The risk of myopathy, including rhabdomyolysis is increased by concomitant administration. For patients chronically receiving simvastatin 80 mg/day who need to be started on dronedarone, the manufacturer of simvastatin recommends switching to an alternative statin with less potential for interactions. Dronedarone is metabolized by CYP3A and is an inhibitor of CYP3A, CYP2D6, and P-gp. Simvastatin is a substrate for CYP2D6 and CYP3A. Coadministration of dronedarone and simvastatin resulted in an increase in simvastatin and simvastatin acid exposure by 4- and 2-fold, respectively. Monitor for signs and symptoms of myopathy in patients receiving dronedarone concurrently with simvastatin.
Edoxaban: Coadministration of edoxaban and simvastatin may result in increased concentrations of edoxaban. Edoxaban is a P-glycoprotein (P-gp) substrate and simvastatin is a P-gp inhibitor. Increased concentrations of edoxaban may occur during concomitant use of simvastatin; monitor for increased adverse effects of edoxaban. Dosage reduction may be considered for patients being treated for deep venous thrombosis (DVT) or pulmonary embolism.
Efavirenz: Efavirenz has potential to induce CYP3A4 isoenzymes according to in vivo studies with other CYP3A4 substrates. Until data with HMG-CoA reductase inhibitors are available, efavirenz should be coadministered with simvastatin with caution.
Efavirenz; Emtricitabine; Tenofovir: Caution is advised when administering tenofovir, PMPA, a P-glycoprotein (P-gp) substrate, concurrently with inhibitors of P-gp, such as simvastatin. Coadministration may result in increased absorption of tenofovir. Monitor for tenofovir-associated adverse reactions. Efavirenz has potential to induce CYP3A4 isoenzymes according to in vivo studies with other CYP3A4 substrates. Until data with HMG-CoA reductase inhibitors are available, efavirenz should be coadministered with simvastatin with caution.
Elbasvir; Grazoprevir: The manufacturer of elbasvir; grazoprevir recommends caution during concurrent administration with simvastatin. Although this interaction has not been studied, use of these drugs together may result in elevated simvastatin plasma concentrations. Use the lowest effective simvastatin dose and monitor patients for statin-related adverse events (such as myopathy). Simvastatin is a substrate for the hepatic enzymes CYP3A; grazoprevir is a weak CYP3A inhibitor.
Eliglustat: Coadministration of simvastatin and eliglustat may result in increased plasma concentrations of simvastatin. Monitor patients closely for simvastatin-related adverse effects including myalgia, myopathy, myasthenia, and/or rhabdomyolysis. Simvastatin is a CYP2D6 and P-glycoprotein (P-gp) substrate; eliglustat is a CYP2D6 and P-gp inhibitor.
Eltrombopag: Use caution and monitor for adverse reactions if eltrombopag and ezetimibe are coadministered. Eltrombopag is an inhibitor of the transporter OATP1B1. Drugs that are substrates for this transporter, such as ezetimibe, may exhibit an increase in systemic exposure if coadministered with eltrombopag. Use caution and monitor for adverse reactions if eltrombopag and simvastatin are coadministered. Eltrombopag is an inhibitor of the transporter OATP1B1. Drugs that are substrates for this transporter, such as simvastatin, may exhibit an increase in systemic exposure if coadministered with eltrombopag.
Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate: |
