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| __NOTOC__
| | #REDIRECT [[Simvastatin#Drug Interactions]] |
| {{Simvastatin}}
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| {{CMG}}; {{AE}} {{SS}}
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| ==Drug Interactions==
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| ===Strong CYP3A4 Inhibitors, cyclosporine, or danazol===
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| Strong CYP3A4 inhibitors: Simvastatin, like several other inhibitors of HMG-CoA reductase, is a substrate of CYP3A4. Simvastatin is metabolized by CYP3A4 but has no CYP3A4 inhibitory activity; therefore it is not expected to affect the plasma concentrations of other drugs metabolized by CYP3A4.
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| Elevated plasma levels of HMG-CoA reductase inhibitory activity increases the risk of [[myopathy]] and [[rhabdomyolysis]], particularly with higher doses of simvastatin. [SeeWarnings and Precautions (5.1) and Clinical Pharmacology (12.3).] Concomitant use of drugs labeled as having a strong inhibitory effect on CYP3A4 is contraindicated [see Contraindications (4)]. If treatment with [[itraconazole]], [[ketoconazole]], [[posaconazole]], [[voriconazole]], [[erythromycin]], [[clarithromycin]] or [[telithromycin]] is unavoidable, therapy with simvastatin must be suspended during the course of treatment.
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| Cyclosporine or Danazol: The risk of [[myopathy]], including [[rhabdomyolysis]] is increased by concomitant administration of [[cyclosporine]] or [[danazol]]. Therefore, concomitant use of these drugs is contraindicated. [see Contraindications (4), Warnings and Precautions (5.1) and Clinical Pharmacology (12.3)].
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| ===Lipid-Lowering Drugs That Can Cause myopathy When Given Alone===
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| [[Gemfibrozil]]: Contraindicated with simvastatin [see Contraindications (4) and Warnings and Precautions (5.1)].
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| Other [[fibrates]]: Caution should be used when prescribing with simvastatin [see Warnings and Precautions (5.1)].
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| ===Amiodarone, Dronedarone, Ranolazine, or Calcium Channel Blockers===
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| The risk of [[myopathy]], including [[rhabdomyolysis]], is increased by concomitant administration of [[amiodarone]], [[dronedarone]], [[ranolazine]], or [[calcium channel blockers]] such as [[verapamil]], [[diltiazem]], or [[amlodipine]] [see Dosage and Administration (2.3) and Warnings and Precautions (5.1), and Table 3 in Clinical Pharmacology (12.3)].
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| ===Niacin===
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| Cases of [[myopathy]]/[[rhabdomyolysis]] have been observed with simvastatin coadministered with lipid-modifying doses (≥1 g/day [[Niacin]]) of [[Niacin]]-containing products. In particular, caution should be used when treating Chinese patients with simvastatin doses exceeding 20 mg/day coadministered with lipid-modifying doses of [[Niacin]]-containing products. Because the risk for [[myopathy]] is dose-related, Chinese patients should not receive simvastatin 80 mg coadministered with lipid-modifying doses of [[Niacin]]-containing products. [See Warnings and Precautions (5.1) and Clinical Pharmacology (12.3).]
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| ===Digoxin===
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| In one study, concomitant administration of digoxin with simvastatin resulted in a slight elevation in [[digoxin]] concentrations in plasma. Patients taking [[digoxin]] should be monitored appropriately when simvastatin is initiated [see Clinical Pharmacology (12.3)].
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| ===Coumarin Anticoagulants===
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| In two clinical studies, one in normal volunteers and the other in hypercholesterolemic patients, simvastatin 20-40 mg/day modestly potentiated the effect of coumarin anticoagulants: the prothrombin time, reported as International Normalized Ratio (INR), increased from a baseline of 1.7 to 1.8 and from 2.6 to 3.4 in the volunteer and patient studies, respectively. With other [[statins]], clinically evident bleeding and/or increased prothrombin time has been reported in a few patients taking coumarin anticoagulants concomitantly. In such patients, prothrombin time should be determined before starting simvastatin and frequently enough during early therapy to ensure that no significant alteration of prothrombin time occurs. Once a stable prothrombin time has been documented, prothrombin times can be monitored at the intervals usually recommended for patients on coumarin anticoagulants. If the dose of simvastatin is changed or discontinued, the same procedure should be repeated. Simvastatin therapy has not been associated with bleeding or with changes in prothrombin time in patients not taking anticoagulants.
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| ===Colchicine===
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| Cases of [[myopathy]], including [[rhabdomyolysis]], have been reported with simvastatin coadministered with [[colchicine]], and caution should be exercised when prescribing simvastatin with [[colchicine]].<ref name="dailymed.nlm.nih.gov">{{Cite web | last = | first = | title = ZOCOR (SIMVASTATIN) TABLET, FILM COATED [MERCK SHARP & DOHME CORP.] | url = http://dailymed.nlm.nih.gov/dailymed/lookup.cfm?setid=fdbfe194-b845-42c5-bb87-a48118bc72e7 | publisher = | date = | accessdate = 18 February 2014 }}</ref>
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| ==References==
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| {{Reflist|2}}
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| {{Statins}}
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| {{Merck&Co}}
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| [[Category:Alcohols]] | | [[Category:Alcohols]] |