Voxilaprevir and Simvastatin: 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
Simvastatin
Voxilaprevir
No brand names on record
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.
Let's talk about taking simvastatin (Zocor) together with voxilaprevir, a medicine used to treat hepatitis C. Voxilaprevir can slow down how your body clears simvastatin, which means more of the statin may build up in your blood than usual.
Why does that matter? Higher statin levels raise the chance of muscle side effects, like aches, weakness, or (rarely) more serious muscle breakdown. This is expected based on how these drugs behave, though it hasn't been heavily studied. The good news is your care team can manage it easily, often by keeping your statin dose low and watching how you feel. Let your pharmacist or doctor know if you notice new muscle pain.
Effect: Voxilaprevir may increase plasma concentrations of simvastatin, raising the risk of dose-dependent myopathy and rhabdomyolysis.
Mechanism/direction: Voxilaprevir inhibits transporters (OATP1B) and likely reduces hepatic uptake/clearance of simvastatin, increasing systemic exposure. Simvastatin's active effect increases (not a prodrug concern here in the direction of reduced efficacy).
- Onset: unspecified
- Evidence: theoretical; magnitude not quantified
- Severity: moderate
Management: Use caution; if coadministered, use the lowest approved simvastatin dose. Monitor for muscle symptoms and consider CK if myopathy is suspected.
What happens
Increased plasma concentrations of the HMG-CoA reductase inhibitor
Interaction Deep Dive
Caution is warranted when voxilaprevir is given together with this drug, since the combination may raise this drug's plasma levels and heighten the likelihood of adverse effects such as myopathy and rhabdomyolysis. Should the two need to be used together, the lowest approved statin dose should be employed1.
Why it happens (mechanism)
Unknown
How to manage this interaction
Here is how a care team typically handles this combination:
- Keep taking both as prescribed unless your doctor or pharmacist tells you otherwise.
- If both are needed together, your team will usually keep simvastatin at the lowest approved dose to limit muscle risk.
- They may monitor you more closely and adjust and individualize your dose based on how you respond.
What to watch for and report: new or unexplained muscle pain, tenderness, weakness, or dark-colored urine. Contact your pharmacist or prescriber promptly if any of these occur.
Management is individual — confirm any change with your pharmacist or prescriber.
Common questions
Can I take Voxilaprevir and Simvastatin together?
Voxilaprevir can raise simvastatin levels and increase muscle-related side effects, so if you take both, your care team will typically keep the statin dose low and watch for muscle symptoms. Report any new muscle pain or weakness to your pharmacist or doctor. Always confirm with your pharmacist or prescriber before making any change.
How serious is the Voxilaprevir and Simvastatin interaction?
It is rated moderate. Can be significant — usually manageable with monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How is the Voxilaprevir and Simvastatin interaction managed?
Here is how a care team typically handles this combination: Keep taking both as prescribed unless your doctor or pharmacist tells you otherwise. If both are needed together, your team will usually keep simvastatin at the lowest approved dose to limit muscle risk. They may monitor you more closely and adjust and individualize your dose based on how you respond. What to watch for and report: new or… 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 Voxilaprevir or Simvastatin 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 anything you'd monitor while I'm on both?
References (1)
- Product Information: VOSEVI(TM) oral tablets, sofosbuvir velpatasvir voxilaprevir oral tablets. Gilead Sciences Inc (per manufacturer), Foster City, CA, 2017. DailyMed
Keep reading about Simvastatin
Keep reading about Voxilaprevir
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