simvastatin : Complexes, Storage & Clinical Research on Healthline.com

Drug or Food	Interaction	Comments
Amiodarone	Increased risk of myopathy and/or rhabdomyolysis, particularly when used with higher dosages of simvastatin	If used concomitantly, simvastatin dosage should not exceed 20 mg daily
Anticoagulants, oral (e.g., warfarin)	Possible increased PT. Bleeding observed with other statins	Closely monitor PT until stabilized if simvastatin is initiated or dosage is adjusted in patients receiving a coumarin anticoagulant. Thereafter, monitor PT at intervals usually recommended for patients receiving coumarin anticoagulants
Antileukotrienes (e.g., zileuton)	Possible inhibition of CYP3A4	Concomitant use generally should be avoided or undertaken with caution
Azole antifungals (i.e., itraconazole, ketoconazole)	Inhibition of CYP3A4-dependent metabolism of simvastatin, resulting in decreased elimination of simvastatin and increased risk of myopathy and/or rhabdomyolysis	Concomitant use generally should be avoided. If concomitant use is unavoidable, suspend simvastatin therapy during the course of treatment with antifungal. Avoid concomitant use of simvastatin with other CYP3A4 inhibitors unless benefits of combined therapy outweigh risks
Cyclosporine	Inhibition of CYP3A4-dependent metabolism of simvastatin, resulting in decreased elimination of simvastatin and increased risk of myopathy and/or rhabdomyolysis	If used concomitantly, initiate simvastatin at 5 mg daily; simvastatin dosage should not exceed 10 mg daily
Danazol	Increased risk of myopathy and/or rhabdomyolysis, particularly when used with higher dosages of simvastatin	If used concomitantly, initiate simvastatin at 5 mg daily; simvastatin dosage should not exceed 10 mg daily
Digoxin	Possible increased plasma digoxin concentrations	Monitor patients receiving digoxin when simvastatin is initiated
Diltiazem	Possible increased plasma simvastatin concentrations
Fibric acid derivatives	Increased risk of myopathy and/or rhabdomyolysis Fenofibrate: Pharmacokinetic interaction unlikely Gemfibrozil: Increased peak plasma concentration and AUC of simvastatin acid	Use concomitantly with caution. Concomitant use with gemfibrozil generally should be avoided unless benefits of combined therapy outweigh risks; if used concomitantly, simvastatin dosage should not exceed 10 mg daily
Fluvoxamine	Possible inhibition of CYP3A4	Concomitant use generally should be avoided or undertaken with caution
Glyburide	Possible increased bioavailability of glyburide
Grapefruit juice	Inhibition of CYP3A4-dependent metabolism of simvastatin, resulting in decreased elimination of simvastatin and increased risk of myopathy and/or rhabdomyolysis	Concomitant use should be discouraged, or simvastatin dosage reduced accordingly; consumption of large quantities (>1 quart daily) of grapefruit juice should be avoided
HIV protease inhibitors	Inhibition of CYP3A4-dependent metabolism of simvastatin, resulting in decreased elimination of simvastatin and increased risk of myopathy and/or rhabdomyolysis	Concomitant use generally should be avoided unless benefits of combined therapy outweigh increased risk
Macrolide anti-infectives (i.e., clarithromycin, erythromycin)	Inhibition of CYP3A4-dependent metabolism of simvastatin, resulting in decreased elimination of simvastatin and increased risk of myopathy and/or rhabdomyolysis	Concomitant use generally should be avoided. If concomitant use is unavoidable, suspend simvastatin therapy during the course of treatment with the anti-infective. Avoid concomitant use of simvastatin with other CYP3A4 inhibitors unless benefits of combined therapy outweigh risks
Metronidazole	Possible inhibition of CYP3A4	Concomitant use generally should be avoided or undertaken with caution
Nefazodone	Inhibition of simvastatin metabolism via CYP3A4, resulting in increased risk of myopathy and/or rhabdomyolysis	Concomitant use generally should be avoided
Niacin	Increased risk of myopathy and/or rhabdomyolysis	Concomitant use with antilipemic dosages (≥1 g daily) of niacin generally should be employed with caution; weigh benefits against risks of concomitant therapy
Telithromycin	Inhibition of CYP3A4-dependent metabolism of simvastatin, resulting in decreased elimination of simvastatin and increased risk of myopathy and/or rhabdomyolysis	Concomitant use generally should be avoided. If concomitant use is unavoidable, suspend simvastatin therapy during the course of treatment with the anti-infective. Avoid concomitant use of simvastatin with other CYP3A4 inhibitors unless benefits of combined therapy outweigh risks
Troleandomycin	Possible inhibition of CYP3A4	Concomitant use generally should be avoided or undertaken with caution
Verapamil	Increased plasma simvastatin concentrations. Increased risk of myopathy and/or rhabdomyolysis, particularly when used with higher dosages of simvastatin	Concomitant use generally should be avoided; if used concomitantly, simvastatin dosage should not exceed 20 mg daily

Zocor
ZOCOR / MSD 749 40 mg	ZOCOR / MSD 735 10 mg	ZOCOR / MSD 740 20 mg	543 / 80 80 mg
ZOCOR / MSD 726 5 mg

Drug Notebook

Generic Name: simvastatin

Drug Interactions

Specific Drugs and Foods