CARDIOVASCULAR
CARDIOVASCULAR DRUGS: STATINS AND LIPID LOWERING AGENTS
INSTIs NNRTIs PIs
xBICTEGRAVIR (Biktarvy) xELVITEGRAVIR/ x DORAVIRINE (Pifeltro, x EFAVIRENZ (Sustiva, Boosted with ritonavir xDOLUTEGRAVIR (Tivicay, COBICISTAT (Stribild, Delstrigo) Atripla) (Norvir) or cobicistat Triumeq, Juluca) Genvoya) x RILPIVIRINE (Edurant, x ETRAVIRINE (Intelence) xATAZANAVIR (Reyataz, xRALTEGRAVIR Complera, Odefsey, x NEVIRAPINE Evotaz) (Isentress) Juluca) (Viramune) xDARUNAVIR (Prezista, Prezcobix, Symtuza) xLOPINAVIR (Kaletra) STATINS
xAtorvastatin Potential for n statin Potential for p statin Potential for n statin. Use (Lipitor) lowest statin dose possible (maximum 20 mg atorvastatin daily).
xRosuvastatin Potential for n statin. Use (Crestor) lowest statin dose possible (maximum 10 mg rosuvastatin daily).
xPitavastatin (Livalo)
xPravastatin Potential for n statin Potential for n statin (Pravachol)
xLovastatin Potential for n statin and Potential for p statin Potential for n statin and (Mevacor), toxicity toxicity simvastatin (Zocor) CARDIOVASCULAR
INSTIs NNRTIs PIs
xBICTEGRAVIR (Biktarvy) xELVITEGRAVIR/ x DORAVIRINE (Pifeltro, x EFAVIRENZ (Sustiva, Boosted with ritonavir xDOLUTEGRAVIR (Tivicay, COBICISTAT (Stribild, Delstrigo) Atripla) (Norvir) or cobicistat Triumeq, Juluca) Genvoya) x RILPIVIRINE (Edurant, x ETRAVIRINE (Intelence) xATAZANAVIR (Reyataz, xRALTEGRAVIR Complera, Odefsey, x NEVIRAPINE Evotaz) (Isentress) Juluca) (Viramune) xDARUNAVIR (Prezista, Prezcobix, Symtuza) xLOPINAVIR (Kaletra)
FIBRATES xFenofibrate, bezafibrate, gemfibrozil CHOLESTEROL ABSORPTION INHIBITOR xEzetimibe (Ezetrol)
GASTROINTESTINAL LIPASE INHIBITOR xOrlistat (Xenical) Potential for p ARV absorption
BILE ACID SEQUESTRANTS xCholestyramine Potential for p ARV absorption (Olestyr), colestipol (Colestid)
CARDIOVASCULAR
Mechanism of Drug Interactions, Management and Monitoring
Mechanism of Interaction Main Interacting ARVs Management Monitoring Hmg-Coa Reductase Inhibitors (Statins) Lovastatin, simvastatin Inhibition of CYP3A4 Ritonavir and cobicistat- Contraindicated. Use Statin toxicity: myalgia, boosted protease inhibitors alternate statin. rhabdomyolysis and elvitegravir Atorvastatin, rosuvastatin, Inhibition of CYP3A4, Ritonavir and cobicistat- Use lowest statin dose Statin toxicity: myalgia, pravastatin OATP1B1, BCRP boosted protease inhibitors possible and titrate to effect rhabdomyolysis and elvitegravir Pitavastatin Primarily cleared via UGT, None Most ARVs may be used Statin toxicity: myalgia, OATP1B1 rhabdomyolysis Orlistat Reduced absorption of ARVs All antiretrovirals, Take ARVs at least 2 hours Antiretroviral efficacy by decreasing dietary fat particularly lipophilic agents before/after orlistat absorption Bile acid sequestrants Reduced absorption of ARVs All antiretrovirals Take ARVs either 1 hour Antiretroviral efficacy before or 4-6 hours after bile acid sequestrants
Legend: No dose adjustment required.
Use combination with caution. Adjustment in drug dose or frequency or additional/more frequent monitoring may be required.
May wish to consult with a pharmacist knowledgeable in HIV drug interactions.
Contraindicated/avoid combination.
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