Moderate
Probable
Açıklama
Simvastatin modestly potentiates warfarin anticoagulation, leading to small but potentially clinically relevant INR increases.
Mekanizma
Simvastatin may inhibit CYP2C9-mediated S-warfarin metabolism; the precise mechanism is not fully elucidated but has been observed across multiple statins.
Klinik Önemi
INR increases of ~10–20% have been observed; dose-dependent effect—higher simvastatin doses carry greater risk.
Yönetim
Monitor INR when starting, stopping, or changing the simvastatin dose; adjust warfarin if INR moves outside target range.