Comment
Author: Admin | 2025-04-28
The patient's risk for adverse effects such as myalgias, rhabdomyolysis, elevated creatinine phosphokinase (CPK), and hepatic dysfunction.29,31 One study demonstrated that the 24-hour area under the curve (AUC0-24) for simvastatin increased by more than 3,000% when it was coadministered with saquinavir/ritonavir.30 Another study demonstrated that the AUC0-24 for atorvastatin increased more than 800% and the maximum concentration (Cmax) increased more than 760% when coadministered with tipranavir/ritonavir.33 Two recent studies demonstrated an unexpected drug-drug interaction involving rosuvastatin and the PIs, lopinavir/ritonavir, and tipranavir/ritonavir.34,35 When rosuvastatin was concurrently administered with lopinavir/ritonavir, rosuvastatin's AUC was increased by 2.1-fold and the Cmax was increased by 4.7-fold. There were four patients who experienced elevated CPKs as a result of this increase in rosuvastatin concentrations.34 Furthermore, the combination of tipranavir/ritonavir and rosuvastatin 10 mg resulted in an increase of 37% in rosuvastatin's AUC, and the Cmax was increased by 123%.35 The mechanisms of these drugÒdrug interactions are currently unclear.34,35 Interactions with the NNRTIs have also been established. In one study, volunteers receiving concomitant efavirenz with either simvastatin, atorvastatin, or pravastatin revealed that the AUC0-24 decreased by 58%, 43%, and 40%, respectively.36 This study suggests that patients taking a drug considered to be an inducer of the CYP450 system will probably require higher doses of interacting statins in order to achieve optimal lipid-lowering effects.36 Since etravirine is also an inducer of CYP450 3A4, atorvastatin, simvastatin, and lovastatin concentrations will likely be decreased when coadministered with etravirine. Additionally, since fluvastatin is metabolized by CYP2C9 and etravirine is an
Add Comment