Amiodarone with statins

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

Herman D, LocateUi I, Grabnar I, Petemel P, Stegnar M, Lainscak M, Mrhar A, Breskvar K, Dolzan V. The influence of co-treatment with carbamazepine, amiodarone and statins on warfarin metabolism and maintenance 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The manufacturers of simvastatin note that in an ongoing unpublished clinical study, myopathy (clinically significant muscle pain with a creatinine kinase at least 10 times the upper limit of normal ) has been reported in 6% of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. ... 

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

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... 

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