Major
Amiodarone × Lovastatin
Class III antiarrhythmics (Vaughan Williams)×HMG-CoA reductase inhibitor (statin)
Mechanism
Amiodarone inhibits CYP3A4. Lovastatin rises 2-3 fold. FDA recommends capping lovastatin at 40 mg/day with amiodarone.
Symptoms
Myalgia, weakness, dark urine, rising CK within 5-10 days.
Management
Cap lovastatin at 40 mg/day. Better – pravastatin or rosuvastatin.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.