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In a pharmacokinetic study of 12 HIV-uninfected volunteers, subjects received either rosuvastatin 10 mg daily or darunavir/ritonavir 600/100 mg twice daily for 7 days, followed by a 7-day washout period and then crossover to the alternative treatment. After another 7-day washout, subjects were given both rosuvastatin and darunavir/ritonavir for 7 days.

Pharmacokinetic analysis showed that rosuvastatin levels were significantly increased by darunavir/ritonavir: the rosuvastatin AUC was 48% higher and the C_max 144% higher when the 3 medications were given concurrently. Neither the darunavir nor the ritonavir AUC or C_max changed, though the ritonavir half-life increased. Decreases in LDL were comparable whether rosuvastatin was given with or without darunavir/ritonavir, and no adverse events occurred.

Clinical Bottom Line
Although no additional lipid-lowering effects or adverse events were seen during the brief time that rosuvastatin was given with darunavir/ritonavir, it is important to realize that clinical effects of "boosting" rosuvastatin may take longer to manifest and that, with continued use, coadministration of rosuvastatin with darunavir/ritonavir may increase the risk of statin-related adverse effects. For patients on darunavir/ritonavir, atorvastatin may be the preferred statin, as pharmacokinetic changes are less significant with that combination.

References

Fichtenbaum C, Samineni D, Moore E, et al. Darunavir/ritonavir increases rosuvastatin concentrations but does not alter lipid-lowering effect in healthy volunteers. In: Program and abstracts of the XVIII International AIDS Conference; July 18-23, 2010; Vienna. Abstract WePE0101.