Описание
Cyclosporine raises simvastatin exposure by 6- to 10-fold through inhibition of CYP3A4, OATP1B1, and P-gp, creating an extremely high risk of rhabdomyolysis.
Механизм
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.
Клиническое значение
This combination is contraindicated; multiple cases of severe and fatal rhabdomyolysis have been reported in transplant recipients.
Тактика ведения
Contraindicated. Do not use simvastatin in patients taking cyclosporine. Use pravastatin or fluvastatin at low doses instead.
Медицинский отказ от ответственности
This content is for educational and informational purposes only. It is not a substitute for professional medical advice, diagnosis, or treatment. Always consult a qualified healthcare provider before making medication decisions.