Major
Atazanavir × Atorvastatin
Antiretroviral, HIV protease inhibitor×HMG-CoA reductase inhibitors (statins)
Mechanism
Atazanavir inhibits CYP3A4. Atorvastatin rises 8-fold – rhabdomyolysis risk.
Symptoms
Myalgia, weakness, dark urine, rising CK within 5-10 days.
Management
Cap atorvastatin at 10 mg/day. Better – pravastatin 40 mg.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.