Fluvastatin Ciclosporin

Most drug interactions associated with rhabdomyolysis occur when ciclosporin is combined with simvastatin or lovastatin. It has been suggested that if a statin is to be combined with ciclosporin, pravastatin or fluvastatin should be chosen instead (80). 

From an analysis of changes in ciclosporin clearance and systemic availability obtained from the medical records of 100 transplant patients, atorvastatin, fluvastatin, pravastatin, and simvastatin were found to affect ciclosporin pharmacokinetics (228). 

Ciclosporin can cause marked rises in the plasma levels of atorv-astatin, fluvastatin, lovastatin, pravastatin, rosuvastatin, and simvastatin, and for some of the statins this has led to the development of serious myopathy (rhabdomyolysis) accompanied by renal failure. The plasma levels of ciclosporin appear not to be affected by fluvastatin, lovastatin, pravastatin, or rosuvastatin, but some moderate changes in ciclosporin levels have been seen when atorvastatin or simvastatin were given. 

Effect on ciclosporin. When fluvastatin 20 mg daily was given to 16 patients taking ciclosporin 21 to 103 months after renal transplantation, no significant changes were seen in their ciclosporin levels. Similar results were seen in other studies, one using fluvastatin 20 mg twice daily, and one in 17 renal transplant recipients taking extended-release fluvastatin. ... 

---