Recommendations for Coadministration of PIs and NNRTIs with Statin Medications

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Generally safe to begin treatment with usual starting dosage

Caution; start with low dosage, monitor effects

Coadministration is contraindicated

No data

	Atorvastatin	Fluvastatin	Lovastatin	Pitavastatin	Pravastatin	Rosuvastatin	Simvastatin
Protease Inhibitors
Atazanavir				(unboosted) (ritonavir boosted)		Rosuvastatin AUC ? 213% and Cmax ? 600%
Darunavir/ ritonavir					Pravastatin AUC ? 81%-500%
Fosamprenavir					May need to ? pravastatin dosage
Indinavir
Lopinavir/ ritonavir	Atorvastatin AUC ? 488%					Rosuvastatin AUC ? 108%, Cmax ? 466%
Nelfinavir
Ritonavir
Saquinavir					Saquinavir + ritonavir: May need to ? pravastatin dosage
Tipranavir	Atorvastatin AUC ? 836%
Nonnucleoside Reverse Transcriptase Inhibitors
Efavirenz	May need to ? atorvastatin dosage	May need to ? fluvastatin dosage	May need to ? lovastatin dosage		May need to ? pravastatin dosage		May need to ? simvastatin dosage
Etravirine	May need to ? atorvastatin dosage	May ? fluvastatin levels	May need to ? lovastatin dosage				May need to ? simvastatin dosage
Rilpivirine

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 C_max 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