Lipodystrophy syndrome(s)

November 2001     View PDF     En español

Statin inhibitors and HIV drug interactions

New information on the statin drugs used to lower cholesterol and their interaction with protease inhibitors show that they should be used with caution. Fifty-two volunteers took ritonavir (Norvir) and saquinavir (Fortovase) at the standard 400mg dose each taken twice a day. They also took one of three statins: pravastatin (Pravachol), simvastatin (Zocor) or atorvastatin (Lipitor). The statin dose was 40mg once a day.

The study found that pravastatin levels decreased 47%, atorvastatin levels increased 343% and simvastatin levels increased 2,676%. These results suggest that pravastatin can be used safely with protease inhibitors without need for a dose adjustment. Other statins like fluvastatin (Lescol), and lovastatin (Mevacor) behave similarly to pravastatin, atorvastatin and simvastatin respectively.

The activity of the statins is not directly related to their drug levels found in blood, but statin side effects are directly related. Atorvastatin should be used with great caution. Simvastatin should not be used with ritonavir and saquinavir and likely applies to other protease inhibitors as well.

One serious side effect associated with increased statin levels is a muscle disorder called rhabdomyolysis. People experiencing muscle aches should report this to their healthcare providers. People with mild kidney dysfunction (a creatinine clearance above 1.5mg/dl) are more at risk for developing statin side effects. Gemfibrozil (Lopid), a drug sometimes combined with the statins to lower triglyceride levels, can also result in muscle disorders and kidney failure.