The statin is now contraindicated for use in combination with ciclosporin, danazol and gemfibrozil, the MHRA has advised. In addition, the agency has recommended a new maximum dose of 20mg per day for simvastatin when used in conjunction with amlodipine or diltiazem.
The recommendations take into account the potential for increased plasma concentrations of simvastatin when used concomitantly with these medicines, resulting in an increased risk of myopathy and/or rhabdomyolysis.
Other medicines contraindicated for use with simvastatin include azole antifungals, macrolide antibiotics and HIV protease inhibitors. Dose restrictions for simvastatin also apply during concomitant use with amiodarone and verapamil (maximum 20mg daily) and other fibrates (except for fenofibrate, maximum 10mg daily).
Further information: MHRA