Pravastatin Ritonavir

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... 

Clinically important, potentially hazardous interactions with amiloride, aminoglycosides, amphotericin B, ampicillin, anisindione, anticoagulants, armodafinil, atorvastatin, azathioprine, azithromycin, bacampicillin, basiliximab, bezafibrate, bosentan, bupropion, carbenicillin, caspofungin, cholestyramine, clarithromycin, cloxacillin, co-trimoxazole, corticosteroids, cyclophosphamide, daclizumab, danazol, dicloxacillin, dicumarol, digoxin, diltiazem, disulfiram, echinacea, erythromycin, ethotoin, etoposide, ezetimibe, flunisolide, fluoxymesterone, fluvastatin, foscarnet, fosphenytoin, gemfibrozil, hemophilus B vaccine, HMG-CoA reductase inhibitors, imatinib, imipenem/cilastatin, influenza vaccines, ketoconazole, lanreotide, lopinavir, lovastatin, mephenytoin, methicillin, methoxsalen, methylphenidate, methylprednisolone, methyltestosterone, mezlocillin, mizolastine, mycophenolate, nafcillin, nisoldipine, NSAIDs, orlistat, oxacillin, penicillins, phellodendron, phenytoin, pravastatin, prednisolone, prednisone, pristinamycin, ranolazine, red rice yeast, rifabutin, rifampin, rifapentine, ritonavir, rosuvastatin, simvastatin, sirolimus, spironolactone, St John s wort, sulfacetamide, sulfadiazine, sulfamethoxazole, sulfisoxazole, sulfonamides, tacrolimus, telithromycin, tenoxicam, testosterone, ticarcillin, tolvaptan, trabectedin, triamterene, troleandomycin, ursodeoxycholic acid, vaccines, vecuronium, warfarin, zofenopril... 

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. 

Either atorvastatin 20 mg daily or pravastatin 20 mg daily were given to 24 healthy subjects for 4 days during a 14-day course of lopinavir/ritonavir 400/100 mg twice daily. The maximum serum levels and AUC of atorvastatin were increased by between 4.7- and 5.9-fold and the maximum serum levels and AUC of pravastatin were only increased by about 30%. Atorvastatin and pravastatin had no effect on the pharmacokinetics of lopinavir or ritonavir. ... 

Ritonavir 300 mg twice daily and saquinavir 400 mg twice daily were given to healthy subjects for 3 days, after which the dose was increased to ritonavir 400 mg twice daily and saquinavir 400 mg twice daily for a further 11 days. On the last 4 days atorvastatin, pravastatin, or simvastatin (all 40 mg daily) were also given. The mean pravastatin AUC was approximately halved (13 subjects), the mean atorvastatin AUC was increased approximately fourfold (14 subjects) and the mean simvastatin acid AUC was increased approximately 32-fold (14 subjects). No cases of rhabdomyolysis were noted. ... 

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