Simvastatin 4- Fusidate

A 71-year-old man developed nausea, abdominal discomfort, and myalgia after taking fusidic acid for 4 weeks. The next day he had myoglobinuria. Simvastatin, which he had taken for 8 years, was withdrawn. Prompt clinical improvement followed (108). 

Yuen SL, McGarity B. Rhabdomyolysis secondary to interaction of fusidic acid and simvastatin. Med J Aust 2003 179 172. 

STATINS FUSIDIC ACID Cases of rhabdomyolysis reported when fusidic acid was co-adminis-tered with atorvastatin or simvastatin Uncertain at present Monitor LFTs and CK closely warn patients to report any features of rhabdomyolysis... 

Acute rhabdomyolysis has been attributed to an interaction of fusidic acid with simvastatin (25). 

The authors identified only one previous report of a patient with rhabdomyolysis who had taken simvastatin and fusidic acid. 

Kotanko R Kirisits W, Skrabal F. Rhabdomyolysis and acute renal graft impairment in a patient treated with simvastatin, tacrolimus, and fusidic acid (letter). Nephron 2002 90 234-235. 

Rhabdomyolysis has been described in patients given atorvastatin or simvastatin with fusidic acid. 

The clinical significance of this possible interaction is unclear, but it would seem wise to remind patients taking either atorvastatin or simvastatin with fusidic acid to be on the look out for the symptoms of myopathy and rhabdomyolysis (i.e. otherwise unexplained muscle pain, tenderness or weakness or dark coloured urine). If myopathy does occur, the statin should be stopped immediately. See also muscle toxicity , (p.l086), for further guidance on monitoring, and risk factors for muscle toxicity. 

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