Drug interactions
Azithromycin + Simvastatin
Severity: Moderate
Azithromycin and Simvastatin: moderate interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Azithromycin is a weak CYP3A4 inhibitor and may slightly raise simvastatin levels, with a theoretical increase in myopathy risk. Rhabdomyolysis has been reported occasionally with macrolides and statins, but the risk is far lower than with clarithromycin or erythromycin.
What this interaction means in plain words
Azithromycin and Simvastatin can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken.
Azithromycin belongs to Anti Bacterial; Simvastatin belongs to Cardiovascular.
Why it happens
Possible weak inhibition of CYP3A4 and intestinal P-glycoprotein, which may raise simvastatin concentrations.
What to do
Advise the patient to report unexplained muscle pain, weakness or dark urine, and check creatine kinase if symptoms occur. Consider pausing simvastatin during the azithromycin course in patients on high doses or with other risk factors.
What to ask your pharmacist
- Should I take them at different times of day?
- Does the dose of either medicine need to change?
- Is there anything I should avoid, such as alcohol or certain foods, while on both?
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Other interactions of Azithromycin
- Azithromycin + Cisapride Contraindicated
- Azithromycin + Domperidone Contraindicated
- Azithromycin + Dronedarone Contraindicated
- Azithromycin + Pimozide Contraindicated
- Azithromycin + Piperaquine Contraindicated
- Azithromycin + Thioridazine Contraindicated
Other interactions of Simvastatin
- Atazanavir + Simvastatin Contraindicated
- Clarithromycin + Simvastatin Contraindicated
- Cobicistat + Simvastatin Contraindicated
- Cyclosporin + Simvastatin Contraindicated
- Danazol + Simvastatin Contraindicated
- Darunavir + Simvastatin Contraindicated
Frequently asked questions
Can I take Azithromycin with Simvastatin?
MediHelp rates the interaction as moderate. Azithromycin and Simvastatin can affect each other. The combination is often manageable, but it may need a change of dose, a change of timing, or extra checks while both are taken. Azithromycin is a weak CYP3A4 inhibitor and may slightly raise simvastatin levels, with a theoretical increase in myopathy risk. Rhabdomyolysis has been reported occasionally with macrolides and statins, but the risk is far lower than with clarithromycin or erythromycin.
How serious is the interaction between Azithromycin and Simvastatin?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Advise the patient to report unexplained muscle pain, weakness or dark urine, and check creatine kinase if symptoms occur. Consider pausing simvastatin during the azithromycin course in patients on high doses or with other risk factors.
What other medicines interact with Azithromycin?
MediHelp also lists interactions of Azithromycin with, for example, Cisapride, Domperidone, Dronedarone. The full list is on the Azithromycin page.
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