Pravastatin Amiodarone

Until more is known, caution is certainly warranted. See also muscle toxicity, (p. 1086), for further guidance on monitoring and risk factors for muscle toxicity. Lovastatin is metabolised in the same way as simvastatin, and shares many of its interactions the manufacturers of lovastatin suggest a maximum dose of 40 mg daily in the presence of amiodarone. Pravastatin appears less likely to interact. 

The catabolism of lovastatin, simvastatin, and atorvastatin proceeds chiefly through CYP3A4, whereas that of fluvastatin and rosuvastatin is mediated by CYP2C9. Pravastatin is catabolized through other pathways, including sulfation. The 3A4-dependent reductase inhibitors tend to accumulate in plasma in the presence of drugs that inhibit or compete for the 3A4 cytochrome. These include the macrolide antibiotics, cyclosporine, ketoconazole and its congeners, HIVprotease inhibitors, tacrolimus, nefazodone, fibrates, and others (see Chapter 4). Concomitant use of reductase inhibitors with amiodarone or verapamil also causes an increased risk of myopathy. 

Cardiac drugs Amiodarone, atorvastatin, " diltiazem, " digoxin, disopyramide, lovastatin, " nadolol, pravastatin, propranolol, quinidine,"" timolol, verapamil "... 

The manufacturers of simvastatin note that in an ongoing unpublished clinical study, myopathy (clinically significant muscle pain with a creatinine kinase at least 10 times the upper limit of normal ) has been reported in 6% of patients receiving simvastatin 80 mg daily with amiodarone. " There is some evidence from reports to the US FDA that the concurrent use of simvastatin with amiodarone is associated with a higher incidence of muscle toxicity than pravastatin with amiodarone. They reported that the percentage of reports of muscle, liver, pancreas, and bone marrow toxicity associated with statins and involving concurrent amiodarone was 1% for simvastatin and 0.4% for pravastatin. ... 

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