Zocor drug interactions

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

List of precautions

Amiodarone or Verapamil

Propranolol

Digoxin

Warfarin

Antifungal drugs

Complete list of drug interactions



Amiodarone or Verapamil

The risk of myopathy / rhabdomyolysis is increased by concomitant administration of amiodarone or verapamil. Return to top

Propranolol

In healthy male volunteers there was a significant decrease in mean Cmax, but no change in AUC, for simvastatin total and active inhibitors with concomitant administration of single doses of ZOCOR and propranolol. The clinical relevance of this finding is unclear. The pharmacokinetics of the enantiomers of propranolol were not affected. Return to top

Digoxin

Concomitant administration of a single dose of digoxin in healthy male volunteers receiving simvastatin resulted in a slight elevation (less than 0.3 ng/mL) in digoxin concentrations in plasma (as measured by a radioimmunoassay) compared to concomitant administration of placebo and digoxin. Patients taking digoxin should be monitored appropriately when simvastatin is initiated. Return to top

Warfarin

In two clinical studies, one in normal volunteers and the other in hypercholesterolemic patients, simvastatin 20-40 mg/day modestly potentiated the effect of coumarin anticoagulants: the prothrombin time, reported as International Normalized Ratio (INR), increased from a baseline of 1.7 to 1.8 and from 2.6 to 3.4 in the volunteer and patient studies, respectively. With other reductase inhibitors, clinically evident bleeding and/or increased prothrombin time has been reported in a few patients taking coumarin anticoagulants concomitantly. In such patients, prothrombin time should be determined before starting simvastatin and frequently enough during early therapy to insure that no significant alteration of prothrombin time occurs. Once a stable prothrombin time has been documented, prothrombin times can be monitored at the intervals usually recommended for patients on coumarin anticoagulants. If the dose of simvastatin is changed or discontinued, the same procedure should be repeated. Simvastatin therapy has not been associated with bleeding or with changes in prothrombin time in patients not taking anticoagulants. Return to top

Antifungal drugs

Itraconazole increases the plasma concentrations of some HMG-CoA reductase inhibitors and may increase the risk of rhabdomyolysis. The mechanism has been reported to be inhibition of hepatic CYP450 3A4 enzymes responsible for HMG-CoA reductase inhibitor metabolism. Itraconazole greatly increases levels of lovastatin and its active metabolite, lovastatin acid and significantly increases simvastatin levels.

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Complete list of drug interactions

Major Interactions

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Moderate Interactions

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Minor Interactions

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Adapted from the FDA Package Insert.


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