Burger David, Stroes Erik, Reiss Peter
Department of Clinical Pharmacy, Radboud University Nijmegen Medical Centre, 6525 GA Nijmegen, The Netherlands.
Curr Opin HIV AIDS. 2008 May;3(3):247-51. doi: 10.1097/COH.0b013e3282fbaa54.
Both antiretroviral agents and statins are well known for their independent roles in causing drug-drug interactions.
Not surprisingly, combined use of statins and antiretroviral agents may lead to a variety of clinically relevant drug-drug interactions, including reduced lipid-lowering effects (as a result from increased metabolism of statins) as well as an increased risk of potentially fatal rhabdomyolysis (as a result of reduced metabolism of the statin or impaired hepatic uptake). Initially, attention has focused on the cytochrome P450 system as being the source of the observed drug-drug interactions, but nowadays it is clear that other pathways, such as UDP-glucuronosyltransferase and the organic anion polypeptide B transporter, may also be involved. Here we review current literature on statin-antiretroviral interactions. The review is preceded by a brief overview of pharmacokinetic properties of antiretroviral agents and statins.
Clinically relevant interactions between statins and antiretroviral agents do occur. The clinical relevance relates to an increased risk of statin-induced toxicity or reduced lipid-lowering activity of the statin. The information listed in this review should help the clinician to select the most appropriate combination. Whenever needed it is recommended to consult a clinical pharmacologist or pharmacist.
