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MHRA recommendations on simvastatin interactions: …

Conclusions The MHRA Drug Safety Update (August 2012) highlights changes to the simvastatin SmPC regarding interactions that can increase the risk of myopathy and/or rhabdomyolysis. When used with amlodipine, the maximum dose of simvastatin is now 20mg; higher doses are off-label . For patients taking amlodipine and simvastatin 40mg consider: 1. Reducing simvastatin dose to 20mg most patients can be managed this way as the interaction with amlodipine leads to an increase in simvastatin exposure that is similar to taking simvastatin 40mg alone. 2. Staying on simvastatin 40mg discuss the risks and benefits of this off-label option with the patient. Be aware that, due to the interaction with amlodipine, exposure to adverse effects is similar to that associated with simvastatin 80mg when given alone. 3. Change to an alternative statin Pravastatin, fluvastatin or rosuvastatin do not interact with amlodipine. Atorvastatin (20mg or 40mg daily) is an option if a more potent statin is needed.

Myopathy is an adverse effect associated with statins. The risk of myopathy increases with higher plasma levels ... • Use 40mg simvastatin or drug of similar efficacy and acquisition cost. ... Comparative costs for 28 days treatment (Drug Tariff September 2012) Amlodipine 10mg . Simvastatin 40mg .

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