Table 2.

Statins' potential drug-drug interactions with medications used for COVID-19 or assessed in clinical trials and recommendations.

	Statins
	Atorvastatin	Simvastatin	Rosuvastatina	Fluvastatin	Pitavastatina	Pravastatin
Metabolism [124]	CYP34A [124,125]	CYP34A [126]	CYP2C9 [125]	CYP2C9 [124,125]	CYP2C9 minimal [125]	CYP34A [125]
Remdesivir –inpart metabolised by CYP3A4 [127]	May compete for metabolism [127] Recommend: Switch to low dose Rosuvastatin	May compete for metabolism [127] Recommend: Switch to low dose Rosuvastatin	NSI Recommend: Continue	NSI Recommend: Continue	NSI Recommend: Continue	May compete for metabolism [127] Recommend: Switch to low dose Rosuvastatin
Hydroxychloroquineb [128]	NSI Recommend: Continue	NSI Recommend: Continue	NSI Recommend: Continue	NSI Recommend: Continue	NSI Recommend: Continue	NSI Recommend: Continue
Lopinavir [129]	Caution- increased risk of hepatotoxicity & rhabdomyolysis Recommend: reduce the dose to 10 mg daily or switch to low dose Rosuvastatin	Caution- increased risk of hepatotoxicity & rhabdomyolysis Recommend: Switch to low dose Rosuvastatin	Caution- increased risk of hepatotoxicity & rhabdomyolysis Recommend: Reduce dose to 10 mg OD	NSI Recommend: Continue	Caution- increased risk of hepatotoxicity & rhabdomyolysis Recommend: Switch to low dose Rosuvastatin	NSI Recommend: Continue
Ritonovir [129]	Caution- increased risk of hepatotoxicity & rhabdomyolysis: Recommend: Switch to low dose Rosuvastatin	Caution- increased risk of hepatotoxicity & rhabdomyolysis: Recommend: Switch to low dose Rosuvastatin	Caution- increased risk of hepatotoxicity & rhabdomyolysis: Recommend: Reduce dose to 10 mg OD	NSI Recommend: Continue	Caution- increased risk of hepatotoxicity & rhabdomyolysis: Recommend: Switch to low dose Rosuvastatin	NSI Recommend: Continue
Ribavirin [130]	NSI Recommend: Continue	NSI Recommend: Continue	NSI Recommend: Continue	NSI Recommend: Continue	NSI Recommend: Continue	NSI Recommend: Continue
Inteferon-Beta-1-Alpha [130]	Increased risk of hepatoxicity Recommend: Temporarily stop treatment	Increased risk of hepatoxicity Recommend: Temporarily stop treatment	Increased risk of hepatoxicity Recommend: Temporarily stop treatment	Increased risk of hepatoxicity Recommend: Temporarily stop treatment	Increased risk of hepatoxicity Recommend: Temporarily stop treatment	Increased risk of hepatoxicity Recommend: Temporarily stop treatment
Melatonin [131]- previously suggested to be hepato-protective against statins	NSI Recommend: Continue	NSI Recommend: Continue	NSI Recommend: Continue	NSI Recommend: Continue	NSI Recommend: Continue	NSI Recommend: Continue
Dexamethasone	NSI Recommend: Continue	NSI Recommend: Continue	NSI Recommend: Continue	NSI Recommend: Continue	NSI Recommend: Continue	NSI Recommend: Continue
Azithromycinc [[132], [133], [134], [135]]	Caution- interaction with macrolide Recommend: Temporarily stop treatment	Caution- interaction with macrolide Recommend: Temporarily stop treatment	Caution- interaction with macrolide Recommend: Temporarily stop treatment	Caution- interaction with macrolide Recommend: Temporarily stop treatment	Caution- interaction with macrolide Recommend: Temporarily stop treatment	Caution- potential interaction with macrolide Recommend: Temporarily stop treatment
Tocilizumab [136] –impacts both CYP34A and CYP2C9 [137]	Caution- interaction with metabolising enzymes [138] Recommend: Temporarily stop treatment	Caution- interaction with metabolising enzymes Recommend: Temporarily stop treatment	Caution- interaction with metabolising enzymes Recommend: Temporarily stop treatment	Caution- interaction with metabolising enzymes. Recommend: Temporarily stop treatment	Caution- interaction with metabolising enzymes. Recommend: Temporarily stop treatment	Caution- interaction with metabolising enzymes. Recommend: Temporarily stop treatment

NSI: no significant interactions.

Refer to individual drugs summary of product characteristics (SmPC).

^aPitavastatin is minimally metabolised by the cytochrome P450 enzymes are therefore is not subject to interactions involving enzyme inhibitors and inducers [125].

^bThere is disquiet regarding the risk of ventricular arrythmias with hydroxychloroquine use in COVID-19 patients. A study showing increased risk published in the Lancet was recently retracted [139].

^cWe like to emphasise the risk of myositis with all statins and all macrolide antibiotics.