Atorvastatin with Cobicistat Interaction Details
Brand Names Associated with Atorvastatin
- Atorvastatin
- Caduet® (as a combination product containing Amlodipine, Atorvastatin)
- Lipitor®
- Liptruzet® (as a combination product containing Atorvastatin, Ezetimibe)
Brand Names Associated with Cobicistat
- Cobicistat
- Tybost®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Mar 04, 2024
Interaction Effect
Increased atorvastatin exposure and an increased risk of myopathy
Interaction Summary
Coadministration of atorvastatin (a CYP3A4 substrate) and cobicistat (a strong CYP3A4 inhibitor) can increase atorvastatin plasma concentrations and increase the risk of adverse effects, including myopathy[1][2]. During pharmacokinetic studies, coadministration of atorvastatin elvitegravir/cobicistat resulted in increased atorvastatin AUC and Cmax. Initiate treatment at the lowest possible dose and titrate cautiously. Do not exceed atorvastatin dosage of 20 mg/day [2][3]. Administration of atorvastatin is not recommended when cobicistat is coadministered with atazanavir [4].
Severity
Major
Onset
Unspecified
Evidence
Established
How To Manage Interaction
Coadministration of atorvastatin (a CYP3A4 substrate) and cobicistat (a strong CYP3A4 inhibitor) can increase atorvastatin plasma concentrations and increase the risk of adverse effects, including myopathy[1][2]. Initiate treatment at the lowest possible dose and titrate cautiously. Do not exceed atorvastatin dosage of 20 mg/day [2][3]. Administration of atorvastatin is not recommended when cobicistat is coadministered with atazanavir [4].
Mechanism Of Interaction
Inhibition of CYP3A-mediated metabolism of atorvastatin
Literature Reports
A) During pharmacokinetic studies, coadministration of a single dose of atorvastatin 10 mg along with elvitegravir 150 mg/cobicistat 150 mg/day (with emtricitabine and tenofovir alafenamide) resulted in a 132% and 160% increase in atorvastatin AUC and Cmax, respectively (N=16) [2].
B) During pharmacokinetic studies (n=16), coadministration of a single dose of atorvastatin 10 mg along with atazanavir 300 mg/cobicistat 150 mg/day resulted in a mean ratio of AUC and Cmax of atorvastatin with and without cobicistat/atazanavir as 9.22 (90% CI, 7.58 to 11.22) and 18.85 (90% CI, 13.53 to 26.27) respectively [5].
C) During pharmacokinetic studies (n=16), coadministration of a single dose of atorvastatin 10 mg along with darunavir 800 mg/cobicistat 150 mg/day resulted in a mean ratio of AUC and Cmax of atorvastatin with and without cobicistat/darunavir as 3.9 (90% CI, 3.52 to 4.32) and 4.19 (90% CI, 3.67 to 4.78) respectively [5].
References
1 ) Product Information: LIPITOR(R) oral tablets, atorvastatin calcium oral tablets. Parke-Davis (per FDA), New York, NY, 2017.
2 ) Product Information: STRIBILD(R) oral tablets, elvitegravir cobicistat emtricitabine tenofovir disoproxil fumarate oral tablets. Gilead Sciences Inc (per FDA), Foster City, CA, 2021.
3 ) Product Information: SYMTUZA(R) oral tablets, darunavir, cobicistat, emtricitabine, tenofovir alafenamide oral tablets. Janssen Products, LP (per FDA), Horsham, PA, 2023.
4 ) Product Information: EVOTAZ(R) oral tablets, atazanavir cobicistat oral tablets. Bristol-Myers Squibb Company (per FDA), Princeton, NJ, 2023.
5 ) Product Information: TYBOST(R) oral tablets, cobicistat oral tablets. Gilead Sciences Inc (per manufacturer), Foster City, CA, 2020.
Atorvastatin Overview
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Atorvastatin is used together with diet, weight loss, and exercise to reduce the risk of heart attack and stroke and to decrease the chance that heart surgery will be needed in people who have heart disease or who are at risk of developing heart disease. Atorvastatin is also used to decrease the amount of fatty substances such as low-density lipoprotein (LDL) cholesterol ('bad cholesterol') and triglycerides in the blood and to increase the amount of high-density lipoprotein (HDL) cholesterol ('good cholesterol') in the blood. Atorvastatin may also be used to decrease the amount of cholesterol and other fatty substances in the blood in children and teenagers 10 to 17 years of age who have familial heterozygous hypercholesterolemia (an inherited condition in which cholesterol cannot be removed from the body normally). Atorvastatin is in a class of medications called HMG-CoA reductase inhibitors (statins). It works by slowing the production of cholesterol in the body to decrease the amount of cholesterol that may build up on the walls of the arteries and block blood flow to the heart, brain, and other parts of the body.
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Accumulation of cholesterol and fats along the walls of your arteries (a process known as atherosclerosis) decreases blood flow and, therefore, the oxygen supply to your heart, brain, and other parts of your body. Lowering your blood level of cholesterol and fats with atorvastatin has been shown to prevent heart disease, angina (chest pain), strokes, and heart attacks.
Cobicistat Overview
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Cobicistat is used to increase the amounts of atazanavir (Reyataz, in Evotaz ) in adults and children weighing at least 77 pounds (35 kg) or darunavir (Prezista, in Prezcobix ) in adults and children weighing at least 88 pounds (40 kg) in the blood when these medications are used to treat human immunodeficiency virus (HIV). Cobicistat is in a class of medications called pharmacokinetic boosters. It works by increasing the amount of atazanavir or darunavir in the body so that they can have a greater effect.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.