Glecaprevir / Pibrentasvir

Simvastatin

Contraindicated.

Available pharmaceutical opinion

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

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Mechanism

Glecaprevir / Pibrentasvir may inhibit CYP 3A4 and OATP1B1 and increase the plasma concentration of Simvastatin.

Glecaprevir / Pibrentasvir

Pharmacodynamic effects

Recommendations

Alternative solution(s)

Simvastatin

Pharmacodynamic effects

Possible increased risk of HMG CoA inhibitor toxicity.

Increased risk of myopathy and rhabdomyolysis.

Recommendations

Avoid association. Choose an alternative.

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

Pharmacokinetic parameters
Parameters
Reference number
# patients
HCV
Dose
Frequency
Cmax
AUC
Glecaprevir / Pibrentasvir
3373
12
-
300/120 mg
QD
 
 
Simvastatin
3373
12
-
5 mg
QD
+ 99% (2x) *
+ 132% (2.3x) *
Comment

Ref #3373 : * Simvastatin acid (metabolite) AUC +348% (4.5x) and Cmax +970% (10.7x).

Reference
  • 3373
    Glecaprevir/Pibrentasvir (Maviret), Abbvie, Québec, Canada, 28 novembre 2018.