Lovastatin; Simvastatin/Selected CYP3A4 Inhibitors Interactions

This information is generalized and not intended as specific medical advice. Consult your healthcare professional before taking or discontinuing any drug or commencing any course of treatment.

Medical warning:

Very Serious. These medicines may interact and cause very harmful effects and are usually not taken together. Contact your healthcare professional (e.g. doctor or pharmacist) for more information.

How the interaction occurs:

When these two medicines are taken together, your body may not process your cholesterol medicine properly.

What might happen:

The blood levels of your cholesterol medicine may increase and cause toxic effects including muscle pain, tenderness, weakness, or discoloration of the urine.

What you should do about this interaction:

Let your healthcare professionals (e.g. doctor or pharmacist) know right away that you are taking these medicines together. You may need to take a different cholesterol medicine.Tell your doctor right away if you experience muscle pain, tenderness, or weakness; unexplained tiredness; or discolored urine.Your healthcare professionals may already be aware of this interaction and may be monitoring you for it. Do not start, stop, or change the dosage of any medicine before checking with them first.

View Reference
  • 1.USFood and Drug Administration. FDA Drug Safety Communication: New restrictions, contraindications, and dose limitations for Zocor (simvastatin) to reduce the risk of muscle injury. available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-drug-safety-com munication-new-restrictions-contraindications-and-dose-limitations-zocor June 8, 2011.
  • 2.Zocor (simvastatin) US prescribing information. Merck & Co., Inc. March, 2023.
  • 3.Vytorin (ezetimibe/simvastatin) US prescribing information. Merck/Schering-Plough Pharmaceuticals September, 2020.
  • 4.Mevacor (lovastatin) US prescribing information. Merck & Co., Inc. February, 2014.
  • 5.Reyataz (atazanavir sulfate) US prescribing information. Bristol-Myers Squibb Company November, 2023.
  • 6.Prezista (darunavir) US prescribing information. Janssen Therapeutics March, 2023.
  • 7.Lexiva (fosamprenavir calcium) US prescribing information. GlaxoSmithKline March, 2019.
  • 8.Crixivan (indinavir sulfate) US prescribing information. Merck & Co., Inc. September, 2016.
  • 9.Kaletra (lopinavir/ritonavir tablets) US prescribing information. Abbott Laboratories December, 2019.
  • 10.Norvir (ritonavir) US prescribing information. Abbott Laboratories December, 2019.
  • 11.Invirase (saquinavir mesylate) US prescribing information. Roche Laboratories, Inc. March, 2019.
  • 12.Aptivus (tipranavir) US prescribing information. Boehringer Ingelheim Pharmaceuticals, Inc. June, 2020.
  • 13.Agenerase (amprenavir) Capsules US prescribing information. GlaxoSmithKline May, 2005.
  • 14.Viracept (nelfinavir mesylate) US prescribing information. Agouron Pharmaceuticals, Inc. September, 2016.
  • 15.Fichtenbaum CJ, Gerber JG, Rosenkranz SL, Segal Y, Aberg JA, Blaschke T, Alston B, Fang F, Kosel B, Aweeka F. Pharmacokinetic interactions between protease inhibitors and statins in HIV seronegative volunteers: ACTG Study A5047. AIDS 2002 Mar 8;16(4):569-77.
  • 16.Hsyu PH, Schultz-Smith MD, Lillibridge JH, Lewis RH, Kerr BM. Pharmacokinetic interactions between nelfinavir and 3-hydroxy-3- methylglutaryl coenzyme A reductase inhibitors atorvastatin and simvastatin. Antimicrob Agents Chemother 2001 Dec;45(12):3445-50.
  • 17.Paxlovid (nirmatrelvir tablets and ritonavir tablets) US prescribing information. Pfizer Inc. May, 2023.
  • 18.Stribild (elvitegravir, cobicistat, emtricitabine, tenofovir) US prescribing information. Gilead Sciences, Inc. September, 2021.
  • 19.Aberg JA, Rosenkranz SL, Fichtenbaum CJ, Alston BL, Brobst SW, Segal Y, Gerber JG. Pharmacokinetic interaction between nelfinavir and pravastatin in HIV-seronegative volunteers: ACTG Study A5108. AIDS 2006 Mar 21; 20(5):725-9.
  • 20.Benesic A, Zilly M, Kluge F, Weissbrich B, Winzer R, Klinker H, Langmann P. Lipid lowering therapy with fluvastatin and pravastatin in patients with HIV infection and antiretroviral therapy: comparison of efficacy and interaction with indinavir. Infection 2004 Aug;32(4):229-33.
  • 21.Hare CB, Vu MP, Grunfeld C, Lampiris HW. Simvastatin-nelfinavir interaction implicated in rhabdomyolysis and death. Clin Infect Dis 2002 Nov 15;35(10):e111-2.
  • 22.Cheng CH, Miller C, Lowe C, Pearson VE. Rhabdomyolysis due to probable interaction between simvastatin and ritonavir. Am J Health Syst Pharm 2002 Apr 15;59(8):728-30.
  • 23.Kantola T, Kivisto KT, Neuvonen PJ. Grapefruit juice greatly increases serum concentrations of lovastatin and lovastatin acid. Clin Pharmacol Ther 1998 Apr;63(4):397-402.
  • 24.Phansalkar S, Desai AA, Bell D, Yoshida E, Doole J, Czochanski M, Middleton B, Bates DW. High-priority drug-drug interactions for use in electronic health records. J Am Med Inform Assoc 2012 Sep-Oct; 19(5):735-43.
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CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.