Atazanavir/Ritonavir + Rosuvastatin = Precautionary

Effect on Concentration

Atazanavir/Ritonavir
No change
Applies within class?
No
Rosuvastatin
Increase
Applies within class?
No

Pharmacologic Effects

Atazanavir/Ritonavir
Effect
N/A
Applies within class?
No
Rosuvastatin
Effect
N/A
Applies within class?
No

Interaction History

N/A

Last Updated 16-Jul-2018

Summary

Sources

Effects of atazanavir/ritonavir or fosamprenavir/ritonavir on the pharmacokinetics of rosuvastatin. ^

Study Design

In one study, 6 HIV-seronegative participants received rosuvastatin (10mg/day) for 6 days, followed by a 6 day washout period, and then 6 days on atazanavir/ritonavir (300/100 mg). Upon the last day of atazanavir/ritonavir therapy, a single 10 mg dose of rosuvastatin was given. Blood samples of rosuvastatin were taken at 0, 0.5, 1, 1.5, 2, 4, 6, 8, 10, 12, 24 h following the rosuvastatin dose.

Study Results

During co-administration of rosuvastatin and atazanavir/ritonavir, the AUC of rosuvastatin increased by 213% and Cmax increased by 600%.

Study Conclusions

Recommendations suggest that the dose of rosuvastatin should not exceed 10mg once daily if combined with atazanavir/ritonavir. Titrate the rosuvastatin dose carefully and use the lowest rosuvastatin dose necessary, while implementing careful monitoring. Increase monitoring for adverse events, such as muscle pain and breakdown (rhabdomyolysis) and hepatotoxicity (abnormal liver function tests), etc.

References

Busti AJ, Bain AM, Hall RG. Effects of atazanavir/ritonavir or fosamprenavir/ritonavir on the pharmacokinetics of rosuvastatin. Journal Of Cardiovascular Pharmacology . 2008; 6: 605-610.