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| Interactions: | Bezafibrate
Adverse Effect: an increased risk of myopathy or rhabdomyolysis Clinical Management: In general, the dose of simvastatin should not exceed 10 mg daily if given concomitantly with fibrates. If concurrent therapy is required, monitor the patient for signs and symptoms of myopathy or rhabdomyolysis
Clarithromycin
Adverse Effect: an increased risk of myopathy or rhabdomyolysis Clinical Management:If concurrent therapy is required, monitor the patient for signs and symptoms of myopathy or rhabdomyolysis .
Digoxin
Adverse Effect: An increased risk of digoxin toxicity (nausea, vomiting, arrhythmias) Clinical Management: When simvastatin therapy is initiated in a patient stabilized on digoxin, monitor the digoxin levels. Dosage adjustments should be made if indicated.
Diltiazem
Adverse Effect: An increased risk of myopathy or rhabdomyolysis Clinical Management: If concurrent therapy is required, monitor the patient for signs and symptoms of myopathy or rhabdomyolysis (muscle pain, tenderness, or weakness). Monitor creatine kinase (CK) levels and discontinue use if CK levels show a marked increase, or if myopathy or rhabdomyolysis is diagnosed or suspected.
Erythromycin
Adverse Effect: an increased risk of myopathy or rhabdomyolysis Clinical Management: If concurrent therapy is required, monitor the patient for signs and symptoms of myopathy or rhabdomyolysis
Fluoxetine
Decreased hepatic metabolism of simvastatin and atorvastatin
Gemfibrozil
Adverse Effect: an increased risk of myopathy or rhabdomyolysis Clinical Management: The combined use of gemfibrozil and statins should generally be avoided. If concurrent therapy is required, monitor the patient for signs and symptoms of myopathy or rhabdomyolysis
Itraconazole
Adverse Effect: an increased risk of myopathy or rhabdomyolysis Clinical Management: Concomitant administration of itraconazole and simvastatin is contraindicated.
Ketoconazole
Adverse Effect: an increased risk of myopathy or rhabdomyolysis Clinical Management: Therapy with simvastatin should be interrupted temporarily if antifungal treatment with ketoconazole is necessary.
Nicotinic Acid
Adverse Effect: an increased risk of myopathy or rhabdomyolysis Clinical Management: If concurrent therapy is required, monitor the patient for signs and symptoms of myopathy or rhabdomyolysis.
Phenytoin
Adverse Effect: loss of simvastatin efficacy Clinical Management: Patients receiving phenytoin and simvastatin should be monitored for simvastatin efficacy, as measured by total cholesterol and triglycerides.
Verapamil
Adverse Effect: an increased risk of myopathy or rhabdomyolysis Clinical Management: If concurrent therapy is required, monitor the patient for signs and symptoms of myopathy or rhabdomyolysis
Warfarin
Adverse Effect: increased risk of bleeding and an increased risk of rhabdomyolysis Clinical Management: Adjustments of the warfarin dose may be necessary in order to maintain the desired level of anticoagulation. Also monitor the patient for signs and symptoms of myopathy or rhabdomyolysis
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