HIV Medication & Statin Safety Checker
Check Your Medication Combination
Select your HIV medication and statin to see if they're safe together. This tool is based on current guidelines from the University of Liverpool HIV Drug Interactions database.
Select your medications to see safety information.
Important Safety Information
- Never take simvastatin or lovastatin with any HIV medication containing ritonavir or cobicistat.
- Pitavastatin is the safest choice with most HIV medications.
- Always get a baseline creatine kinase (CK) test before starting statins.
- Stop immediately if you experience muscle pain, weakness, or dark urine.
- For the most accurate check: Use the University of Liverpool HIV Drug Interactions Checker
When you’re living with HIV and also need to manage high cholesterol, taking statins isn’t just an option-it’s often a lifesaver. But here’s the catch: not all statins are safe with HIV medications. Some combinations can cause serious, even life-threatening muscle damage. The key isn’t avoiding statins altogether-it’s knowing which ones to use, at what dose, and with which HIV drugs.
Why This Mix Can Be Dangerous
HIV medications, especially those with ritonavir or cobicistat, are designed to boost the levels of other drugs in your system. They do this by blocking enzymes in your liver-mainly CYP3A4-that break down medications. The problem? Statins also rely on these same enzymes to get cleared from your body. When both are taken together, statins build up to dangerous levels. This isn’t theoretical. Studies show some combinations can increase statin concentrations by up to 300%.The most serious risk? Rhabdomyolysis. That’s when muscle tissue breaks down, spilling proteins into your bloodstream that can crush your kidneys. Symptoms include unexplained muscle pain, weakness, or dark urine. It’s rare, but when it happens with these drug combos, it can be fatal.
Statins You Must Avoid Completely
There are two statins you should never take with any HIV protease inhibitor or booster: simvastatin and lovastatin. These are absolute no-gos. The FDA, the New York State Department of Health, and the University of Liverpool’s HIV Drug Interactions database all agree: combining these with drugs like darunavir/cobicistat, atazanavir/ritonavir, or lopinavir/ritonavir is dangerous.Why? Because these statins are almost entirely broken down by CYP3A4. When that pathway is blocked by HIV meds, levels can spike 20 times higher than normal. That’s not a small risk-it’s a red flag. Even low doses of simvastatin or lovastatin can trigger muscle damage in people on these HIV regimens. If you’re on one of these HIV drugs and still taking simvastatin or lovastatin, talk to your doctor immediately. Switching is not optional-it’s urgent.
Safe Statin Options and Their Limits
The good news? You have choices. Four statins can be used safely with most HIV medications-if you follow the rules.- Pitavastatin (Livalo): This is the safest bet. It’s metabolized mostly by a different enzyme (CYP2C9) and doesn’t rely heavily on CYP3A4. No dose adjustments are usually needed, even with boosted HIV drugs. It’s also less likely to interact with other common meds like blood pressure pills.
- Pravastatin (Pravachol): Also low-risk. It’s cleared by the kidneys and doesn’t use CYP3A4 much. You can use it at standard doses with most HIV regimens.
- Rosuvastatin (Crestor): Works well, but only at low doses. With ritonavir or cobicistat, max dose is 10 mg daily. Higher doses can push levels too high. With unboosted drugs like dolutegravir, you can go up to 20 mg.
- Atorvastatin (Lipitor): Can be used, but with tight limits. With cobicistat, stick to 20 mg daily max (some labels say 10 mg). With ritonavir, 20 mg is the ceiling. Never go higher without close monitoring.
- Fluvastatin (Lescol): An option, but use with caution. It’s broken down by CYP2C9, which can be affected by ritonavir. Exposure can double, so start low and watch for side effects.
Here’s what you need to know: if your HIV regimen includes cobicistat (like in Symtuza or Prezcobix), your statin dose is likely capped. If you’re on unboosted integrase inhibitors like dolutegravir or bictegravir, you’re in the clear for most statins at normal doses. These newer HIV drugs don’t interfere much with liver enzymes, making them easier to pair with cholesterol meds.
What About Other Heart Medications?
It’s not just statins. Other drugs you might be taking can make things worse. For example, some blood pressure meds-like felodipine or amlodipine-are also broken down by CYP3A4. If you’re on one of these and a statin, you’re stacking risks. Talk to your doctor about switching to safer alternatives like lisinopril or metoprolol.And don’t forget about triglyceride-lowering drugs. Gemfibrozil is a big no. It increases statin toxicity by blocking another cleanup pathway. Fenofibrate or omega-3 fatty acids are safer choices for high triglycerides in people with HIV.
