Drug-drug interaction between Protease inhibitors and statins and Proton pump inhibitors

Abstract

Objective: The purpose of this article is to provide a systematic review of the pharmacokinetic and clinical data on drug-drug interactions between protease inhibitors (PIs) and statins, atazanavir and proton pump inhibitors (PPIs)and their clinical relevance. Methods: A literature search was performed using Medline, EMBASE and google scholar, abstracts from 1970 to 2019 of major conferences were searched and FDA drug information package inserts of the manufacturer of every currently available PI was looked at. All data was summarized and verified by at least two investigators. Results: A total of 246 references were identified, 8 of which were studies of pharmacokinetic and pharmacodynamics interactions between simvastatin, lovastatin and protease inhibitors and an additional 7 articles that provided pharmacokinetic of proton pump inhibitors and Atazanavir. Conclusions: Protease inhibitors increases the AUC and Cmax of simvastatin by approximately 500% and 517% respectively. Therefore, simvastatin and Lovastatin are not recommended for a co-administration with a protease inhibitor. Other statins such as rosuvastatin and pravastatin, can be used and are the main statins recommended. Atazanavir can be administered with PPIs but change of an acid reducing agent may be warranted, if possible. Providers should keep a close eye to those patients taking atazanavir and PPIs and consider a change to H2RA.