Research Progress of Pharmacokinetic Interactions between Lopinavir/Ritonavir and Statins

ABSTRACT

OBJECTIVE: To provide references for the selection of an appropriate statin and its dose adjustment in clinical practice when combined lopinavir/ritonavir (LPV/r) and statins. METHODS: Pharmacokinetic interactions between LPV/r and seven commonly used statins were reviewed by searching relevant domestic and foreign literatures. RESULTS AND CONCLUSIONS: Ritonavir is a potent time dependent inhibitor of cytochrome P450 3A4 (CYP3A4) and will greatly increase the plasma exposure of simvastatin and lovastatin, leading to the increasing risk of liver damage and rhabdomyolysis. Therefore, it is forbidden to use LPV/r together with these two statins. Whereas atorvastatin and rosuvastatin need to be used with caution and started at the lowest dose. No clinical data has been reported to support the relationship and extent of fluvastatin and LPV/r interactions, nor is there a dose recommendation for the combination. Moreover, LPV/r almost have no effect on the pharmacokinetic profiles of pravastatin and pitavastatin, so it is recommended to use pravastatin/pitavastatin with LPV/r in clinical practice.