zocor
4 interactions related to zocor
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).