0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Editor's Correspondence |

The Use of Statins in Conjunction With Protease Inhibitors and in Renal Insufficiency

Nasser Mikhail, MD, MSc; Dennis Cope, MD
Arch Intern Med. 2003;163(13):1615-1616. doi:10.1001/archinte.163.13.1615-a.
Text Size: A A A
Published online

Extract

We have 2 comments on the article of Ballantyne et al1 regarding the risk of myopathy with statin therapy in high-risk patients. First, in their discussion related to the interaction of statins with other drugs that interfere with cytochrome CYP3A4 pathways, the authors did not mention the interaction of statins with protease inhibitors, particularly ritonavir, a potent inhibitor of cytochrome CYP3A4.2 In fact, hyperlipidemia is a common metabolic complication encountered in human immunodeficiency virus–infected patients as result of treatment with protease inhibitors.3 In our experience, the degree of dyslipidemia is sometimes severe enough to require maximum doses of statins. Preliminary pharmacokinetic studies showed an increase in the area under the plasma concentration time curve (AUC) of 32-fold for simvastatin and of 4.5-fold for atorvastatin when administered concomitantly with the combination of ritonavir and saquinavir.4 Conversely, a 0.5-fold decrease in the AUC was observed for pravastatin, which is not metabolized via cytochrome P450 CYP pathways.4 In another study,5 nelfinavir, a less potent P450 inhibitor compared with ritonavir,2 increased the AUC and the maximum plasma concentration of simvastatin by approximately 5 times. In the same study,5 nelfinavir increased the AUC and maximum plasma concentration of atorvastatin 74% and 122%, respectively. Furthermore, to our knowledge, at least 2 cases of rhabdomyolysis due to probable interaction between simvastain and ritonavir have been reported.6,7 Clearly, more pharmacokinetic and clinical data with respect to the interaction of other statins and protease inhibitors are needed. Until more information becomes available, pravastatin should be the preferred agent for treatment of protease inhibitor–induced hyperlipidemia, whereas atorvastatin may be used in submaximal doses (eg, ≤20 mg/d). Meanwhile, the concurrent administration of simvastatin and protease inhibitors must be avoided.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

Users' Guides to the Medical Literature
Clinical Scenario

Users' Guides to the Medical Literature
Statin Dosing and LDL Levels

brightcove.createExperiences();