| Interaction Color Code | Clinical Bottom Line | Clinical Effects | Drug 1 effect | Drug 2 dose | Drug 2 effect | Management | |
|---|---|---|---|---|---|---|---|
| Lenacapavir Simvastatin | Yellow: Adjust dosing | Minimal data to guide interaction: weigh risks and benefits of using this combination | Increased risk of simvastatin adverse effects |
Initiate simvastatin with the lowest starting dose and titrate to clinical effect. Monitor for adverse effects of lovastatin (e.g. myopathy, elevated transaminases). |
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| Darunavir Simvastatin 943 | Red: Avoid combination | Do not coadminister: Potential for increased levels of simvastatin | Increased risk of simvastatin adverse effects (e.g. myopathy, rhabdomyolysis) |
Not studied |
Not studied (may increase simvastatin levels) |
Contraindicated. Use alternative agents. |
|
| Atazanavir Simvastatin 831 | Red: Avoid combination | Do not coadminister: Potential for increased levels of simvastatin | Potential Increased simvastatin effects (eg, myopathy, rhabdomyolysis) |
Contraindicated. Use alternative agents. |
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| Efavirenz Simvastatin 378 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of simvastatin | Decreased simvastatin effects |
No significant change |
40 mg daily x 4 days | Simvastatin AUC decreased 68%; Cmax decreased 72%; Cmin decreased 45% |
Monitor statin efficacy. May need to increase simvastatin dose |
| Efavirenz Simvastatin 377 | Yellow: Adjust dosing | Adjust dosing to avoid reduced levels of simvastatin | Decreased lipid effects |
No significant change |
40 mg daily on days 0-3 and 15-18 | Simvastatin AUC decreased 58% |
Monitor statin efficacy. May need to increase simvastatin dose |
| Elvitegravir Simvastatin 200 | Red: Avoid combination | Do not coadminister: Potential for increased levels of simvastatin | Potential for increased simvastatin effects (e.g. myopathy, rhabdomyolysis) |
Contraindicated. Use alternative agents. |
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| Fostemsavir Simvastatin 32 | 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 |
