| Interaction Color Code | Clinical Bottom Line | Clinical Effects | Drug 1 effect | Drug 2 dose | Drug 2 effect | Management | |
|---|---|---|---|---|---|---|---|
| Rilpivirine (IM) Atorvastatin | Green: Administer standard doses | Administer standard doses | |||||
| Darunavir Atorvastatin 871 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of atorvastatin | Increased risk of atorvastatin adverse effects (e.g. myopathy, rhabdomyolysis) |
Not reported |
40 mg once daily on days 1-4, then 10 mg once daily on days 4-7 | Cmax decrease 44%, AUC decrease 15%, Cmin increase 81% (10 mg daily with darunavir / ritonavir compared to atorvastatin 40 mg daily alone) |
Consider using alternative agents. If coadministering, consider low dose atorvastatin and doses < 20 mg. Monitor for myopathy |
| Rilpivirine Atorvastatin 648 | Green: Administer standard doses | Administer standard doses | No significant change |
40 mg daily | Atorvastatin Cmin decreased 15%; Cmax increased 35% |
||
| Nevirapine Atorvastatin 591 | Green: Administer standard doses | Administer standard doses | Decreased lipid effects |
Atorvastatin AUC decreased 32%-43% |
Monitor for statin efficacy. May need to increase atorvastatin dose |
||
| Etravirine Atorvastatin 514 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of atorvastatin | Decreased atorvastatin effects |
No significant change |
40 mg daily | Atorvastatin AUC decreased 37% 2-hydroxyatorvastatin AUC increased 27%; Cmax increased 76% |
Consider low dose atorvastatin and titrate to effect; monitor for myopathy |
| Efavirenz Atorvastatin 407 | Green: Administer standard doses | Administer standard doses | Decreased lipid effects |
No significant change |
10 mg daily x 5 days | Atorvastatin AUC decreased 43%; Cmax decreased 14%, Cmin decreased 69%. Atorvastatin and metabolites AUC decreased 32%, Cmin decreased 48%, Cmax decreased 15% |
Monitor for statin efficacy. May need to increase atorvastatin dose |
| Efavirenz Atorvastatin 406 | Green: Administer standard doses | Administer standard doses | Decreased lipid effects |
No significant change |
10 mg daily on days 0-3 and 15-18 | Atorvastatin AUC decreased 43%; Atorvastatin and metabolites AUC decreased 34% |
Monitor for statin efficacy. May need to increase atorvastatin dose |
| Efavirenz Atorvastatin 405 | Green: Administer standard doses | Administer standard doses | Decreased lipid effects |
No significant change |
10 mg daily x 4 days | Atorvastatin AUC decreased 43%, Cmax decreased %14, cmin decreased 69% Atorvastatin and metabolites AUC decreased 32% |
Monitor for statin efficacy. May need to increase atorvastatin dose |
| Elvitegravir Atorvastatin 127 | Yellow: Adjust dosing | Adjust dosing to avoid increased levels of atorvastain | Potential for increased atorvastatin adverse effects (e.g. myopathy) |
AUC decreased 8% |
10 mg single dose | Cmax increased 132%; AUC increased 160%. |
Initiate with lowest Potential dose of atorvastatin. Titrate carefully while monitoring for adverse effects. Do not exceed 20 mg of atorvastatin daily. |
| Fostemsavir Atorvastatin 29 | Orange: Minimal data to guide interaction | Minimal data to guide interaction: weigh risks and benefits of using this combination | Increased statin exposure and risk of statin associated adverse events |
If co-adminstering, use lowest possible starting dose and monitor for statin associated adverse events |
