Magazine article Clinical Psychiatry News

Simvastatin-Amiodarone Interaction Prompts Alert

Magazine article Clinical Psychiatry News

Simvastatin-Amiodarone Interaction Prompts Alert

Article excerpt

Patients on amiodarone and simvastatin should not take more than 20 mg of the statin a day, because of an increased risk of rhabdomyolysis when the two drugs are used together, according to a Food and Drug Administration alert.

"This risk is dose-related and increases when a dose of simvastatin greater than 20 mg per day is given with amiodarone," the FDA advises. This information was added to the simvastatin label in 2002, but the agency has continued to receive reports of rhabdomyolysis in patients on both drugs since that time, particularly among those on more than 20 mg of simvastatin a day.

Rhabdomyolysis, a rare, potentially fatal condition that involves muscle injury and can lead to kidney failure, has been reported with all statins, whether or not they are administered with amiodarone. However, "compared to other statins, the risk of rhabdomyolysis is more pronounced when simvastatin is administered with amiodarone," the alert says.

Although the precise mechanism is not known, it is related to amiodarone's inhibition of the cytochrome P450 3A4 (CYP3A4) enzyme, which also metabolizes simvastatin, a HMG-CoA reductase inhibitor, according to the FDA.

The FDA is advising that health care professionals consider prescribing another statin in patients who need more than 20 mg of simvastatin to reach their lipid goals and are either taking amiodarone or starting amiodarone treatment. …

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