STOP — Contraindicated
FDA contraindication. Temporarily discontinue simvastatin during clarithromycin treatment.
Evidence level: STRONG
Clarithromycin with simvastatin can cause simvastatin levels to rise up to 10-fold, dramatically increasing the risk of dangerous muscle breakdown (rhabdomyolysis).
Clarithromycin (strong CYP3A4 inhibitor) dramatically increases simvastatin exposure. Rhabdomyolysis risk. FDA simvastatin label contraindicates strong CYP3A4 inhibitors. Duplicate of earlier entry to ensure bidirectional coverage.
Stop simvastatin while taking clarithromycin. Resume after antibiotic course is complete.
Some antibiotics (erythromycin, clarithromycin) strongly inhibit CYP3A4 and can dramatically increase statin levels, raising rhabdomyolysis risk. Take Simvastatin in the evening as usual. Your prescriber may temporarily pause or reduce the statin during short antibiotic courses.
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.
Severe muscle pain, dark urine, weakness, nausea, kidney pain
Temporarily discontinue statin. Consider azithromycin as alternative.
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.
Clarithromycin with simvastatin can cause simvastatin levels to rise up to 10-fold, dramatically increasing the risk of dangerous muscle breakdown (rhabdomyolysis).
Some antibiotics (erythromycin, clarithromycin) strongly inhibit CYP3A4 and can dramatically increase statin levels, raising rhabdomyolysis risk. Take Simvastatin in the evening as usual. Your prescriber may temporarily pause or reduce the statin during short antibiotic courses.
Severe muscle pain, dark urine, weakness, nausea, kidney pain
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.
Temporarily discontinue statin. Consider azithromycin as alternative.
Or browse the full interaction database (121,000+ pairs).