Major
Established
説明
Cyclosporine raises simvastatin exposure by 6- to 10-fold through inhibition of CYP3A4, OATP1B1, and P-gp, creating an extremely high risk of rhabdomyolysis.
機序
Simvastatin acid depends on CYP3A4 for metabolism, OATP1B1 for hepatocyte uptake, and P-gp for efflux; cyclosporine's broad transporter/enzyme inhibition blocks all clearance pathways.
臨床的意義
This combination is contraindicated; multiple cases of severe and fatal rhabdomyolysis have been reported in transplant recipients.
対処法
Contraindicated. Do not use simvastatin in patients taking cyclosporine. Use pravastatin or fluvastatin at low doses instead.