zocor
4 interactions related to zocor
simvastatin + coq10
Simvastatin blocks HMG-CoA reductase, the enzyme upstream of both cholesterol and coenzyme Q10 (CoQ10) synthesis, so it lowers circulating CoQ10 alongside cholesterol. This depletion is a plausible contributor to statin-associated muscle symptoms, and some randomized trials suggest CoQ10 supplements modestly ease those symptoms — though the evidence is mixed.
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 the same mechanism and metabolism, adding to the risk of muscle injury, rhabdomyolysis, and liver problems.
simvastatin + berberine
Simvastatin is activated and cleared by the CYP3A4 enzyme. A human study found that repeated berberine inhibits CYP3A4, which could raise simvastatin levels and increase the risk of muscle-related side effects. Some animal data suggest berberine can also induce CYP3A4 over time, so the net effect on statin exposure is hard to predict. There are no published human case reports of myopathy from this specific combination, so the concern is mechanistic and moderate.
simvastatin + st. john's wort
St. John's wort induces the CYP3A4 enzyme and the P-glycoprotein transporter that simvastatin depends on, sharply increasing the drug's first-pass breakdown. In a controlled crossover study of healthy volunteers, two weeks of St. John's wort substantially lowered the amount of active simvastatin reaching the bloodstream, weakening its cholesterol-lowering effect.