircautioncautiondo not coadministercautionOK to coadminister

May need to ? pravastatin dosage

OK to coadministerdo not coadminister
Indinavircautioncautiondo not coadministerdo not coadministercautioncautiondo not coadminister
Lopinavir/
ritonavir
caution

Atorvastatin AUC ? 488%

cautiondo not coadministerOK to coadministercautiondo not coadminister

Rosuvastatin AUC ? 108%, Cmax ? 466%

do not coadminister
Nelfinavircautioncautiondo not coadministercautioncautioncautiondo not coadminister
Ritonavircautioncautiondo not coadministercautioncautioncautiondo not coadminister
Saquinavircautioncautiondo not coadministercautionOK to coadminister

Saquinavir + ritonavir: May need to ? pravastatin dosage

cautiondo not coadminister
Tipranavirdo not coadminister

Atorvastatin AUC ? 836%

cautiondo not coadministercautioncautioncautiondo not coadminister
Nonnucleoside Reverse Transcriptase Inhibitors
EfavirenzOK to coadminister

May need to ? atorvastatin dosage

caution

May need to ? fluvastatin dosage

OK to coadminister

May need to ? lovastatin dosage

cautionOK to coadminister

May need to ? pravastatin dosage

cautionOK to coadminister

May need to ? simvastatin dosage

EtravirineOK to coadminister

May need to ? atorvastatin dosage

caution

May ? fluvastatin levels

OK to coadminister

May need to ? lovastatin dosage

cautionOK to coadministercautionOK to coadminister

May need to ? simvastatin dosage

RilpivirineOK to coadministercautioncautioncautioncautioncautioncaution

Notes:
Nevirapine in combination with statins has not been well studied; its interactions would be expected to be similar to those of efavirenz. Delavirdine's interactions would be expected to be similar to those of PIs. Rilpivirine has been studied only with atorvastatin: atorvastatin Cmax is increased modestly.

Other risk factors for elevated rosuvastatin levels include Asian or Pacific Islander heritage, renal insufficiency, and concurrent treatment with gemfibrozil; use with extra caution.

From Lipid-Lowering Medications
Primary Care of Veterans with HIV
Office of Clinical Public Health Programs
Veterans Health Administration, 2009