Monitoring: What Your Doctor Should Check
Even with the right statin and dose, you need regular check-ins. Here’s what should be tracked:- Creatine kinase (CK): A blood test for muscle damage. Check at baseline and 4-12 weeks after starting or changing statins.
- Liver enzymes (ALT, AST): Statins can affect the liver. Monitoring every 3-6 months is standard.
- Symptoms: If you feel new muscle soreness, weakness, or dark urine, call your doctor. Don’t wait.
- Age and kidney function: Older adults and those with reduced kidney function are more vulnerable. Lower doses may be needed.
According to the University of Liverpool’s guidelines, elderly patients on boosted HIV regimens should start with the lowest possible statin dose and increase slowly-if at all. Many clinicians now use pitavastatin 2 mg or pravastatin 20 mg as a starting point for older patients.
Real-World Gaps and What You Can Do
Despite clear guidelines, many people with HIV still get the wrong statin. A 2018 study found that 15% of patients were on contraindicated statins in 2007. By 2015, that dropped to under 5%. Progress, yes-but not enough. Only about half of eligible patients are getting statins at all, even when they have high cardiovascular risk.Why? Many doctors don’t know the interactions by heart. A 2023 survey showed only 58% of primary care providers regularly check drug interactions before prescribing statins to HIV patients. That’s a gap you can help close.
Always ask: “Is this statin safe with my HIV meds?” Bring a list of all your meds-prescription, over-the-counter, supplements, even herbal ones. Use the University of Liverpool’s HIV Drug Interactions Checker (they update it monthly). Print it out. Show it to your doctor. It’s the gold standard.
The Bigger Picture: Why This Matters
People with HIV are living longer. Many are now in their 60s and 70s. Cardiovascular disease is now the leading cause of death-not AIDS. Statins reduce heart attacks, strokes, and death by 25-30% in high-risk groups. Avoiding them because of fear of interactions is a bigger risk than using them safely.The goal isn’t to avoid statins. It’s to use them wisely. Pitavastatin and pravastatin are excellent first choices. Atorvastatin and rosuvastatin work too-if you stick to the limits. Simvastatin and lovastatin? Never.
Your HIV care team should be talking to your cardiologist or primary doctor. If they’re not, ask them to. The right combination of HIV meds and statins can give you decades more healthy life. The wrong one? That’s a preventable tragedy.
Can I take atorvastatin with cobicistat?
Yes, but only at a maximum of 20 mg daily. Some labels, like the one for Symtuza, recommend no more than 10 mg. Always start low and increase slowly under your doctor’s supervision. Never exceed 20 mg if you’re on cobicistat or ritonavir.
Is pitavastatin safe with all HIV medications?
Pitavastatin is the safest statin for people on HIV meds. It’s metabolized differently and has minimal interaction with CYP3A4. You can usually take it at standard doses-even with boosted HIV drugs like darunavir/cobicistat. It’s often the first choice for older patients or those on multiple medications.
What happens if I accidentally take simvastatin with my HIV drugs?
Stop taking simvastatin immediately and contact your doctor. This combination can lead to rapid buildup of the drug in your blood, increasing your risk of rhabdomyolysis. Symptoms include severe muscle pain, weakness, and dark urine. If you experience these, go to the emergency room. This is not something to wait on.
Can I take rosuvastatin at 20 mg with dolutegravir?
Yes. Dolutegravir and other unboosted integrase inhibitors like bictegravir have very few drug interactions. You can safely take rosuvastatin at 20 mg daily with these HIV medications. No dose reduction is needed.
Should I get my muscles tested if I’m on a statin and HIV meds?
Yes. A baseline creatine kinase (CK) test before starting the statin is recommended. Then, check again 4 to 12 weeks after starting or changing the dose. If you develop unexplained muscle pain or weakness, get tested right away. Regular liver function tests are also important.
Are there any new statins being developed for people with HIV?
Not yet, but research is active. Scientists are studying statin formulations that bypass CYP3A4 metabolism and personalized dosing based on genetic testing. Long-acting HIV injectables are also changing the game-because they stay in your system for months, interactions can linger longer than expected. For now, stick to the proven safe options: pitavastatin, pravastatin, and carefully dosed atorvastatin or rosuvastatin.
What if my doctor doesn’t know about these interactions?
Bring the University of Liverpool’s HIV Drug Interactions website to your appointment. It’s updated monthly by 37 global experts and is the most trusted resource in the world for this exact issue. Print the interaction report for your meds. Many doctors don’t memorize all the combos-but they’ll trust a trusted, real-time tool. Your life depends on it.