simvastatin and cyclosporine

ContraindicatedDo not co-prescribe these two.

Mechanism

Cyclosporine inhibits the CYP3A4 enzyme and the hepatic OATP1B1 transporter. This reduces the metabolism and hepatic uptake of simvastatin, leading to marked increases in simvastatin plasma concentrations.

What it means clinically

Elevated simvastatin levels substantially increase the risk of myopathy and rhabdomyolysis, which can cause severe muscle pain, weakness, and potentially fatal kidney damage.

What to do

Co-prescription is contraindicated. Do not use simvastatin with cyclosporine. If a statin is needed, consider an alternative with lower interaction risk, such as pravastatin, under specialist advice.

Evidence

Well established from pharmacokinetic studies and clinical case reports, and reflected in the product labelling.

The two drugs

simvastatinHMG-CoA reductase inhibitorRead the monograph cyclosporinecalcineurin inhibitorRead the monograph

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Other interactions involving simvastatin or cyclosporine

Educational reference for students and clinicians in training. It does not replace professional judgement, local protocols or current prescribing information.