Simvastatin with Fusidic Acid Interaction Details
Brand Names Associated with Simvastatin
- Flolipid®
- Juvisync® (as a combination product containing Simvastatin, Sitagliptin)
- Simcor® (as a combination product containing Niacin, Simvastatin)
- Simvastatin
- Vytorin® (as a combination product containing Ezetimibe, Simvastatin)
- Zocor®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Nov 10, 2023
Interaction Effect
An increased risk of myopathy or rhabdomyolysis
Interaction Summary
Simvastatin combined with fusidic acid therapy should be approached with caution. This combination may result in rhabdomyolysis.
Severity
Major
Onset
Delayed
Evidence
Probable
How To Manage Interaction
The concurrent administration of simvastatin and fusidic acid should be approached with caution. Monitor patient for signs and symptoms of simvastatin toxicity, including rhabdomyolysis.
Mechanism Of Interaction
Inhibition by fusidic acid of cytochrome P450 3A4-mediated simvastatin metabolism
Literature Reports
A) One case report describes a patient maintained on simvastatin 40 mg/day who experienced nausea, abdominal discomfort and myalgia following therapy with fusidic acid (250 mg three times daily) and rifampicin (600 mg daily). The patient was dehydrated with mild right upper quadrant tenderness. Test results showed the following: aspartate transaminase 1618 U/L; alanine transaminase 657 U/L; alkaline phosphatase 133 U/L; total bilirubin 29 mcmol/L; gamma-glutamyltransferase 37 U/L; urea 24.7 mmol/L; creatinine 0.35 mmol/L. The patient's clinical status declined the following day with generalized muscle pain and weakness. His serum creatine kinase levels were 66710 U/L and myoglobinuria was noted. There was immediate clinical improvement when simvastatin therapy was discontinued. His renal function returned to normal and the serum creatine kinase concentration was 1153 U/L and creatinine concentration was 0.12 mmol/L. Fusidic acid is not known to be an inhibitor of the cytochrome P450 3A4 enzyme system, although this case is suggestive of that .
B) Rhabdomyolysis has been described in a patient treated concomitantly with simvastatin and tacrolimus. A 51-year-old female with insulin dependent diabetes mellitus and dialysis-dependent renal failure due to diabetic nephropathy received a pancreas-kidney graft. The pancreas was removed 4 weeks later due to a hemorrhagic pancreatitis. Simvastatin 10 mg/day was initiated 8 months later. Other medications included tacrolimus, aprednislone and azathioprine. Simvastatin dose was increased to 20 mg/day 4 months later due to persistent hyperlipidemia. Ten days later fusidic acid (500 mg TID) was started because of soft tissue infection and osteomyelitis of the second left toe. The patient was admitted to the hospital 5 weeks later because of muscle pain, which had started 2 weeks earlier. Her serum creatinine concentration was 3 mg/dL (270 mcmol/L), creatinine clearance was 12 mL/min, serum creatine kinase (CK) was 24,000 U/mL. The tacrolimus trough level 4 days prior to admission was 9.1 ng/mL (11.3 nanomol/L). Simvastatin and fusidic acid therapy was discontinued and renal function improved. The patient was discharged on day 13 with a creatinine clearance of 45 mL/min and a CK level of 298 U/L. Simvastatin ws replaced with fluvastatin. Another soft tissue infection occurred several months later and was treated with fusidic acid. No side effects occurred with the combination of fusidic acid and fluvastatin. Combined use of tacrolimus and simvastatin may put a patient at increased risk for rhabdomyolysis .
Simvastatin Overview
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Simvastatin is used together with diet, weight-loss, and exercise to reduce the risk of heart attack and stroke and to decrease the chance that heart surgery will be needed in people who have heart disease or who are at risk of developing heart disease. Simvastatin is also used to decrease the amount of fatty substances such as low-density lipoprotein (LDL) cholesterol (''bad cholesterol'') and triglycerides in the blood and to increase the amount of high-density lipoprotein (HDL) cholesterol (''good cholesterol'') in the blood. Simvastatin may also be used to decrease the amount of cholesterol and other fatty substances in the blood in children and teenagers 10 to 17 years of age who have familial heterozygous hypercholesterolemia (an inherited condition in which cholesterol cannot be removed from the body normally). Simvastatin is in a class of medications called HMG-CoA reductase inhibitors (statins). It works by slowing the production of cholesterol in the body to decrease the amount of cholesterol that may build up on the walls of the arteries and block blood flow to the heart, brain, and other parts of the body.
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Accumulation of cholesterol and fats along the walls of your arteries (a process known as atherosclerosis) decreases blood flow and, therefore, the oxygen supply to your heart, brain, and other parts of your body. Lowering your blood level of cholesterol and fats with simvastatin has been shown to prevent heart disease, angina (chest pain), strokes, and heart attacks.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.