Atorvastatin with Tipranavir 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 Tipranavir

  • Aptivus®
  • Tipranavir

Medical Content Editor
Last updated Mar 04, 2024

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Interaction Effect

Increased atorvastatin exposure and an increased risk of myopathy and rhabdomyolysis

Interaction Summary

Concomitant use of tipranavir/ritonavir and atorvastatin may cause significant increases in the plasma concentrations of atorvastatin. Tipranavir/ritonavir is a potent inhibitor of CYP3A4, and atorvastatin is a substrate of CYP3A4. The profound decrease in atorvastatin metabolism resulting from tipranavir/ritonavir CYP3A4 inhibition significantly increases the risk of myopathy and rhabdomyolysis[1]. Concomitant use of atorvastatin and tipranavir/ritonavir should be avoided [2].[3]. Monitor for signs and symptoms of myopathy particularly during initiation of therapy and during upward dose titration of either drug [3].

Severity

Major

Onset

Unspecified

Evidence

Established

How To Manage Interaction

Concomitant use of atorvastatin with tipranavir/ritonavir should be avoided due to an increased risk of myopathy/rhabdomyolysis[2]. [3]. If coadministration cannot be avoided, monitor for signs and symptoms of myopathy particularly during initiation of therapy and during upward dose titration of either drug [3].

Mechanism Of Interaction

Inhibition of OATP1B1-mediated efflux transport of atorvastatin by tipranavir/ritonavir; inhibition of CYP3A4-mediated metabolism of atorvastatin by tipranavir/ritonavir

Literature Reports

A) Coadministration of tipranavir/ritonavir with atorvastatin may increased the plasma concentrations atorvastatin significantly. In one study subjects (n=22) received tipranavir 500 mg/ritonavir 200 mg twice daily for 17 doses and a single dose of 10 mg atorvastatin. Pharmacokinetic parameters were presented as the ratio of atorvastatin plus tipranavir/ritonavir to atorvastatin alone (90% CI). The ratios of maximum concentration (Cmax), area under the concentration-time curve (AUC) and minimum concentration (Cmin) of atorvastatin all showed a profound increase with results of 8.61 (range 7.25 to 10.21), 9.36 (range 1.43 to 1.73), and 5.19 (range 4.21 to 6.40), respectively. In a similar study 22 subjects received 14 doses of tipranavir 500 mg/ritonavir 200 mg twice daily and a single dose of atorvastatin 10 mg. Results were expressed as the ratio of tipranavir/ritonavir plus atorvastatin to tipranavir/ritonavir alone (90% CI). Ratios of the pharmacokinetic parameters Cmax, AUC, and Cmin demonstrated no significant change in plasma concentrations of tipranavir when coadministered with atorvastatin [1].

B) Coadministration of tipranavir 500 mg/ritonavir 200 mg twice daily with atorvastatin 10 mg once daily for 7 days increased the atorvastatin AUC by 9.36-fold and Cmax by 8.58-fold compared with atorvastatin alone [3].

References

    1 ) Product Information: APTIVUS(R) oral capsules, tipranavir oral capsules. Boehringer Ingelheim Pharmaceuticals,Inc, Ridgefield, CT, 2007.

    2 ) Product Information: LIPITOR(R) oral tablets, atorvastatin calcium oral tablets. Pfizer (Per FDA), New York, NY, 2012.

    3 ) Product Information: ATORVALIQ(R) oral suspension, atorvastatin calcium oral suspension. CMP Pharma Inc (per FDA), Farmville, NC, 2023.

Atorvastatin Overview

  • 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.

  • 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.

See More information Regarding Atorvastatin

Tipranavir Overview

  • Tipranavir is used with ritonavir (Norvir) and other medications to treat human immunodeficiency virus infection (HIV). Tipranavir is in a class of medications called protease inhibitors. It works by decreasing the amount of HIV in the blood. Although tipranavir does not cure HIV, it may decrease your chance of developing acquired immunodeficiency syndrome (AIDS) and HIV-related illnesses such as serious infections or cancer. Taking these medications along with practicing safer sex and making other lifestyle changes may decrease the risk of transmitting the HIV virus to other people.

See More information Regarding Tipranavir

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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.