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Altocor and Crixivan

Determining the interaction of Altocor and Crixivan and the possibility of their joint administration.

Check result:

Altocor <> Crixivan

Relevance: 09.10.2023 Reviewer: Shkutko P.M., M.D., in

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Consumer:

Using lovastatin together with indinavir is not recommended. Combining these medications may significantly increase the blood levels of lovastatin. This can increase the risk of side effects such as liver damage and a rare but serious condition called rhabdomyolysis that involves the breakdown of skeletal muscle tissue. In some cases, rhabdomyolysis can cause kidney damage and even death. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications, or your doctor may prescribe alternative medications that do not interact. Let your doctor know immediately if you have unexplained muscle pain, tenderness, or weakness during treatment with lovastatin or similar medications, especially if these symptoms are accompanied by fever or dark colored urine. You should also seek immediate medical attention if you develop fever, chills, joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, dark colored urine, and/or yellowing of the skin or eyes, as these may be signs and symptoms of liver damage. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

Professional:

CONTRAINDICATED: Protease inhibitors (PIs) may significantly increase the plasma concentrations of certain HMG-CoA reductase inhibitors. The mechanism is PI inhibition of CYP450 3A4 metabolism. High levels of HMG-CoA reductase inhibitory activity in plasma are associated with an increased risk of musculoskeletal toxicity, including myopathy and rhabdomyolysis, which may be accompanied by acute renal failure secondary to myoglobinuria and may result in death.

MANAGEMENT: Simvastatin and lovastatin are considered contraindicated in patients treated with indinavir due to the potential for severe interaction. Red yeast rice (which contains lovastatin) should also be avoided in patients treated with PIs. Fluvastatin and pravastatin are probably safer alternatives, since they are not metabolized by CYP450 3A4. All patients treated with HMG-CoA reductase inhibitors should be advised to promptly report any unexplained muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever. Therapy should be discontinued if creatine kinase is markedly elevated in the absence of strenuous exercise or if myopathy is otherwise suspected or diagnosed.

References

"Product Information. Prezista (darunavir)." Ortho Biotech Inc, Bridgewater, NJ.
"Product Information. Viracept (nelfinavir)." Agouron Pharma Inc, La Jolla, CA.
Neuvonen PJ, Backman JT, Niemi M "Pharmacokinetic comparison of the potential over-the-counter statins simvastatin, lovastatin, fluvastatin and pravastatin." Clin Pharmacokinet 47 (2008): 463-74
Dresser GK, Spence JD, Bailey DG "Pharmacokinetic-pharmacodynamic consequences and clinical relevance of cytochrome P450 3A4 inhibition." Clin Pharmacokinet 38 (2000): 41-57
Malaty LI, Kuper JJ "Drug interactions of HIV protease inhibitors." Drug Safety 20 (1999): 147-69
Piliero PJ "Interaction between ritonavir and statins." Am J Med 112 (2002): 510-1
Schmidt GA, Hoehns JD, Purcell JL, Friedman RL, Elhawi Y "Severe rhabdomyolysis and acute renal failure secondary to concomitant use of simvastatin, amiodarone, and atazanavir." J Am Board Fam Med 20 (2007): 411-6
Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0
Fichtenbaum CJ, Gerber JG, Rosenkranz SL, et al. "Pharmacokinetic interactions between protease inhibitors and statins in HIV seronegative volunteers: ACTG Study A5047." AIDS 16 (2002): 569-577
Hare CB, Vu MP, Grunfeld C, Lampiris HW "Simvastatin-nelfinavir interaction implicated in rhabdomyolysis and death." Clin Infect Dis 35 (2002): E111-2
Mangum EM, Graham KK "Lopinavir-Ritonavir: a new protease inhibitor." Pharmacotherapy 21 (2001): 1352-63
"Product Information. Agenerase (amprenavir)." Glaxo Wellcome, Research Triangle Pk, NC.
"Product Information. Norvir (ritonavir)." Abbott Pharmaceutical, Abbott Park, IL.
Cheng CH, Miller C, Lowe C, Pearson VE "Rhabdomyolysis due to probable interaction between simvastatin and ritonavir." Am J Health Syst Pharm 59 (2002): 728-30
"Product Information. Reyataz (atazanavir)." Bristol-Myers Squibb, Princeton, NJ.
"Product Information. Lexiva (fosamprenavir)." GlaxoSmithKline, Research Triangle Park, NC.
Barry M, Mulcahy F, Merry C, Gibbons S, Back D "Pharmacokinetics and potential interactions amongst antiretroviral agents used to treat patients with HIV infection." Clin Pharmacokinet 36 (1999): 289-304
"Product Information. Crixivan (indinavir)." Merck & Co, Inc, West Point, PA.
"Product Information. Fortovase (saquinavir)" Roche Laboratories, Nutley, NJ.

Altocor

Generic Name: lovastatin

Brand name: Altocor, Altoprev, Mevacor

Synonyms: n.a.

What is Altocor?

Crixivan

Generic Name: indinavir

Brand name: Crixivan

Synonyms: n.a.

What is Crixivan?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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