Table 1:
Interactions of statins with other medications.
| Target | Medication | Statin | Effect on statin levels | Ref |
|---|---|---|---|---|
| ↓ CYP3A4 | Amiodarone | Lovastatin | 1.8 × AUC | (Wiggins et al., 2016) |
| Simvastatin | 1.8 × AUC | |||
| ↓ CYP3A4 | Amlodipine | Simvastatin | 1.8 × AUC | (Zhou et al., 2014b) |
| Lovastatin | Minor magnitude | |||
| Azelnidipine | Simvastatin | 1.9 × AUC | ||
| Lercanidipine | Simvastatin | 56% Increased bioavailability | ||
| Lercanidipine | Fluvastatin | 1.13 × AUC | ||
| ↓ CYP3A4 | Diltiazem | Lovastatin | 4.6 × AUC | (Wiggins et al., 2016) |
| Simvastatin | 3.6 × AUC | |||
| Atorvastatin | 1.51 × AUC | |||
| ↓ CYP3A4 | Verapamil | Lovastatin | 3.6 × AUC | (Wiggins et al., 2016) |
| Simvastatin | 2.5 × AUC | |||
| ↓ OATP1B1 | Cyclosporine | Lovastatin | 5–20 × AUC | (Wiggins et al., 2016) |
| Atorvastatin | 6–15 × AUC | |||
| Pravastatin | 5–10 × AUC | |||
| Simvastatin | 6–8 × AUC | |||
| Rosuvastatin | 7 × AUC | |||
| Pitavastatin | 5 × AUC | |||
| Fluvastatin | 2–4 × AUC | |||
| ↓ OATP1B1 | Gemfibrozil | Lovastatin | 2–3 × AUC | (Wiggins et al., 2016) |
| Simvastatin | 2–3 × AUC | |||
| Pravastatin | 2 × AUC | |||
| Rosuvastatin | 1.6–1.9 × AUC | |||
| Pitavastatin | 1.5 × AUC | |||
| Atorvastatin | 1.4 × AUC | |||
| No known interaction | Fenofibrate/Fenofebric Acid | Fluvastatin | Magnitude likely to be minor | (Wiggins et al., 2016) |
| Lovastatin | ||||
| Atorvastatin | 1.0 × AUC | |||
| Rosuvastatin | 1.1 × AUC | |||
| Simvastatin | 1.1 × AUC | |||
| Pitavastatin | 1.2 × AUC | |||
| ↓ OATP1B1, ↓ p-gp and ↓ CYP3A4 | Clarithromycin | Simvastatin | 10–11 × AUC | (Abu Mellal et al., 2019; Eljaaly and Alshehri, 2017) |
| Atorvastatin | 3.2–4.4 × AUC | (Eljaaly and Alshehri, 2017) | ||
| Pravastatin | 2 × AUC | |||
| Erithromycin | Pitavastatin | 2.8 × AUC | (Kellick et al., 2014) | |
| Telithromycin | Simvastatin | 4.0 × AUC | ||
| ↓ CYP3A4 | Itroconazole | Simvastatin | 19 × AUC | (Eljaaly and Alshehri, 2017) |
| Lovastatin | 15 × AUC | |||
| Atorvastatin | 2.5–3.3 × AUC | |||
| Fluconazole | Fluvastatin | 1.7 × AUC | (Kellick et al., 2014) | |
| Posaconazole | Simvastatin | 4.0 × AUC | ||
| ↑ CYP3A4 | Rifampin | Simvastatin | 0.13 × AUC | (Kyrklund et al., 2000) |
| ↓ OAT1B1, ↓ CYP3A4 | Lopinavir/Ritonavir | Atorvastatin | 2.9 × AUC | (Kellick et al., 2014) |
| Rosuvastatin | 2.1 × AUC | |||
| Tipranavir/Ritonavir | Atorvastatin | 9.4 × AUC | ||
| Telepravir | 7.88 × AUC | |||
| Saquinavir/Ritonavir | 3.9 × AUC | |||
| Darunavir/Ritonavir | 3.9 × AUC | |||
| Fosamprenavir/Ritonavir | 2.53 × AUC | |||
| Nelfinavir | 1.74 × AUC | |||
| Atazanavir/Ritonavir | Rosuvastatin | 3.1 × AUC | ||
| Not fully understood | Digoxin | Atorvastatin | 1.2 × AUC | (Wiggins et al., 2016) |
| ↓ p-gp | Dronedarone | Simvastatin | 3.9 × AUC | (Wiggins et al., 2016) |
| Lovastatin | Unknown, likely similar to simvastatin | |||
| ↓ CYP3A4, ↓ p-gp | Ranolazine | Simvastatin | 1.9 × AUC | |
| Lovastatin | Unknown, likely similar to simvastatin | |||
| ↓ CYP3A4, ↓ p-gp | Conivaptan | Lovastatin | 3 × AUC | (Wiggins et al., 2016) |
| Simvastatin | 3 × AUC | |||
| ↓ CYP3A4, ↓ p-gp | Ticagrelor | Simvastatin | 2–3 × AUC | (Wiggins et al., 2016) |
| Lovastatin | Unknown, likely similar to simvastatin | |||
| Atorvastatin | 1.4 × AUC | |||
| ↓ CYP2C9 | Warfarin | Simvastatin | Increase in simvastatin exposure is unlikely to be significant; effects may include increase in INR due to increased warfarin exposure | (Wiggins et al., 2016) |
| Fluvastatin | ||||
| Lovastatin | ||||
| Rosuvastatin |