Pravastatin with Nelfinavir Interaction Details

Brand Names Associated with Pravastatin

Brand Names Associated with Nelfinavir

Medical Content Editor Dr. Brian Staiger, PharmD
Last updated Nov 11, 2023

Interaction Effect

Decreased pravastatin plasma concentration

Interaction Summary

In an open-label, multi-dose pharmacokinetic study, coadministration of nelfinavir and pravastatin in healthy, HIV-seronegative volunteers resulted in decrease pravastatin AUC values and plasma concentrations by approximately 50%. Additionally, a decreased lipid-lowering effect of pravastatin was observed with coadministration, although, this result was not statistically significant. If nelfinavir and pravastatin are used concurrently, higher pravastatin doses may be necessary in order to achieve the desired therapeutic outcome.

Severity

Moderate

Onset

Delayed

Evidence

Established

How To Manage Interaction

Concomitant administration of nelfinavir and pravastatin in healthy, HIV-seronegative subjects has resulted in decreased pravastatin plasma concentrations, which may potentially lower efficacy. If these agents are administered concurrently, consider using higher doses of pravastatin to achieve the desired lipid-lowering effect.

Mechanism Of Interaction

Unknown

Literature Reports

A) In an open-label pharmacokinetic study, coadministration of nelfinavir and pravastatin in healthy, HIV-seronegative subjects resulted in decreased pravastatin AUC values and plasma concentrations. Subjects (n=18) received oral pravastatin 40 milligrams (mg) for 4 days. From day 4 to 12, nelfinavir 1250 mg was administered twice daily with meals. Pravastatin was restarted on day 13 through 16. Blood samples were taken to determine the pravastatin AUC from 0 to 24 hours before and after coadministration of nelfinavir (primary endpoint). Among the 14 evaluable subjects, pravastatin AUC values had decreased by a median of 46.5% (-64.4% to 10.5%) going from 86.5 ng-hr/mL on day 3 to 46.8 ng-hr/mL on day 16 (p=0.0004). Median Cmax values for pravastatin were 27.9 ng/mL and 12.4 ng/mL for days 3 and 16, respectively (p=0.0023; median within-subject change of 40.1%). There was a trend towards a decreased low-density lipoprotein (LDL) lowering effect of pravastatin with mean LDL changes of -200 mg/L on day 3 (pravastatin monotherapy) and -155 mg/L from day 13 to 16 (coadministration with nelfinavir); however, this result was not statistically significant. While the mechanism for this interaction is unknown, it is proposed that higher doses of pravastatin may be necessary to achieve the desired lipid-lowering efficacy when it is coadministered with nelfinavir .

Pravastatin Overview

• Pravastatin 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. Pravastatin is also used to reduce 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. Pravastatin 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 pravastatin has been shown to prevent heart disease, angina (chest pain), strokes, and heart attacks.

Nelfinavir Overview

• Nelfinavir is used along with other medications to treat human immunodeficiency virus (HIV) infection. Nelfinavir is in a class of medications called protease inhibitors. It works by decreasing the amount of HIV in the blood. Although nelfinavir 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.

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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:

• Gold Standard Drug Database
• Micromedex
• Lexicomp
• DrugBank

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.