Pitavastatin is slightly metabolized by CYP 2C9 and to a lesser extent by CYP 2C8.
Cyclosporine: Co-administration is absolute contraindicated. Pharmacokinetic interaction is reported, 6.6 fold increase of peak plasma concentration (Cmax) and 4.6 fold increase of area under the plasma concentration-time curve (AUC) of pitavastatin. This leads to the risk of serious adverse reaction such as myopathy or rhabdomyolysis.
Fibric acid derivatives (fenofibrate, gemfibrozil, etc.): Pitavastatin should avoid administration concurrently with these medications especially patients with renal problems. Augmented risk of musculoskeletal effects (e.g., myopathy or rhabdomyolysis) and laboratory abnormalities may observed (elevation of CK, blood and urine myoglobin, or aggravation of renal function).
Niacin: Possible increased risk of musculoskeletal effects. Coadministration of pitavastatin and niacin, pitavastatin dosage reduction should be considered.
Erythromycin: Coadministration cause pharmacokinetic interaction, 3.6 fold increase of Cmax and 4.6 fold increase of AUC of pitavastatin. If used concomitantly, the dosage of pitavastatin should not be exceeded 1 mg once daily.
Rifampin: Rifampin significantly increased pitavastatin exposure. In patients taking rifampin, a dose of pitavastatin 2 mg once daily should not be exceeded.