Interaction between Zocord (simvastatin) and Cordarone (amiodaron)./nA patient has been treated for

Fråga: Interaction between Zocord (simvastatin) and Cordarone (amiodaron).

A patient has been treated for several months with amiodarone (200 mg x1) and has now started simvastatin (10 mg per day as initial dose). Should the dose of amiodarone be adjusted in some way?

The patient is also taking Capoten (captopril), Lasix (furosemide) and Trombyl (acetylsalicylic acid).

Sammanfattning: Simvastatin is an antihyperlipidemic treatment that inhibits hydroxymethylglutaryl coenzyme-A reductase. Pharmacokinetic data for simvastatin are limited. According to the manufacturer, inactive simvastatin is highly extracted by the liver after oral absorption and hydrolyzed to the active beta-hydroxy-acid form of the drug. For the most part, the metabolites are excreted in the bile. The most common clinical adverse effects associated with simvastatin were headache (6.5 per cent), constipation (5.7 per cent), nausea (4.4 per cent), flatulence (3.4 per cent), diarrhoea (2.9 per cent), dyspepsia (2.9 per cent), abdominal pain (2.8 per cent) and fatigue (2.7 per cent). Elevations of serum transaminases and creatinine phosphokinase have also been shown to be associated with simvastatin use (cf 1).

Limited data are available concerning drug interactions associated with simvastatin. It has been documented that simvastatin enhances the prothrombin time slightly in patients receiving warfarin and also interacts with digoxin (cf 1). Pharmacodynamic adverse effects were not observed when simvastatin was concurrently used with beta- blockers, diuretics, calcium-channel blockers, or non-steroidal antiinflammatory agents (cf 1). There is no report in the literature regarding the interactions between simvastatin and amiodarone. Plasma concentrations of amiodarone can be monitored if changes of the drug concentration are suspected.

Svar: Se sammanfattning/konklusjon.