Warfarin Institute of America
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SIMVASTATIN INTERACTION WITH WARFARIN
Brand Name: Zocor
Interactions between these two medications have not been widely reported. However, Mogyorosi and colleagues reported an interaction that is serious enough to make everyone proceed with caution when using this combination.
They report the case of an 82-year-old African-American male who had been taking simvastatin for 18 months to control high cholesterol. He developed a blood clot in his leg and was started on warfarin 5 mg per day. After one week, he was admitted to the hospital muscle pain in his legs and weakness. His INR was only mildly elevated at 4.3. He developed kidney failure. A diagnosis of rhabdomyolysis was made. This is a serious breakdown of muscle with the components which can cause kidney failure and death. The simvastatin was discontinued, and he was treated aggressively with intravenous fluids. He recovered and was discharged with a lower dose of warfarin.
The authors speculate that this interaction is not seen more often because close monitoring of patients results in the warfarin dose being lowered and thus serious adverse reactions are prevented. They recommend that everyone starting this combination of drugs be closely monitored to prevent similar reactions. However, as of November 2004, I can find no other reports of this in any medical journals.
Reference:
Mogyorosi A et al. Rhabdomyolysis and Acute Renal Failure Due to Combination Therapy with Simvastatin and Warfarin. J Intern Med 1999;246:599-602
Editor's Note: Also see the pages on atorvastatin ( a similar drug) and grapefruit juice.
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Last updated November 21, 2004