Elbasvir / Grazoprevir

Simvastatin

Dosage adjustment may be necessary.

Available pharmaceutical opinion

Document made available to the pharmacist to communicate a drug interaction to the doctor.

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Mechanism

Elbasvir / Grazoprevir can inhibit BCRP and increase the plasma concentration of Simvastatin.

Elbasvir / Grazoprevir

Pharmacodynamic effects

Recommendations

Alternative solution(s)

Simvastatin

Pharmacodynamic effects

Possible increased risk of HMG CoA inhibitor toxicity.

Recommendations

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.

Alternative solution(s)

Monitor

Symptoms of toxicity associated with hypolipidemic agents : gastrointestinal effects, fatigue and muscular weaknesses, myalgias, muscular cramps, myopathies, rhabdomyolysis and myoglobinuria leading to renal insufficiency.

Tests

CK

AST

ALT

Lipidic profile

Pharmacokinetic parameters

Comment

See elbasvir/grazoprevir with atorvastatin and rosuvastatin.

Reference
  • 3222
    Elbasvir/Grazoprevir (Zepatier), Merck, Québec, Canada, 28 juin 2017.