Lovastatin Extended-Release Tablets and Ticagrelor

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.

Ticagrelor may increase the blood levels and effects 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. Your doctor may be able to prescribe alternatives that do not interact, or you may need a dose adjustment or more frequent monitoring by your doctor to safely use both medications. Let your doctor know immediately if you have unexplained muscle pain, tenderness, or weakness while taking these 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 ticagrelor may increase the plasma concentrations of lovastatin and simvastatin as well as their pharmacologically active acid metabolites. The mechanism may involve enhanced absorption and/or reduced clearance due to inhibition of intestinal/hepatic CYP450 3A4 by ticagrelor. In healthy volunteers, administration of simvastatin in combination with ticagrelor increased the simvastatin peak plasma concentration (Cmax) and systemic exposure (AUC) by 81% and 56%, respectively, and simvastatin acid Cmax and AUC by 64% and 52%, respectively. Two- to threefold increases were observed in some individuals. There was no effect of simvastatin on ticagrelor plasma concentrations. Although not studied, the interaction is also expected to occur with lovastatin due to its similar metabolic profile to simvastatin. Clinically, high levels of statin or 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: Concomitant use of ticagrelor with simvastatin or lovastatin dosages above 40 mg/day is not recommended. Fluvastatin, pitavastatin, pravastatin and rosuvastatin may be suitable alternatives in patients receiving ticagrelor, since they are not substrates of CYP450 3A4. Atorvastatin, despite being a substrate of CYP450 3A4, has been shown to interact with ticagrelor to a nonsignificant extent, so it may also be considered during treatment with ticagrelor. 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.

Lovastatin Extended-Release Tablets

Generic Name: lovastatin

Brand name: Altoprev, Mevacor, Altocor

Synonyms: Lovastatin

What is Lovastatin Extended-Release Tablets?

Ticagrelor

Generic Name: ticagrelor

Brand name: Brilinta

Synonyms: n.a.

What is Ticagrelor?