Simvastatin and Ceritinib: Interaction Details
AI-assisted, pharmacist-reviewed · AI content regenerated Jul 11, 2026 · Source data updated Jul 4, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Ceritinib
Simvastatin
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.
Ceritinib (Zykadia) is a cancer medicine that slows down a liver enzyme called CYP3A4. That same enzyme is what your body uses to break down simvastatin (Zocor), your cholesterol medicine. When ceritinib slows that enzyme, simvastatin can build up to higher levels than intended.
Too much simvastatin raises the risk of muscle problems, including a serious one called rhabdomyolysis, where muscle tissue breaks down. Warning signs include unexplained muscle pain, tenderness, weakness, or dark-colored urine. Because of this risk, these two are generally not taken together. The good news: your care team has safe ways to handle this, so please talk with your doctor or pharmacist before making any changes.
Mechanism: Ceritinib is a strong CYP3A4 inhibitor; simvastatin is a CYP3A4 substrate (active drug, not a prodrug). Inhibition reduces simvastatin clearance, increasing systemic exposure (AUC/Cmax) and dose-dependent risk of myopathy and rhabdomyolysis.
- Direction: Increased simvastatin effect/toxicity.
- Severity: Contraindicated combination.
- Onset: Unspecified.
- Evidence: Theoretical (mechanism-based).
Management: Avoid coadministration. If ceritinib is required, suspend simvastatin for the duration of ceritinib therapy. Monitor for muscle pain, weakness, and elevated CK; consider a non-CYP3A4-dependent statin per prescriber judgment.
What happens
Increased simvastatin exposure and an increased the risk of myopathy and rhabdomyolysis
Interaction Deep Dive
Combining potent CYP3A4 inhibitors such as ceritinib with simvastatin is contraindicated, because doing so can raise simvastatin exposure and heighten the risk of myopathy and rhabdomyolysis. When a CYP3A4 inhibitor cannot be avoided, discontinue simvastatin for the duration of the strong CYP3A4 inhibitor therapy1.
Why it happens (mechanism)
Inhibition of CYP3A4-substrate metabolism of simvastatin
How to manage this interaction
This combination is generally avoided. Here is what a care team typically does:
- Your doctor may pause simvastatin while you are taking ceritinib, since the cancer treatment usually takes priority.
- They may consider a different cholesterol medicine that is not affected the same way.
- They may watch you more closely for muscle symptoms while your treatment is individualized to you.
What you should do: Do not stop or change either medicine on your own. Tell your pharmacist or prescriber that you take both, and report any muscle pain, weakness, tenderness, or dark urine right away.
Management is individual — confirm any change with your pharmacist or prescriber.
Literature reports
1 report — tap to read
a) In a study evaluating drug interactions, the Cmax and AUC of simvastatin rose by an approximate mean of 6.2-fold and 6-fold, respectively, when simvastatin 20 mg once daily for 28 days was given together with nelfinavir 1250 mg twice daily for 14 days 1.
Common questions
Can I take Simvastatin and Ceritinib together?
Ceritinib can raise simvastatin levels and increase the risk of serious muscle damage, so these two are generally not taken together; your care team will usually pause the statin or switch it while managing your treatment. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Simvastatin and Ceritinib interaction?
It is rated contraindicated. These should generally not be used together.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Simvastatin and Ceritinib interaction managed?
This combination is generally avoided. Here is what a care team typically does: Your doctor may pause simvastatin while you are taking ceritinib, since the cancer treatment usually takes priority. They may consider a different cholesterol medicine that is not affected the same way. They may watch you more closely for muscle symptoms while your treatment is individualized to you. What you should do… Management is individual — always follow your own care team's guidance.
How strong is the evidence for this interaction?
The evidence is graded "theoretical". Predicted from the drugs' pharmacology; not yet confirmed in people.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Simvastatin or Ceritinib 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 (1)
- Product Information: VYTORIN(R) oral tablets, ezetimibe simvastatin oral tablets. Organon LLC (per FDA), Jersey City, NJ, 2024. DailyMed
Keep reading about Ceritinib
Keep reading about Simvastatin
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Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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