Drug interactions
Nirmatrelvir + Simvastatin
Severity: Contraindicated
Nirmatrelvir 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
Nirmatrelvir is given with ritonavir, which strongly inhibits CYP3A and greatly increases simvastatin exposure, with a risk of rhabdomyolysis. Co-administration is contraindicated.
What this interaction means in plain words
Nirmatrelvir 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.
Nirmatrelvir belongs to Anti Virals; Simvastatin belongs to Cardiovascular.
Why it happens
The ritonavir component inhibits CYP3A4, and nirmatrelvir itself is a CYP3A inhibitor, reducing simvastatin metabolism.
What to do
Hold simvastatin from before the start of treatment, throughout the 5-day course, and for several days afterward; consider a temporary alternative such as rosuvastatin or pravastatin or a short pause in statin therapy.
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
Other interactions of Nirmatrelvir
- Alfuzosin + Nirmatrelvir Contraindicated
- Amiodarone + Nirmatrelvir Contraindicated
- Apalutamide + Nirmatrelvir Contraindicated
- Carbamazepine + Nirmatrelvir Contraindicated
- Colchicine + Nirmatrelvir Contraindicated
- Dronedarone + Nirmatrelvir Contraindicated
Frequently asked questions
Can I take Nirmatrelvir with Simvastatin?
MediHelp rates the interaction as contraindicated. Nirmatrelvir 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. Nirmatrelvir is given with ritonavir, which strongly inhibits CYP3A and greatly increases simvastatin exposure, with a risk of rhabdomyolysis. Co-administration is contraindicated.
How serious is the interaction between Nirmatrelvir 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: Hold simvastatin from before the start of treatment, throughout the 5-day course, and for several days afterward; consider a temporary alternative such as rosuvastatin or pravastatin or a short pause in statin therapy.
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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