Date of report 17 Feb 2020
Reported case interaction between
Cobicistat and Rosuvastatin
Cobicistat and Rosuvastatin
Drugs suspected to be involved in the DDI
Complete list of drugs taken by the patient
Rosuvastatin, ezetimibe, alendronic acid, AAS, inhaled beclometasone, hydrochlorothiazide, naproxen, calcium carbonate
Clinical case description
Transient ischemic attack in september 2017. Despite rosuvastatin 20 mg/daily + ezetimibe 10 mg/daily LDL-cholesterol levels 97 mg/dL (objective <70 mg/dL). Rosuvastatin dose was increased to 40 mg/daily (although the US product label states not to exceed 20 mg/day). The patient has tolerated rosuvastatin 40 mg/daily without side effects, with liver enzyme levels and CK, remained within the normal range, and LDL-cholesterol decreased to 62 mg/dL.
Clinical Outcome
Editorial Comment
Coadministration of darunavir/cobicistat (800/150 mg once daily) and rosuvastatin (10 mg) increased rosuvastatin AUC and Cmax by 93% and 277% due to inhibition of BCRP by darunavir/cobicistat. However, rosuvastatin did not affect darunavir/cobicistat exposure. When administration of rosuvastatin and darunavir/cobicistat is required it is recommended to initiate rosuvastatin with the lowest dose, and titrate to desired response while monitoring for safety. (Note, the US product label for Prezcobix states not to exceed rosuvastatin 20 mg/day.) In this case, it is important to take into consideration that that renal function is adequate. The outcome of the DDI may be different with impaired renal function.
University of Liverpool Recommendation
Potential interaction - may require close monitoring, alteration of drug dosage or timing of administration