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. ô+,%#+#,2ô2--*ô$-0 '«5 "03%̞"03%ô',2#0!2'-,1 Printed with the assistance of an unrestricted educational grant from: ฀฀฀฀฀฀฀฀ ฀฀฀฀฀฀฀฀ ฀฀฀฀฀.