Drug interactions
Elvitegravir / cobicistat / emtricitabine / tenofovir df + Simvastatin
Severity: Contraindicated
Elvitegravir / cobicistat / emtricitabine / tenofovir df and Simvastatin: contraindicated 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
Cobicistat in this combination strongly inhibits CYP3A and greatly increases simvastatin exposure, raising the risk of myopathy and rhabdomyolysis. Co-administration is contraindicated.
What this interaction means in plain words
Elvitegravir / cobicistat / emtricitabine / tenofovir df and Simvastatin are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two.
Why it happens
Cobicistat is a potent CYP3A4 inhibitor, and it also inhibits OATP1B1, which reduces simvastatin clearance.
What to do
Do not use together; select a statin with less CYP3A dependence, such as pravastatin or rosuvastatin at a low starting dose, and monitor for muscle symptoms.
What to ask your pharmacist
- Is there an alternative to one of these two medicines for me?
- If both are essential, who is monitoring me and how often?
- Which symptoms mean I should stop and seek help straight away?
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Other interactions of Simvastatin
- Atazanavir + Simvastatin Contraindicated
- Clarithromycin + Simvastatin Contraindicated
- Cobicistat + Simvastatin Contraindicated
- Cyclosporine + Simvastatin Contraindicated
- Cyclosporin + Simvastatin Contraindicated
- Danazol + Simvastatin Contraindicated
Frequently asked questions
Can I take Elvitegravir / cobicistat / emtricitabine / tenofovir df with Simvastatin?
MediHelp rates the interaction as contraindicated. Elvitegravir / cobicistat / emtricitabine / tenofovir df and Simvastatin are not normally used together. Taking them at the same time is expected to cause harm or make one of them unsafe, so a different medicine is usually chosen for one of the two. Cobicistat in this combination strongly inhibits CYP3A and greatly increases simvastatin exposure, raising the risk of myopathy and rhabdomyolysis. Co-administration is contraindicated.
How serious is the interaction between Elvitegravir / cobicistat / emtricitabine / tenofovir df and Simvastatin?
MediHelp rates it contraindicated, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Do not use together; select a statin with less CYP3A dependence, such as pravastatin or rosuvastatin at a low starting dose, and monitor for muscle symptoms.
What other medicines interact with Simvastatin?
MediHelp also lists interactions of Simvastatin with, for example, Atazanavir, Clarithromycin, Cobicistat. The full list is on the Simvastatin page.
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