Pitavastatin
HMG-CoA reductase inhibitor · “The HIV patient's statin”
The Clinical Case
Female, 44 yo. HIV-positive, well-controlled on integrase inhibitor-based ART. LDL 3.5 mmol/L, fasting glucose 6.0 mmol/L (pre-diabetes). HIV physician wants a statin with minimal CYP interactions AND evidence of not worsening glycaemia. A major RCT specifically enrolling HIV+ adults on ART tested this drug and was published in 2023.
The Answer
Played on: 6 Jan 2026 · 20 Jan 2026 · 3 Feb 2026 · 17 Feb 2026 · 3 Mar 2026 · 17 Mar 2026 · 31 Mar 2026 · 14 Apr 2026 · 28 Apr 2026 · 12 May 2026 · 26 May 2026 · 9 Jun 2026 · 23 Jun 2026 · 7 Jul 2026 · 21 Jul 2026 · 4 Aug 2026 · 18 Aug 2026
Clinical Pearl
Metabolism: Metabolised primarily by CYP2C9 (minimal extent) — far fewer drug interactions than CYP3A4 statins; highest bioavailability of all statins (43–51%)
All Hints
Metabolism: Metabolised primarily by CYP2C9 (minimal extent) — far fewer drug interactions than CYP3A4 statins; highest bioavailability of all statins (43–51%)
Glycaemia: Only statin with evidence of not worsening glycaemia; may improve insulin sensitivity in pre-diabetic patients
HIV trial: REPRIEVE 2023: first CV outcomes data in HIV+ adults on ART — reduced MACE in this specific population
Dosing: Half-life 12 h → any time of day dosing (like atorvastatin and rosuvastatin); 2–4 mg achieves ~38–43% LDL reduction — potent despite small dose numbers
REAL-CAD: 13,000+ "patients": 4 mg superior to 1 mg in reducing CV events in stable CAD — dose-response confirmed
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