Drug Interactions between pitavastatin and Prevymis

GENERALLY AVOID: Coadministration with letermovir may significantly increase the plasma concentrations of pitavastatin. The proposed mechanism is letermovir inhibition of the OATP1B1/3-mediated hepatic uptake of pitavastatin. Although the interaction has not been studied, substantial increases in pitavastatin exposure are expected based on known pharmacokinetics of the drugs. Additional use of cyclosporine is likely to further increase the magnitude of interaction, since it is a strong inhibitor of OATP 1B1 and 1B3. 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: Concomitant use of pitavastatin with letermovir should generally be avoided. The combination is considered contraindicated when coadministered with cyclosporine. Fluvastatin or pravastatin may be suitable alternatives, although lower dosages of the statin are recommended in combination with letermovir and/or cyclosporine. Please refer to the statin prescribing information for specific statin dosing recommendations. 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.