Lovastatin 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
Lovastatin
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 lovastatin exposure and an increased risk of myopathy and rhabdomyolysis
Interaction Deep Dive
Concomitant use of lovastatin and cycloSPORINE is not recommended, as it may result in increased lovastatin plasma levels and may increase the risk of myopathy and rhabdomyolysis. In a study in stable kidney transplant patients, it has resulted in a 3- to 5-fold increase in the AUC of lovastatin2. There have been reports of reversible myopathy (rhabdomyolysis) in small studies and case reports 9101112, while 2 small 6-month studies found that low-dose lovastatin (20 mg daily) combined with cycloSPORINE did not produce myopathy in stable renal transplant patients 76.
Why it happens (mechanism)
Inhibition of CYP3A4-mediated metabolism of lovastatin
Literature reports
7 reports — tap to read
a) In a study of cycloSPORINE-treated post kidney transplant patients with stable graft function, coadministration of lovastatin 10 mg daily for 10 days resulted in a 3- to 5-fold increase in the AUC of lovastatin 2.
b) Myositis and elevated creatine phosphokinase have been reported in less than 0.5% of patients receiving lovastatin alone. In patients receiving immunosuppressive therapy, including cycloSPORINE, myopathy occurred in up to 30% of patients within one year after lovastatin was added to therapy 13.
c) Rhabdomyolysis and acute renal failure were reported in a 48-year-old cardiac transplant patient who was later treated for hypercholesterolemia and hypertriglyceridemia. His drug regimen included cycloSPORINE 3 mg per kg per day, azaTHIOprine 100 mg daily, predniSONE 15 mg three times daily, gemfibrozil 300 mg three times daily, and lovastatin 40 mg daily. After 36 hours of combined therapy, the patient experienced muscular aches, weakness, and general malaise. Swollen, hyalinized, eosinophilic muscle fibers without inflammatory infiltrate were seen on muscle biopsy, and renal biopsy revealed widened necrotic tubules filled with eosinophilic, granular material identified as myoglobin. This condition was diagnosed as acute tubular necrosis with myoglobinuria. The hypolipidemic drugs were discontinued and hemodialysis was necessary. The patient recovered fully after four weeks 4.
d) Plasma levels of lovastatin were compared in five groups: 1) six heart transplant recipients receiving cycloSPORINE, prednisolone, and azathioprine, 2) five kidney transplant recipients receiving cycloSPORINE, prednisoLONE, and azaTHIOprine, 3) five kidney recipients receiving azaTHIOprine and prednisoLONE, 4) five patients with psoriasis receiving cycloSPORINE monotherapy, and 5) eight hypercholesterolemic control patients. All patients received lovastatin 10 mg once daily for ten days. By grouping all of the patients who were receiving cycloSPORINE, lovastatin increased the area under the concentration-time curve (AUC) from 0-8 hours to 152 ng/hr/mL, compared to 30 ng/hr/mL for patients not receiving cycloSPORINE. This study demonstrated that patients who receive cycloSPORINE as a single drug have similar lovastatin plasma levels as patients receiving triple drug regimens 5.
e) In a six-month clinical trial of 12 hyperlipidemic kidney graft recipients treated with cycloSPORINE, the addition of a daily dose of 20 mg lovastatin did not produce any evidence of myopathy. Creatine phosphokinase (CPK), liver enzymes, and cycloSPORINE levels remained stable throughout the treatment period, and there was no evidence of myopathy. No patients withdrew due to adverse side effects. The authors point out that in studies in which lovastatin treatment resulted in myopathy, the dose was higher than the 20 mg daily dose used in this trial; however, they do advise vigilance when using lovastatin concomitantly with cycloSPORINE 6.
f) Another study of hyperlipidemic renal transplant patients found that the addition of lovastatin 20 mg daily to their existing cycloSPORINE regimen did not produce changes in liver or muscle enzymes. The 12 patients, who were on a cycloSPORINE mean daily dose of 2.5 +/- 1.2 mg per kg, began a 6-month treatment period with lovastatin 20 mg daily after completing an initial 3-month diet/washout. Halfway through the treatment period, five patients were increased to lovastatin 30 mg daily due to inadequate response. Overall, some patients reported transient muscle pain, but CK and myoglobin laboratory results remained in the normal range throughout the study, as did the renal and hepatic function tests for all patients. Quantitative electromyography performed before and after the study was normal. The authors speculate that adverse events may have been avoided because of the low doses of both cycloSPORINE and lovastatin. Further, they point out that increasing the five inadequate responders' lovastatin dose to 30 mg daily did not produce further lipid-lowering benefit 7.
