Fluvastatin and Cyclosporine Injection: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Cyclosporine Injection
Fluvastatin
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Increased fluvastatin exposure and an increased risk of myopathy or rhabdomyolysis
Interaction Deep Dive
Avoid concurrent use of fluvastatin with cycloSPORINE due to an increased risk of myopathy and rhabdomyolysis. Myopathy and rhabdomyolysis have been observed in patients treated with HMG-CoA reductase inhibitors. Concomitant administration of fluvastatin with cycloSPORINE may increase the risk of these conditions2. However, recent studies have indicated that fluvastatin 20 mg and 40 mg daily may be safe in treating renal transplant patients who are also taking cycloSPORINE 34. When fluvastatin is administered concurrently with cycloSPORINE, reduce the dosage of fluvastatin as required. Temporarily withheld or discontinue statin therapy in patients with signs and symptoms of myopathy or those with risk factors predisposing to severe renal injury, including renal failure, secondary to rhabdomyolysis 1.
Why it happens (mechanism)
Unknown
Literature reports
4 reports — tap to read
a) Concomitant fluvastatin and cycloSPORINE treatment was demonstrated to be safe in a 32-week, blinded study. Sixteen renal transplant patients undergoing cycloSPORINE therapy were treated with placebo for four weeks, fluvastatin 20 mg daily for 12 weeks, and fluvastatin 40 mg daily for 12 weeks, following an initial 4-week baseline period. The authors found no significant change in the cycloSPORINE serum concentrations, attributing that result to the fact that fluvastatin does not inhibit the cytochrome P450 system that metabolizes cycloSPORINE. There were no reports of myalgia, or significant differences in creatine phosphokinase (CPK) levels. The authors speculate that since fluvastatin is less lipophilic than lovastatin, another HMG-CoA reductase inhibitor known for producing myopathy, it cannot enter non-hepatic (e.g. muscle) cells as easily. Therefore, fluvastatin may produce less muscle injury than other HMG-CoA reductase inhibitors 3.
b) Fluvastatin again appeared safe in the early results of an ongoing study of 14 hypercholesterolemic renal transplant patients treated with cycloSPORINE. Following eight weeks of dietary stabilization and four weeks of placebo, patients received fluvastatin 20 mg daily for 12 weeks. At the end of 12 weeks, patients whose total cholesterol was not normalized at 195 mg/deciliter (dL) or less were titrated to fluvastatin 40 mg daily for 36 additional weeks. By week 20, the researchers found no serious adverse effects and no significant changes in creatine phosphokinase. In addition, the mean serum trough level of cycloSPORINE was not significantly affected by either 20 mg or 40 mg daily doses of fluvastatin 4.
c) A study of fluvastatin use in 20 hyperlipidemic postrenal transplant patients bolstered the evidence of the drug's safety when used concomitantly with cycloSPORINE. After eight weeks of dietary stabilization and a 3-week placebo washout period, the patients began the 14-week active treatment period with fluvastatin 20 mg daily. Two patients reported mild myalgia, one case of which was attributed to exercise; in neither case was CPK elevated. A third patient's CPK level at week 8 was greater than 10 times the upper limit of normal; however, this was an isolated event and the patient did not report myalgia. The mean cycloSPORINE levels remained steady during the treatment period, and CPK levels did not change significantly from pretreatment levels, with the above exception. The authors speculate that fluvastatin may be safer because it has a shorter half-life than other HMG Co-A reductase inhibitors and has no active circulating metabolites 5.
d) In the drug-drug interactions studies, coadministration of stable dose of cycloSPORINE twice daily with fluvastatin capsules 20 mg once daily for 14 weeks, increased the AUC and Cmax of fluvastatin by 90% and 30% respectively 2.
Common questions
Can I take Fluvastatin and Cyclosporine Injection together?
Increased fluvastatin exposure and an increased risk of myopathy or rhabdomyolysis Always confirm with your pharmacist or prescriber before making any change.
How serious is the Fluvastatin and Cyclosporine Injection interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Fluvastatin or Cyclosporine Injection need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (5)
- Product Information: SANDIMMUNE(R) oral capsules, oral solution, intravenous injection, cyclosporine oral capsules, oral solution, intravenous injection. Novartis Pharmaceuticals Corporation (per FDA), East Hanover, NJ, 2023. DailyMed
- Product Information: Lescol(R) XL oral extended release tablets, fluvastatin sodium oral extended release tablets. Sandoz, Inc.(per FDA), Princeton, NJ, 2023. DailyMed
- Li PK, Mak TW, Chan TH, et al: Effect of fluvastatin on lipoprotein profiles in treating renal transplant recipients with dyslipoproteinemia. Transplantation 1995; 60:652-656. PubMed
- Holdaas H, Hartmann A, Stenstrom J, et al: Effect of fluvastatin for safely lowering atherogenic lipids in renal transplant patients receiving cyclosporine. Am J Cardiol 1995; 76:102A-106A. DOI
- Goldberg RB & Roth D: A preliminary report of the safety and efficacy of fluvastatin for hypercholesterolemia in renal transplant patients receiving cyclosporine. Am J Cardiol 1995; 76:107A-109A. PubMed
Keep reading about Cyclosporine Injection
Keep reading about Fluvastatin
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