Juvisync and Posaconazole

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.

Using simvastatin together with posaconazole is not recommended. Combining these medications 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, or your doctor may prescribe alternative medications 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.

CONTRAINDICATED: Coadministration with posaconazole may significantly increase the plasma concentrations of HMG-CoA reductase inhibitors that are metabolized by CYP450 3A4 such as atorvastatin, cerivastatin, lovastatin, simvastatin, and red yeast rice (which contains lovastatin). The mechanism is decreased clearance due to inhibition of CYP450 3A4 by posaconazole. The interaction has been studied with simvastatin. In healthy volunteers, administration of a single 40 mg oral dose of simvastatin in combination with posaconazole oral suspension 100 mg once daily for 13 days resulted in an 8.4-fold increase in simvastatin peak plasma concentration (Cmax) and a 9.3-fold increase in systemic exposure. Likewise, simvastatin acid Cmax and AUC increased by 8.2-fold and 6.3-fold, respectively, in the presence of posaconazole. When posaconazole dosage was increased to 200 mg once daily for 13 days, simvastatin Cmax and AUC increased by 10.4-fold and 9.6-fold, respectively, while simvastatin acid Cmax and AUC increased by 8.5-fold and 7.5-fold, respectively. Similar interactions have been reported with various other combinations of HMG-CoA reductase inhibitors and azole antifungal agents. 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 use of posaconazole in combination with HMG-CoA reductase inhibitors that are primarily metabolized by CYP450 3A4 is considered contraindicated. Fluvastatin, pitavastatin, pravastatin, and rosuvastatin may be suitable alternatives, since they are not metabolized by 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.

Juvisync

Generic Name: simvastatin / sitagliptin

Brand name: Juvisync

Synonyms: n.a.

What is Juvisync?

Posaconazole

Generic Name: posaconazole

Brand name: Noxafil

Synonyms: Posaconazole (oral/injection)

What is Posaconazole?