Ezetimibe and Simvastatin Tablets and Ranolazine

In the database of official manuals used in the service creation an interaction registered by statistical results of studies was found, which can either lead to negative consequences for the patient health or strengthen a mutual positive effect. A doctor should be consulted to address the issue of joint drug administration.

Ranolazine may significantly increase the blood levels of simvastatin. This can increase the risk of side effects such as liver damage and a rare but serious condition called rhabdomyolysis that involves the breakdown of skeletal muscle tissue. In some cases, rhabdomyolysis can cause kidney damage and even death. You may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Talk to your doctor if you have any questions or concerns. Your doctor may already be aware of the risks, but has determined that this is the best course of treatment for you and has taken appropriate precautions and is monitoring you closely for any potential complications. Your doctor may also be able to prescribe alternatives that do not interact. Let your doctor know immediately if you have unexplained muscle pain, tenderness, or weakness during treatment with simvastatin or similar medications, especially if these symptoms are accompanied by fever or dark colored urine. You should also seek immediate medical attention if you develop fever, chills, joint pain or swelling, unusual bleeding or bruising, skin rash, itching, loss of appetite, fatigue, nausea, vomiting, dark colored urine, and/or yellowing of the skin or eyes, as these may be signs and symptoms of liver damage. It is important to tell your doctor about all other medications you use, including vitamins and herbs. Do not stop using any medications without first talking to your doctor.

ADJUST DOSE: Coadministration with ranolazine may increase the plasma concentrations of simvastatin and its active metabolite, simvastatin acid, and potentiate the risk of statin-induced myopathy. The mechanism involves reduced clearance of simvastatin and simvastatin acid due to inhibition of intestinal and hepatic CYP450 3A4 by ranolazine. When simvastatin 80 mg once daily was administered with ranolazine 1000 mg twice daily in healthy volunteers, simvastatin peak plasma concentration (Cmax) and systemic exposure (AUC) increased by an average of 1.8- and 1.9-fold, respectively, while Cmax and AUC of simvastatin acid increased by an average of 2.3-fold each. High levels of HMG-CoA reductase inhibitory activity in plasma is associated with an increased risk of musculoskeletal toxicity. Myopathy manifested as muscle pain and/or weakness associated with grossly elevated creatine kinase exceeding ten times the upper limit of normal has been reported occasionally. Rhabdomyolysis has also occurred rarely, which may be accompanied by acute renal failure secondary to myoglobinuria and may result in death.

MANAGEMENT: The benefits of using simvastatin in combination with ranolazine should be carefully weighed against the potentially increased risk of myopathy including rhabdomyolysis. A lower dosage of simvastatin should be considered and close clinical monitoring advised if concomitant use is required. Simvastatin labeling recommends that the dosage not exceed 20 mg daily when prescribed with ranolazine. Fluvastatin, pitavastatin, pravastatin, and rosuvastatin may be safer alternatives in patients receiving ranolazine, since they are not substrates of CYP450 3A4. All patients receiving statin therapy should be advised to promptly report any unexplained muscle pain, tenderness or weakness, particularly if accompanied by fever, malaise and/or dark colored urine. Therapy should be discontinued if creatine kinase is markedly elevated in the absence of strenuous exercise or if myopathy is otherwise suspected or diagnosed.

Ezetimibe and Simvastatin Tablets

Generic Name: ezetimibe / simvastatin

Brand name: Vytorin

Synonyms: Ezetimibe and simvastatin, Ezetimibe and Simvastatin

What is Ezetimibe and Simvastatin Tablets?

Ranolazine

Generic Name: ranolazine

Brand name: Ranexa

Synonyms: n.a.

What is Ranolazine?