Statins Amiodarone

Specific concomitant medications or consumptions (check specific statin package insert for warnings) fibrates (especially gemfibrozil, but other fibrates too), nicotinic acid (rarely), cyclosporine, azole antifungals such as itraconazole and ketoconazole, macrolide antibiotics such as erythromycin and clarithromycin, protease inhibitors used to treat Acquired Immune Deficiency Syndrome, nefazodone (antidepressant), verapamil, amiodarone, large quantities of grapefruit juice (usually more than 1 quart per day), and alcohol abuse (independently predisposes to myopathy)... 

Amiodarone may be another drug that necessitates special caution if used with statins metabolized by CYP3A4. 

AMIODARONE SIMVASTATIN t risk of myopathy with high doses (>40 mg daily) of simvastatin Uncertain amiodarone inhibits intestinal P-gp, which may t the bioavailability of statins Avoid >20 mg daily doses of simvastatin in patients taking amiodarone if higher doses are required, switch to an alternative statin... 

Herman D, Locatelli I, Grabnar I, Petemel P, St nar M, Lainscak M, Mihar A, Bre ar K, Dolzan V. The influence of co-tieatmentwith earbamazepine, amiodarone and statins on war-ferin metabolism and mainlenance dose. EurJ Clin Pharmacol (2006) 62,291-6. 

The manufacturers of simvastatin note that in an ongoing unpublished clinical study, myopathy (clinically significant muscle pain with a creatinine kinase at least 10 times the upper limit of normal ) has been reported in 6% of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. ... 

Amiodarone is an inhibitor of various cytochrome P450 isoenzymes. Whether it inhibits the metabolism of simvastatin and other extensively-metabolised statins, and thereby increases the risk of muscle toxicity, is not known. Amiodarone alone may sometimes cause myopathy. 

Alsheikh-Ali AA, Karas RH Adverse events with ccscomitant amiodarone and statin therapy. Prev Cardiol (2005) 8,95-7. 

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