Fluvastatin,
pravastatin and
rosuvastatin are not predominantly metabolised by CYP3A4, so it seems unlikely that dosage adjustments will be needed if they are given with
protease inhibitors. However, there is some limited evidence to suggest that moderate increases in the levels of some
statins may occur and an increase in some muscle disorders has been reported. The manufacturers of
rosuvastatin note that during
clinical studies there was an increase in myositis and myopathy in patients also taking
protease inhibitors.
Patients should be counselled regarding myopathy (e.g. report any unexplained muscle pain, tenderness or weakness). Note that some manufacturers recommend starting with the lowest doses of
pravastatin or
rosuvastatin.