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Glecaprevir / Pibrentasvir may inhibit CYP 3A4 and OATP1B1 and increase the plasma concentration of Simvastatin.
P-gp and BCRP; OATP1B1/3 (glecaprevir)
P-gp, BCRP, OATP1B1/3; 3A4, 1A2 and UGT 1A1 (weak probably without clinical consequences)
3A4 (major); OATP1B1
2C8, 2C9 and 2D6 (weak); P-gp
Possible increased risk of HMG CoA inhibitor toxicity.
Increased risk of myopathy and rhabdomyolysis.
Avoid association. Choose an alternative.
Symptoms of toxicity associated with hypolipidemic agents : gastrointestinal effects, fatigue and muscular weaknesses, myalgias, muscular cramps, myopathies, rhabdomyolysis and myoglobinuria leading to renal insufficiency.
|+ 99% (2x) *|
|+ 132% (2.3x) *|
Ref #3373 : * Simvastatin acid (metabolite) AUC +348% (4.5x) and Cmax +970% (10.7x).