Drug Interactions between darunavir and rosuvastatin
This report displays the potential drug interactions for the following 2 drugs:
- darunavir
- rosuvastatin
Interactions between your drugs
rosuvastatin darunavir
Applies to: rosuvastatin and darunavir
ADJUST DOSE: Coadministration with protease inhibitors may significantly increase the plasma concentrations of rosuvastatin. The mechanism may involve inhibition of OATP1B1-mediated hepatic uptake and/or BCRP-mediated intestinal and hepatobiliary efflux. In 15 healthy volunteers, administration of rosuvastatin 20 mg once a day with lopinavir-ritonavir 400 mg-100 mg twice a day for 7 days was associated with an approximately 5-fold increase in rosuvastatin steady-state peak plasma concentration (Cmax) and a 2-fold increase in systemic exposure (AUC) compared to administration of rosuvastatin alone. One subject had asymptomatic creatine phosphokinase elevation 17 times the upper limit of normal (ULN) and another had liver function test elevation between 1.1 and 2.5 times ULN. In a study with 11 subjects, administration of rosuvastatin 5 mg once daily in combination with once daily morning doses of ombitasvir/paritaprevir/ritonavir (25 mg/150 mg/100 mg) plus twice daily doses of dasabuvir resulted in increases of rosuvastatin Cmax and AUC by approximately 7.1- and 2.6-fold, respectively. Likewise, atazanavir/ritonavir 300 mg/100 mg given once daily for 8 days increased the Cmax and AUC of a single 10 mg dose of rosuvastatin by 7.0- and 3.1-fold, respectively. 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: The benefits of using rosuvastatin with protease inhibitors should be carefully weighed against the potentially increased risk of myopathy including rhabdomyolysis. If coadministration is required, rosuvastatin should be initiated at the lowest effective dosage and not exceed 10 mg per day when prescribed with lopinavir-ritonavir, atazanavir-ritonavir, atazanavir-cobicistat, or ombitasvir/paritaprevir/ritonavir plus dasabuvir. The dosage of rosuvastatin should be limited to 20 mg once a day when used with darunavir-cobicistat. Nirmatrelvir-ritonavir product labeling advises temporary discontinuation of rosuvastatin be considered during treatment with nirmatrelvir-ritonavir. Alternatively, a different HMG-CoA reductase inhibitor such as fluvastatin may be considered. 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
- (2001) "Product Information. Invirase (saquinavir)." Roche Laboratories
- (2001) "Product Information. Norvir (ritonavir)." Abbott Pharmaceutical
- (2001) "Product Information. Crixivan (indinavir)." Merck & Co., Inc
- (2001) "Product Information. Kaletra (lopinavir-ritonavir)." Abbott Pharmaceutical
- (2003) "Product Information. Crestor (rosuvastatin)." AstraZeneca Pharma Inc
- (2003) "Product Information. Reyataz (atazanavir)." Bristol-Myers Squibb
- (2003) "Product Information. Lexiva (fosamprenavir)." GlaxoSmithKline
- (2005) "Product Information. Aptivus (tipranavir)." Boehringer-Ingelheim
- Cerner Multum, Inc. "UK Summary of Product Characteristics."
- (2006) "Product Information. Prezista (darunavir)." Ortho Biotech Inc
- Hirano M, Maeda K, Shitara Y, Sugiyama Y (2006) "Drug-drug interaction between pitavastatin and various drugs via OATP1B1." Drug Metab Dispos, 34, p. 1229-36
- Neuvonen PJ, Niemi M, Backman JT (2006) "Drug interactions with lipid-lowering drugs: Mechanisms and clinical relevance." Clin Pharmacol Ther, 80, p. 565-81
- Cerner Multum, Inc. "Australian Product Information."
- (2022) "Product Information. Viekira Pak (dasabuvir/ombitasvir/paritaprev/ritonav)." AbbVie US LLC
- (2015) "Product Information. Evotaz (atazanavir-cobicistat)." Bristol-Myers Squibb
- US Food and Drug Administration (2021) FACT SHEET FOR HEALTHCARE PROVIDERS EMERGENCY USE AUTHORIZATION FOR PAXLOVID. https://www.fda.gov/media/155050/download
Drug and food interactions
darunavir food
Applies to: darunavir
ADJUST DOSING INTERVAL: Food enhances the absorption and oral bioavailability of darunavir administered in combination with low-dose ritonavir. The mechanism is unknown. When administered with food, the peak plasma concentration (Cmax) and area under the plasma concentration-time curve (AUC) of darunavir were approximately 30% higher than when administered in the fasting state. Darunavir exposure was similar for the range of meals studied. The total caloric content of the various meals evaluated ranged from 240 Kcal (12 grams fat) to 928 Kcal (56 grams fat).
MANAGEMENT: To ensure maximal oral absorption, darunavir coadministered with ritonavir should be taken with food. The type of food is not important.
References
- (2006) "Product Information. Prezista (darunavir)." Ortho Biotech Inc
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
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