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Elbasvir / Grazoprevir can inhibit BCRP and increase the plasma concentration of Simvastatin.
Elbasvir : 3A4; P-gp (minor) / Grazoprevir : OATP1B1 and 3A4; P-gp (minor)
Elbasvir : BCRP; P-gp (weak at intestinal leveel) / Grazoprévir : BCRP; 3A4 (weak not clinically significant)
3A4 (major); OATP1B1
2C8, 2C9 and 2D6 (weak); P-gp
Possible increased risk of HMG CoA inhibitor toxicity.
Start with a small dosage. Monitor closely for signs and symptoms of toxicity and adjust dosage as a function of efficacy and tolerance.
Maximum dose: 20 mg once daily.
Symptoms of toxicity associated with hypolipidemic agents : gastrointestinal effects, fatigue and muscular weaknesses, myalgias, muscular cramps, myopathies, rhabdomyolysis and myoglobinuria leading to renal insufficiency.
See elbasvir/grazoprevir with atorvastatin and rosuvastatin.