MAJOR — Use With Caution
FDA simvastatin label mandates maximum dose of 20mg/day with amiodarone. Higher doses increase rhabdomyolysis risk.
Evidence level: STRONG
Amiodarone increases simvastatin levels in your blood, raising the risk of muscle damage. The FDA limits your simvastatin dose to no more than 20mg per day if you also take amiodarone.
Amiodarone inhibits CYP3A4 and P-gp. Simvastatin is a CYP3A4 substrate. FDA simvastatin label limits dose to maximum 20mg daily with amiodarone due to rhabdomyolysis risk.
Your simvastatin dose must not exceed 20mg daily while taking amiodarone. If you need more cholesterol lowering, discuss switching to pravastatin or rosuvastatin.
Take Simvastatin in the evening when cholesterol synthesis peaks (exception: atorvastatin and rosuvastatin have long half-lives and can be taken any time). Amiodarone follows its normal prescribed schedule. Report any unexplained muscle pain.
Higher risk for: those with liver impairment, genetic CYP enzyme variations (poor or ultra-rapid metabolizers), elderly, those on multiple CYP3A4 inhibitors, high-dose statin therapy, or history of myopathy.
Muscle pain, tenderness or weakness, dark brown urine, fever, nausea
Verify simvastatin dose limit of 20mg with amiodarone. Consider switching to pravastatin or rosuvastatin which are less affected.
Statin interactions often involve liver enzyme competition. Ask your doctor about alternative statins (rosuvastatin and pravastatin have fewer CYP interactions) or spacing doses 12 hours apart. CoQ10 supplementation may help with statin-related muscle discomfort.
Amiodarone increases simvastatin levels in your blood, raising the risk of muscle damage. The FDA limits your simvastatin dose to no more than 20mg per day if you also take amiodarone.
Take Simvastatin in the evening when cholesterol synthesis peaks (exception: atorvastatin and rosuvastatin have long half-lives and can be taken any time). Amiodarone follows its normal prescribed schedule. Report any unexplained muscle pain.
Muscle pain, tenderness or weakness, dark brown urine, fever, nausea
Statin interactions often involve liver enzyme competition. Ask your doctor about alternative statins (rosuvastatin and pravastatin have fewer CYP interactions) or spacing doses 12 hours apart. CoQ10 supplementation may help with statin-related muscle discomfort.
Verify simvastatin dose limit of 20mg with amiodarone. Consider switching to pravastatin or rosuvastatin which are less affected.
Or browse the full interaction database (121,000+ pairs).