Table 3: Interactions between statins and protease inhibitors or nonnucleoside reverse transcripted inhibitors, from the DHHS Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents, revised Dec. 1, 2009. http://aidsinfo.nih.gov/contentfiles/AdultandAdolescentGL.pdf.

Interactions of statins with PIs

AtorvastatinAll PIsDRV/r 4 folds atorvastatin AUCFPV r atorvastatin AUC by 130–153%
LPV/r atorvastatin AUC by 488%
NFV atorvastatin AUC by 74%
SQV/r atorvastatin AUC by 79%
TPV/r atorvastatin AUC by 836%
Use lowest possible starting dose with careful monitoring for toxicities or consider other HMG-CoA reductase inhibitors with less potential for interaction.
LovastatinAll PIsSignificant lovastatin expectedContraindicated—do not coadminister.
PravastatinDRV/rpravastatin AUC 81%Use lowest possible starting dose with careful monitoring.
LPV/rpravastatin AUC 33%No dose adjustment necessary
pravastatin AUC 47–50%No dose adjustment necessary
RosuvastatinATV/rrosuvastatin AUC 213% and Cmax 600%Use lowest possible starting dose with careful monitoring or consider other HMG-CoA reductase inhibitors with less potential for interaction.
DRV/r, IDV r,
NFV, SQV/r
rosuvastatin possible
FPV rNo significant changeNo dosage adjustment necessary
LPV/rrosuvastatin AUC 108% and Cmax 366%Use lowest possible starting dose with careful monitoring or consider other HMG-CoA reductase inhibitors with less potential for interaction.
TPV/rrosuvastatin AUC 26% and Cmax 123%
SimvastatinAll PIsSignificant simvastatin level
NFV simvastatin AUC 505%
SQV/r 400/400 mg BID simvastatin AUC 3,059%
Contraindicated—do not coadminister.

Interactions of statins with NNRTIs

AtorvastatinEFV, ETR, NVPatorvastatin AUC 32%–43% with EFV, ETRAdjust atorvastatin according to lipid responses, not to exceed the maximum recommended dose.
FluvastatinETR fluvastatin possibleDose adjustments for fluvastatin may be necessary.
Lovastatin
Simvastatin
EFVsimvastatin AUC 68%Adjust simvastatin dose according to lipid responses, not to exceed the maximum recommended dose. If used with RTV-boosted PI, simvastatin and lovastatin should be avoided.
ETR lovastatin possible
simvastatin possible
Adjust lovastatin or simvastatin dose according to lipid responses, not to exceed the maximum recommended dose. If used with RTV-boosted PI, simvastatin and lovastatin should be avoided.
NVP lovastatin possible
simvastatin possible
Adjust lovastatin or simvastatin dose according to lipid responses, not to exceed the maximum recommended dose. If used with RTV-boosted PI, simvastatin and lovastatin should be avoided.
Pravastatin
Rosuvastatin
EFVpravastatin AUC 44%
rosuvastatin: no data
Adjust statin dose according to lipid responses, not to exceed the maximum recommended dose.
ETRNo significant effect expectedNo dosage adjustment necessary