Pravastatin Nelfinavir

Healthy volunteers were given protease inhibitors and statins, and the authors concluded that simvastatin should be avoided and that atorvastatin could be used with caution in people taking ritonavir and saquinavir (111). Dosage adjustment of pravastatin may be necessary with co-administration of ritonavir and saquinavir. Pravastatin does not alter the pharmacokinetics of nelfinavir, and thus appears to be safe for co-administration. 

There has been a study of the effects of ritonavir 400 mg bd plus saquinavir soft-gel capsules 400 mg bd on the pharmacokinetics of pravastatin, simvastatin, and atorvas-tatin (40 mg/day each), and of the effect of pravastatin on the pharmacokinetics of nelfinavir in a randomized, open study in 56 healthy HIV-negative adults (46). Ritonavir - -saquinavir reduced the steady-state AUC of pravastatin, markedly increased the AUC of simvastatin, and slightly increased the AUC of total active atorvastatin. The AUCs of nelfinavir and its active M8 metabolite were not altered by pravastatin. The authors concluded that simvastatin (and by implication lovastatin, which in... 

The levels of atorvastatin and simvastatin are markedly increased by lopinavir and saquinavir (with ritonavir), nelfinavir, and ritonavir alone. Pravastatin seems only moderately affected. Several cases of rhabdomyolysis have been attributed to this interaction. 

One study found that nelfinavir 750 mg three times daily increased the maximum serum levels and AUC of pravastatin 40 mg daily by 29% and 35%, respectively, and increased the maximum serum levels and AUC of atorvastatin 40 mg daily by 32% and 209%, respectively. A further study, in which 14 healthy subjects took nelfinavir 1.25 g twice daily for 12 days, with pravastatin 40 mg daily for the final 4 days, found that the AUC of pravastatin ranged from a decrease of 65% to an increase of 11%, and the maximum serum levels ranged from a decrease of 77% to an increase of 154%. ... 

In another study, 14 healthy subjects were given nelfinavir 1.25 g twice daily for 18 days, with pravastatin 40 mg daily for the last 4 days. No significant change was noted in the pharmacokinetics of nelfinavir, nor of its major metabolite. ... 

Barry M, Belz G, Roll S, O Grady P, Swaminathan A, Geraldes M, Mangold B. Interaction of nelfinavir with atorvastatin and pravastatin in normal healthy volunteers. AlDSflOOfS) 14 (Suppl 4), S90. 

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