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Lovastatin Extended-Release Tablets and Neoral

Determining the interaction of Lovastatin Extended-Release Tablets and Neoral and the possibility of their joint administration.

Check result:

Lovastatin Extended-Release Tablets <> Neoral

Relevance: 02.05.2022 Reviewer: Shkutko P.M., M.D., in

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.

Consumer:

Using lovastatin together with cycloSPORINE is generally not recommended. Combining these medications may significantly increase the blood levels of lovastatin. 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. Talk to your doctor if you have any questions or concerns. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring to safely use both medications. Let your doctor know immediately if you have unexplained muscle pain, tenderness, or weakness during treatment with lovastatin 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.

Professional:

GENERALLY AVOID: Coadministration with cyclosporine may significantly increase the plasma concentrations of lovastatin and its active beta-hydroxyacid metabolite, lovastatin acid. The proposed mechanism is cyclosporine inhibition of intestinal and hepatic CYP450 3A4, the isoenzyme responsible for the metabolic clearance of lovastatin and lovastatin acid. In addition, lovastatin acid is a substrate of the hepatic uptake transporters, organic anion transporting polypeptide protein (OATP) 1B1 and 1B3, which are also inhibited by cyclosporine. When lovastatin (10 mg once daily for 10 days) was administered to 16 cyclosporine-treated patients, there was a 5- to 8-fold increase in lovastatin systemic exposure (AUC) compared to lovastatin administered alone. 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. There have been numerous case reports of musculoskeletal toxicity associated with the use of cyclosporine and HMG-CoA reductase inhibitors, including lovastatin and red yeast rice.

MANAGEMENT: Concomitant use of lovastatin or red yeast rice (which contains lovastatin) with cyclosporine should generally be avoided. Some authorities consider this combination contraindicated. Fluvastatin or pravastatin may be suitable alternatives, although lower dosages of the statins are recommended in combination with cyclosporine. The product labeling for fluvastatin recommends that fluvastatin dosage not exceed 20 mg twice a day when given with cyclosporine. The product labeling for pravastatin recommends starting pravastatin at 10 mg/day and not exceeding 20 mg/day when given with cyclosporine. In general, the benefits of using statins in combination with cyclosporine should be carefully weighed against the potential risks. 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.

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Lovastatin Extended-Release Tablets

Generic Name: lovastatin

Brand name: Altoprev, Mevacor, Altocor

Synonyms: Lovastatin

What is Lovastatin Extended-Release Tablets?

Neoral

Generic Name: cyclosporine

Brand name: Gengraf, Neoral, Sandimmune, Sandimmune

Synonyms: Neoral (Capsules, Modified)

What is Neoral?

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In the course of checking the drug compatibility and interactions, data from the following reference sources was used: Drugs.com, Rxlist.com, Webmd.com, Medscape.com.

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