simvastatin
9 interactions related to simvastatin
simvastatin + coq10
Simvastatin inhibits HMG-CoA reductase, the enzyme upstream of both cholesterol and coenzyme Q10 synthesis. This produces a measurable decline in circulating CoQ10 and may contribute to mitochondrial dysfunction underlying statin-associated muscle symptoms.
simvastatin + red yeast rice
Red yeast rice contains monacolin K, which is chemically identical to the prescription statin lovastatin. Adding it to simvastatin stacks two statins with similar mechanisms and metabolism, sharply increasing the risk of myopathy, rhabdomyolysis, and liver injury.
simvastatin + berberine
Simvastatin is extensively metabolized by CYP3A4, and berberine inhibits CYP3A4 in vitro, which can raise simvastatin levels and increase the risk of myopathy and rhabdomyolysis. The interaction is bidirectional in some models (induction is also possible), making net effect unpredictable.
simvastatin + st. john's wort
St. John's wort induces intestinal and hepatic CYP3A4 and P-glycoprotein, sharply increasing simvastatin's first-pass metabolism. In a crossover study of healthy adults, the AUC of active simvastatin hydroxy acid was cut roughly in half (to about 48% of placebo).
blood orange + simvastatin
Blood orange (Citrus sinensis var.) is a sweet orange and does not contain the furanocoumarins (bergamottin, 6',7'-dihydroxybergamottin) that drive the grapefruit-statin interaction. Published reviews of citrus furanocoumarin content list blood orange among the sweet oranges as essentially free of clinically significant CYP3A4-inhibiting compounds.
pomegranate + statins
Pomegranate juice inhibits intestinal CYP3A4, the main enzyme that metabolizes simvastatin, atorvastatin, and lovastatin. A published case report links pomegranate juice consumption to rhabdomyolysis in a patient stable on rosuvastatin, and the same enzyme inhibition can raise the systemic exposure and muscle toxicity risk of CYP3A4-metabolized statins.
cbd + simvastatin
Simvastatin is heavily dependent on CYP3A4 for first-pass and systemic clearance, and CBD inhibits CYP3A4. Co-administration is expected to raise simvastatin and active-metabolite exposure, increasing the risk of muscle pain, transaminase elevation, and rare rhabdomyolysis.
bergamot + statins
Bergamot orange (Citrus bergamia) is the source of bergamottin, the prototype furanocoumarin that irreversibly inhibits CYP3A4. Bergamot juice and high-dose bergamot polyphenol supplements (BPF), often marketed for cholesterol, can theoretically raise levels of CYP3A4-metabolized statins (simvastatin, atorvastatin, lovastatin), though human pharmacokinetic data with statins are limited.
pomelo + simvastatin
Pomelo (Citrus maxima) contains furanocoumarins that irreversibly inhibit intestinal CYP3A4, the enzyme that metabolizes simvastatin during first-pass absorption. With CYP3A4 disabled, simvastatin plasma concentrations rise substantially, increasing the risk of myopathy and rhabdomyolysis.