31
Table 11. Interactions Between ART and Statins
a
Statin Antiretroviral Therapy Drug Class
Protease Inhibitor, Including
Cobicistat
Non-nucleoside Reverse
Transcriptase Inhibitor
Atorvastatin
• AUC ↑↑
• Use lowest starting dose and
titrate carefully
• Do not exceed 20 mg daily
with DRV/r, FPV/r, SQV/r
• AUC ↑↑ 488% with LPV/r.
• ↑↑↑ 836% with TPV/r
and should not be
co-administered
• Start with lowest
recommended dose and
titrate while monitoring
for safety with all cobicistat
containing regimens
• AUC ↓ 43% with efavirenz
• ⟷ but Cmax ↓ 37% with
etravirine
• No data for nevirapine.
• May need higher starting dose
with efavirenz and etravirine
• No dose adjustments for
rilpivirine
Fluvastatin • Use not recommended with
nelfinavir
• AUC ↑with etravirine
• May require higher starting
dose with etravirine
Lovastatin • Contraindicated with all PIs
and cobicistat (AUC ↑↑↑)
• AUC ↓↓with efavirenz. May
require higher starting dose
• No adjustment needed for
rilpivirine
Pitavastatin
• Modest AUC ↑ with ATV/r
(31%)
• Modest ↓ AUC with DRV/r
(20-26%) and LPV/r (20%).
No dose adjustment required
• No dose adjustment with
cobicistat
• ⟷ with efavirenz and no
dose adjustment needed
• No dose adjustment needed
for rilpivirine
Pravastatin
• ↓AUC of except with
DRV/r and LPV/r which
• ↑ AUC by 81% and 33%
respectively. Use lowest
possible starting dose
• AUC ↓ 40% with efavirenz
• ⟷ with etravirine. May need
higher starting dose
Rosuvastatin
• AUC ↑↑213% and Cmax
↑↑↑ 600% with LPV/r.
• AUC ↑↑ 108% and Cmax
• Allowed. ⟷. No reported
interactions
a
Nucleoside reverse transcriptase inhibitors and integrase inhibitors, except when boosted with
cobicistat, do not have any significant drug-drug interactions with statins.
Abbreviations and symbols: ↑, some increase; ↑↑, moderate increase; ↑↑↑, large increase;
↓, some decrease; ↔, no significant change; ATV/r, atazanavir/ritonavir; AUC, area under the
concentration-time curve; Cmax, maximum drug concentration; DRV/r, darunavir/ritonavir;
FPV/r, fosamprenavir/ritonavir; LPV/r, lopinavir/ritonavir; SQV/r, saquinavir/ritonavir
Table modified from Myerson Met al. J Clin Pharmacol. 2015;55:957–74. Permission to use
adaptation was obtained.
