MajorImmunosuppressants. Calcineurin inhibitors×Statin (HMG-CoA reductase inhibitor)
Updated · Methodology
Mechanism
Cyclosporine inhibits OATP1B1. Fluvastatin rises 2-fold. FDA recommends dose cap.
Symptoms
Myalgia, weakness, dark urine, rising CK within 5–10 days.
Management
In patients taking cyclosporine, do not exceed fluvastatin capsules 20 mg twice daily (FDA label). The FDA advises avoiding fluvastatin 80 mg extended-release tablets with cyclosporine. The Spanish fluvastatin SmPC requires the lowest possible starting and maintenance dose with cyclosporine, and the cyclosporine SmPC requires statin dose reduction. If muscle pain, weakness or dark urine appear, check creatine kinase (CK). Stop fluvastatin if CK exceeds 5 times the upper limit of normal (fluvastatin SmPC).
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.
Summary of a multi-drug list →
Medicine list: everything you take in one place →
Sources
- FDA: Lescol XL (fluvastatin sodium) extended-release tablets prescribing information (2024)– FDA label, DailyMed setid 726ea2db-f1b0-4b73-a515-02157db88a42, sections 7.1, 12.3
- AEMPS: Ficha técnica de Sandimmun Neoral 100 mg cápsulas blandas (ciclosporina) (2026)– AEMPS CIMA, nregistro 60320, secciones 4.4, 4.5
- AEMPS: Ficha técnica de Lescol Prolib 80 mg comprimidos de liberación prolongada (fluvastatina) (2023)– AEMPS CIMA, nregistro 64648, secciones 4.4, 4.5
- FDA: Fluvastatin capsules prescribing information (2026)– FDA label, DailyMed setid ccd6bbe1-e293-4e1c-9ec4-e6c217612e77, sections 2.4, 7.1