Oravig and Simvastatin

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.

Talk to your doctor before using simvastatin together with miconazole. Combining these medications may significantly increase the blood levels of simvastatin in rare cases. 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. 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.

GENERALLY AVOID: Coadministration with potent inhibitors of CYP450 3A4 including azole antifungal agents may significantly increase the plasma concentrations of HMG-CoA reductase inhibitors that are substrates of the isoenzyme. 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. The interaction has not been studied with clotrimazole troches or miconazole buccal tablets. Although systemic absorption following mucous membrane exposure is limited, the potential for interaction with drugs metabolized by CYP450 3A4 such as lovastatin, simvastatin, and atorvastatin cannot be ruled out.

MANAGEMENT: Given the potential for serious and life-threatening musculoskeletal toxicity associated with increased plasma levels of HMG-CoA reductase inhibitors, the concomitant use of lovastatin, red yeast rice (which contains lovastatin), and simvastatin with clotrimazole or miconazole mucous membrane preparations should be avoided if possible. Atorvastatin may be used with caution, although the dosage should start low and probably not exceed 40 mg/day. 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. No interaction is expected with fluvastatin and pravastatin, since they are not metabolized by CYP450 3A4.

Oravig

Generic Name: miconazole

Brand name: Oravig, Monistat IV, Oravig

Synonyms: n.a.

What is Oravig?

Simvastatin

Generic Name: simvastatin

Brand name: Zocor, Flolipid

Synonyms: n.a.

What is Simvastatin?