Major
Simvastatin × Ticagrelor
HMG-CoA reductase inhibitors (statins)×Reversible P2Y12 receptor inhibitor
Mechanism
Ticagrelor inhibits P-glycoprotein. Simvastatin rises 1.5-fold. FDA Brilinta caps simvastatin at 40 mg/day.
Symptoms
Myalgia, rising CK.
Management
Cap simvastatin at 40 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.