g) In two case studies, lovastatin and cycloSPORINE combination therapy was associated with the development of rhabdomyolysis in cardiac transplant patients. A 46-year old cardiac transplant patient developed muscle pain, elevated CK (peak at 23,832 units/L), and myoglobinuric acute renal failure after taking both cycloSPORINE (150 mg twice daily) and lovastatin 40 mg twice daily for 14 months. Two weeks before the development of muscle pain, the patient had been hospitalized for Legionella pneumonia, and had received erythromycin both in the hospital and after discharge. Lovastatin was temporarily discontinued, cycloSPORINE dosage reduced, and erythromycin discontinued. After the patient recovered, he was rechallenged with lovastatin 80 mg daily, and his CK levels were normal. In a second case, a 36-year old transplant patient was hospitalized with muscle aches and a CK of 8920 units/L nine months after lovastatin 80 mg daily was added to his regimen of cycloSPORINE 120 mg twice daily. The lovastatin metabolite level at that time was ten times the expected value. The patient recovered after the two drugs were discontinued. The authors speculate that both patients had liver impairment caused by elevated levels of cycloSPORINE which resulted in high lovastatin levels and rhabdomyolysis 8.
Common questions
Can I take Lovastatin and Cyclosporine Injection together?
Increased lovastatin exposure and an increased risk of myopathy and rhabdomyolysis Always confirm with your pharmacist or prescriber before making any change.
How serious is the Lovastatin 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 "established". Well documented — supported by controlled studies or strong clinical data.
Questions for your pharmacist
- Does my dose of Lovastatin 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 (12)
- Lake KD: Management of drug interactions with cyclosporine. Pharmacotherapy 1991; 11:110S-118S. DOI
- Product Information: ALTOPREV(R) oral extended-release tablets, lovastatin oral extended-release tablets. Covis Pharma (per FDA), King of Prussia, PA, 2024. DailyMed
- Walker JF: HMG CoA reductase inhibitors: current clinical experience. Drugs 1988; 36(Suppl 3):83-86. PubMed
- de Alava E, Sola JJ, Dolores Lozano M, et al: Rhabdomyolysis and acute renal failure in a heart transplant recipient treated with hypolipemiants (letter). Nephron 1994; 66:242-243. PubMed
- Gullestad L, Nordal KP, Berg KJ, et al: Interaction between lovastatin and cyclosporine A after heart and kidney transplantation. Transplant Proc 1999; 31:2163-2165. DOI
- Traindl O, Reading S, Franz M, et al: Low-dose lovastatin in hyperlipidemic kidney graft recipients with cyclosporine A. Transplant Proc 1992; 24:2745-2747.
- Kandus A, Kovac D, Koselj M, et al: Lovastatin treatment of hyperlipidemia in kidney transplant recipients on cyclosporine immunosuppression. Transplant Proceed 1994; 26:2642-2643.
- Corpier CL, Jones PH, Suki WN, et al: Rhabdomyolysis and renal injury with lovastatin use. Report of two cases in cardiac transplant recipients. JAMA 1988; 260:239-241. DOI
- Marais GE & Larsen KK: Rhabdomyolysis and acute renal failure induced by combination lovastatin and gemfibrozil therapy. Ann Intern Med 1990; 112:228-230. PubMed
- East C, Alivizatos PA, Grundy SM, et al: Rhabdomyolysis in patients receiving lovastatin after cardiac transplantation. N Engl J Med 1988; 318:47-48. DOI
- McKenney JM: Lovastatin: A new cholesterol-lowering agent. Clin Pharm 1988; 7:21-36. DOI
- Norman DJ, Illingworth DR, Munson J, et al: Myolysis and acute renal failure in heart-transplant recipient receiving lovastatin (letter). N Engl J Med 1988; 318:46.
Keep reading about Cyclosporine Injection
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