Major
Simvastatin × Verapamil
HMG-CoA reductase inhibitors (statins)×Non-dihydropyridine calcium channel blocker
Mechanism
Verapamil inhibits CYP3A4 and P-glycoprotein. Simvastatin rises 2–3 fold with myopathy and rhabdomyolysis risk. FDA Zocor Section 7 caps simvastatin at 10 mg/day with verapamil.
Symptoms
Myalgia, weakness, rising CK within 1–3 weeks.
Management
Cap simvastatin at 10 mg/day. Alternative: 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.