How do HMG-CoA reductase inhibitors and protease inhibitors (PIs) interact?

Updated: Jan 15, 2019
  • Author: Jason F Okulicz, MD, FACP, FIDSA; Chief Editor: Michelle R Salvaggio, MD, FACP  more...
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In combination with PIs, consider the lowest possible atorvastatin starting dose with careful monitoring for toxicities (myopathy, rhabdomyolysis), or consider other HMG-CoA reductase inhibitors.

Simvastatin and lovastatin are contraindicated with all PIs; avoid combination.

ATV may increase pitavastatin levels and LPV/r may decrease pitavastatin levels; no dosage adjustment necessary with coadministered PIs.

DRV/RTV in combination with pravastatin may lead to increased pravastatin levels; use the lowest possible starting dose and monitor closely.

No dose adjustments are needed with pravastatin and LPV/RTV or SQV/RTV.

Use the lowest rosuvastatin starting dose, or consider other HMG-CoA inhibitors with less potential for interactions in combination with PIs.

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