Drug Interactions between cobicistat and Pravachol
This report displays the potential drug interactions for the following 2 drugs:
- cobicistat
- Pravachol (pravastatin)
Interactions between your drugs
pravastatin cobicistat
Applies to: Pravachol (pravastatin) and cobicistat
MONITOR: Coadministration with cobicistat may increase the plasma concentrations of most HMG-CoA reductase inhibitors (i.e., statins) to varying degrees. Cobicistat is a potent inhibitor of CYP450 3A4 and can significantly increase exposure to statins that are primarily metabolized by the isoenzyme (e.g., atorvastatin, lovastatin, simvastatin). Cobicistat may also inhibit the OATP 1B1- and 1B3- mediated hepatic uptake of statins, thus even those that are not metabolized by CYP450 3A4 may be affected. High levels of HMG-CoA reductase inhibitory activity in plasma is associated with an increased risk of musculoskeletal toxicity. Myopathy manifested as muscle pain and/or weakness associated with grossly elevated creatine kinase exceeding ten times the upper limit of normal has been reported occasionally. Rhabdomyolysis has also occurred rarely, which may be accompanied by acute renal failure secondary to myoglobinuria and may result in death.
MANAGEMENT: Caution is advised when statins are prescribed with cobicistat-containing regimens. The lowest starting dosage of the statin is recommended, then titrated as needed based on clinical response and tolerance. Some statins such as lovastatin and simvastatin are contraindicated for use with cobicistat. All patients receiving statin therapy should be advised to promptly report any unexplained muscle pain, tenderness or weakness, particularly if accompanied by fever, malaise and/or dark colored urine. Therapy should be discontinued if creatine kinase is markedly elevated in the absence of strenuous exercise or if myopathy is otherwise suspected or diagnosed.
References
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- Cerner Multum, Inc. "Australian Product Information."
- (2014) "Product Information. Prezcobix (cobicistat-darunavir)." Janssen Pharmaceuticals
- (2015) "Product Information. Evotaz (atazanavir-cobicistat)." Bristol-Myers Squibb
- Suttels V, Florence E, Leys J, et al. (2015) "A 68-year old male presenting with rhabdomyolysis-associated acute kidney injury following concomitant use of elvitegravir/cobicistat/emtricitabine/tenofovir disoproxil fumarate and pravastatin/fenofibrate: a case report." J Med Case Reports, 9, p. 190
- (2018) "Product Information. Symtuza (cobicistat/darunavir/emtricitabine/tenofovir)." Janssen Pharmaceuticals
Drug and food interactions
pravastatin food
Applies to: Pravachol (pravastatin)
MONITOR: Concomitant use of statin medication with substantial quantities of alcohol may increase the risk of hepatic injury. Transient increases in serum transaminases have been reported with statin use and while these increases generally resolve or improve with continued therapy or a brief interruption in therapy, there have been rare postmarketing reports of fatal and non-fatal hepatic failure in patients taking statins. Patients who consume substantial quantities of alcohol and/or have a history of liver disease may be at increased risk for hepatic injury. Active liver disease or unexplained transaminase elevations are contraindications to statin use.
MANAGEMENT: Patients should be counseled to avoid substantial quantities of alcohol in combination with statin medications and clinicians should be aware of the increased risk for hepatotoxicity in these patients.
References
- (2001) "Product Information. Pravachol (pravastatin)." Bristol-Myers Squibb
- (2001) "Product Information. Zocor (simvastatin)." Merck & Co., Inc
- (2001) "Product Information. Lescol (fluvastatin)." Novartis Pharmaceuticals
- (2001) "Product Information. Lipitor (atorvastatin)." Parke-Davis
- (2002) "Product Information. Altocor (lovastatin)." Andrx Pharmaceuticals
- (2003) "Product Information. Crestor (rosuvastatin)." AstraZeneca Pharma Inc
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- Cerner Multum, Inc. "Australian Product Information."
- (2010) "Product Information. Livalo (pitavastatin)." Kowa Pharmaceuticals America (formerly ProEthic)
Therapeutic duplication warnings
No warnings were found for your selected drugs.
Therapeutic duplication warnings are only returned when drugs within the same group exceed the recommended therapeutic duplication maximum.
See also
Drug Interaction Classification
Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. | |
Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. | |
Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. | |
No interaction information available. |
Further information
Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.
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