Lovastatin and Rapamune

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.

Ask your doctor before using lovastatin together with sirolimus. Using lovastatin together with sirolimus can increase the blood levels or add to the side effects of either medication. This may cause a dangerous side effect on your muscles. If your doctor prescribes these medications together, you may need a dose adjustment or special tests to safely use both medications. You should also watch for muscle symptoms and call the doctor if you have muscle pain, tenderness, or weakness, especially if you also have dark colored urine. 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.

GENERALLY AVOID: Coadministration of a macrolide immunosuppressant with certain HMG-CoA reductase inhibitors may result in elevated plasma concentrations of both due to competitive inhibition of CYP450 3A4 metabolism. High levels of HMG-CoA reductase inhibitory activity in plasma is associated with an increased risk of musculoskeletal toxicity including rhabdomyolysis, which can be fatal. In one case report, severe rhabdomyolysis complicated by acute renal transplant failure occurred in a diabetic woman whose drug regimen at the time of hospital admission consisted of tacrolimus, azathioprine, prednisolone, felodipine, citalopram, aspirin, insulin, simvastatin, and fusidic acid. The patient developed muscle pain accompanied by a grossly elevated serum creatine kinase level several weeks after simvastatin was increased from 10 to 20 mg/day and fusidic acid was initiated to treat soft tissue infection and osteomyelitis of a toe. She recovered after discontinuation of simvastatin and fusidic acid and institution of supportive therapy. Simvastatin was later replaced with fluvastatin, and fusidic acid was administered on another occasion without incident. The authors suggest that use of tacrolimus with simvastatin at a dosage exceeding 10 mg/day may increase the risk of rhabdomyolysis. The use of fusidic acid may have presented an additional risk factor in the case patient. In another report, a transplant patient developed significantly elevated sirolimus serum trough levels following addition of atorvastatin to her regimen. No adverse effects were reported, but a 50% reduction in sirolimus dosage was required.

MANAGEMENT: In general, lovastatin, red yeast rice (which contains lovastatin), and simvastatin should preferably be avoided in patients treated with sirolimus or tacrolimus due to the potential for serious interaction. Atorvastatin may be used with caution, although the dosage should start low, and immunosuppressant blood levels should be closely monitored. Pravastatin and fluvastatin are probably the safest alternatives, since they are not metabolized by CYP450 3A4. All patients treated with HMG-CoA reductase inhibitors should be advised to promptly report any unexplained muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever. Therapy should be discontinued if creatine kinase is markedly elevated in the absence of strenuous exercise or if myopathy is otherwise suspected or diagnosed.

Lovastatin

Generic Name: lovastatin

Brand name: Altoprev, Mevacor, Altocor

Synonyms: n.a.

What is Lovastatin?

Rapamune

Generic Name: sirolimus

Brand name: Rapamune

Synonyms: n.a.

What is Rapamune?