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Ask the Experts about Switching/Simplifying Treatment
Is Lipator the wrong drug for high cholesterol
Jan 4, 2000
I have heard that I should not take Lipator with Crixivan to address my elevated cholesterol levels. They are supposedly metabolized the same way which could impact the blood levels of the Indinivir. Merck was supposed to publish something but has not... what is a good alternative if this is correct that I can take without worrying? Thanks
Response from Dr. Pavia
Lipitor (atorvastatin) is metabolized by the same enzyme system, cytochrome 3A4, that is affected by all of the available protease inhibitors. When taken with crixivan, viracept, fortavase or agenerase, the predicted effect is a modest increase in the blood level of lipitor. Formal studies are finally being done (we agitated for them for a while) but the effect is probably not large. Norvir (ritonavir) might be a different story, and we need to see those studies.
Because lipitor is one of the best "statins" at lowering triglycerides as well as cholesterol, and because many PWA's have high triglycerides, even without protease inhibitors, lipitor is often used in patients on PI's. I start at the lowest dose, go up slowly, and tell the patients to watch for muscle pain, which may indicate muscle inflamation from high levels of any "statin" drug.
If you would rather not worry, the "statin" that is not metabolized by 3A4 is Pravachol (pravostatin). If a patient is on norvir, which is a much stronger blocker of 3A4, I would rather use pravachol, but otherwise might start with Lipitor, Pravachol, or Zocor.
Good luck
ATP
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