Major
Ciclosporin × Fluvastatin
Immunosuppressants. Calcineurin inhibitors×Statin (HMG-CoA reductase inhibitor)
Mechanism
Cyclosporine inhibits OATP1B1. Fluvastatin rises 2-fold. FDA recommends dose cap.
Symptoms
Myalgia, weakness, dark urine, rising CK within 5-10 days.
Management
Cap fluvastatin at 20 mg/day.
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.