Date of report 10 May 2019
Reported case interaction between
 Cobicistat and Atorvastatin

FLS Science

Drugs suspected to be involved in the DDI

Drug A
Cobicistat (Perpetrator)
Daily Dose
150 (mg)
Dose adjustment performed
No
Administration Route
Oral
Start date
April 1, 2016
End date
Ongoing
Drug B
Atorvastatin (Victim)
Daily Dose
40 (mg)
Dose adjustment performed
No
Administration Route
Oral
Start date
Jan. 1, 2019
End date
Ongoing

Complete list of drugs taken by the patient

Antiretroviral treatment
Elvitegravir/Cobicistat/Emtricitabine/Tenofovir-AF
Complete list of all comedications taken by the patient, included that involved in the DDI
Atorvastatin, Aspirin, Bisoprolol

Clinical case description

Gender
Male
Age
66
eGFR (mL/min)
>60
Liver function impairment
No
Description
66 year-old male. Coronary disease with MI in 2005 (coronary stent). HIV infection on cART with elvitegravir/cobicistat/FTC/TAF since April 2016. Dyslipidemia on treatment with atorvastatin. Suboptimal control of LDL-cholesterol with atorvastatin 20 mg qd (LDL 92 mg/dL; target <70 mg/dL). In January 2019 atorvastatin dose in increased to 40 mg qd. Good tolerance. In May 2019 LDL-cholesterol decreased to 62 mg/dL. Liver enzyme levels (AST/ALT) and CPK levels remained within the normal range.

Outcome

No unwanted outcome

Editorial Comment

Atorvastatin is metabolized by CYP3A4. Coadministration with elvitegravir/cobicistat is expected to increase atorvastatin concentrations. If the use of atorvastatin is considered necessary, start with the lowest dose of atorvastatin and titrate carefully while monitoring for safety. A daily dose of 40 mg atorvastatin should not be exceeded with careful safety monitoring. Suboptimal cardiovascular risk management has been described in HIV patients. Intensification of lipid lowering therapy and control of other cardiovascular risk factors may be required (Rosan A van Zoest, et al. Eur J Prev Cardiol. 2017 Aug; 24(12): 1297–1307).