- Statin toxicity can be increased by additive effects in combination with lopinavir
- Monitoring is necessary and statin dosage may have to be reduced
- Pravastatin is least prone to interactions

Rutgers University

- Anticoagulants and antiplatelet drugs
- Lipid lowering drugs
- Anti-hypertensives
- Drugs in heart failure
- Drugs in angina pectoris
- Anti-arrhythmic drugs
- Oral anti-diabetics

Drugs in Cardiovascular Disease

- Use of low molecular weight or unfractionated heparin recommended depending on the situation
- Antivitamin K and DOACs are not recommended 
- Effects of some drugs may be reduced in effect by combination with enzyme inhibitors like lopinavir

Anticoagulants and antiplatelet drugs

Lipid lowering drugs

- Sartans and diuretics not prone to significant pharmacokinetic interactions
- Combinations of calcium channel blockers (CCBs) with lopinavir/r can increase the plasma exposure of CCBs
- Combinations of beta blockers with lopinavir/r or hydroxychloroquine can increase the plasma exposure of beta blockers
- Contraindication of use of the beta blocker metoprolol with lopinavir/r

Anti-hypertensives

- Increased plasma exposure of eplerenone in combination with lopinavir/r
- Replacement of eplerenone with spironolactone is worth consideration

Drugs in heart failure

- Ivabradine is extensively metabolized by CYP3A4 and have significant interactions with lopinavir/r so such use is contraindicated
- Interactions between the two may cause severe bradycardia

Drugs in angina pectoris

- Lopinavir/r increases the exposure of quinidine and propafenone (class I AADs or sodium channel blockers) which could cause cardiac disorders
- ECG monitoring required
- Class III AADs (or potassium channel blockers) like amiodarone are contraindicated in combination with lopinavir/r due to an increased risk of torsade de pointes

Anti-arrhythmic drugs

- Lopinavir/r can cause hyperglycemia
- Hydroxychloroquine can worsen hypoglycemia
- Exposure of sulphonylureas can be reduced by ritonavir
- Exposure and concentration of gliptins can be increased by lopinavir/r
- Case by case assessment of COVID-19 patients is necessary when considering oral anti-diabetics 

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