Drug interactions
Simvastatin + Tacrolimus
Severity: Moderate
Simvastatin and Tacrolimus: 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
Tacrolimus may raise simvastatin exposure, possibly through hepatic uptake transporter inhibition, which could increase the risk of myopathy. Simvastatin may also slightly affect tacrolimus handling through P-glycoprotein, but this effect is poorly established. Transplant patients often have other risk factors for muscle toxicity.
What this interaction means in plain words
Simvastatin and Tacrolimus 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.
Simvastatin belongs to Cardiovascular; Tacrolimus belongs to Miscellaneous.
Why it happens
Possible inhibition of OATP1B1-mediated hepatic uptake of simvastatin by tacrolimus, with minor competition at P-glycoprotein.
What to do
Use the lowest effective simvastatin dose and consider a statin with less interaction potential in transplant recipients. Monitor for muscle pain, weakness and CK elevation, and check tacrolimus trough levels when therapy changes.
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 Simvastatin
- Atazanavir + Simvastatin Contraindicated
- Clarithromycin + Simvastatin Contraindicated
- Cobicistat + Simvastatin Contraindicated
- Cyclosporine + Simvastatin Contraindicated
- Cyclosporin + Simvastatin Contraindicated
- Danazol + Simvastatin Contraindicated
Other interactions of Tacrolimus
- Adenovirus types 4 and 7 live + Tacrolimus Contraindicated
- Bcg vaccine live + Tacrolimus Contraindicated
- Cidofovir + Tacrolimus Contraindicated
- Cyclosporin + Tacrolimus Contraindicated
- Influenza virus vaccine quadrivalent intranasal + Tacrolimus Contraindicated
- Measles mumps and rubella vaccine live + Tacrolimus Contraindicated
Frequently asked questions
Can I take Simvastatin with Tacrolimus?
MediHelp rates the interaction as moderate. Simvastatin and Tacrolimus 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. Tacrolimus may raise simvastatin exposure, possibly through hepatic uptake transporter inhibition, which could increase the risk of myopathy. Simvastatin may also slightly affect tacrolimus handling through P-glycoprotein, but this effect is poorly established. Transplant patients often have other risk factors for muscle toxicity.
How serious is the interaction between Simvastatin and Tacrolimus?
MediHelp rates it moderate, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Use the lowest effective simvastatin dose and consider a statin with less interaction potential in transplant recipients. Monitor for muscle pain, weakness and CK elevation, and check tacrolimus trough levels when therapy changes.
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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