The levels of
simvastatin appear to be markedly increased by nelfinavir,
ritonavir and saquinavir/ritonavir. Two cases of rhabdomyolysis have been attributed to the use of
ritonavir with
simvastatin. The manufacturers of
atazanavir,
amprenavir and fosamprenavir state that they may increase
simvastatin and
lovastatin levels.
It is generally recommended that
simvastatin and
lovastatin be avoided in patients taking any
protease inhibitor. The manufacturers of
amprenavir and fosamprena- vir recommend
fluvastatin or
pravastatin as alternatives.