Simvastatin 4- Fluconazole

Shaul Benekli M, Vladuthi GD, Slack JL, Wetzler M, Baer MR. Simvastatin-fluconazole causing ihabdomyofysis.. /4wwPfea/ iacoi r(2003) 37,1032—5. 

Clinically important, potentially hazardous interactions with alfentanil, aminophylline, amisulpride, amoxicillin, ampicillin, anticonvulsants, astemizole, atorvastatin, benzodiazepines, bromocriptine, buprenorphine, bupropion, carbamazepine, cilostazol, ciprofloxacin, cisapride, clindamycin, colchicine, cyclosporine, dasatinib, digoxin, dihydroergotamine, diltiazem, disopyramide, enoxacin, eplerenone, ergotamine, eszopiclone, everolimus, fluconazole, fluoxetine, fluvastatin, gatifloxacin, HMG-CoA reductase inhibitors, imatinib, itraconazole, ketoconazole, lomefloxacin, lorazepam, lovastatin, methadone, methylprednisolone, methysergide, midazolam, mizolastine, moxifloxacin, nitrazepam, norfloxacin, ofloxacin, paroxetine, pimozide, pravastatin, quinolones, ranolazine, repaglinide, rupatadine, sertraline, sildenafil, simvastatin, sparfloxacin, sulpiride, tacrolimus, terfenadine, triazolam, troleandomycin, vardenafil, verapamil, vinblastine, warfarin, zaleplon, zolpidem, zuclopenthixol... 

CYP3A4 Alfentanil Alprazolam Astern izole Carbamazepine Cisapride Cyclosporine Diltiazem Erythromycin Felodipine Fluconazole Itraconazole Ketoconazole Lidocaine Lova statin Midazolam Nifedipine Quinidine Simvastatin Tacrolimus Terfenadine Verapamil... 

Cimetidine, fluconazole, fluvastatin, isoniazid, lovastatin, pravastatin, simvastatin, sulfaphenazole, tienilic acid, tolbutamide, warfarin... 

Fluconazole modestly increases the levels of fluvastatin and rosuvastatin, but not pravastatin. Miconazoie wouid be expected to interact simiiariy. Itraconazoie causes a marked rise in the serum ieveis of atorvastatin, iovastatin, pravastatin and simvastatin, but no change in fluvastatin or rosuvastatin ieveis. Ketoconazole wouid be expected to interact simiiariy. Rhabdomyolysis has been reported in some cases. Due to the risk of myopathy, the manufacturers of voriconazoie caution, and the manufacturers of posaco-nazoie contraindicate, concurrent use with atorvastatin, iovastatin and simvastatin. 

An 83-year-old man who had been taking multiple medications including simvastatin 40 mg daily for 2 years was given fluconazole 400 mg daily as part of a prophylactic regimen against chemotherapy-induced neutropenic sepsis. After one week he developed generalised muscle weakness and was found to have brown urine and an elevated serum creatine kinase. His medication was stopped, and he was treated with hydration and diuretics, after which his symptoms resolved. ... 

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