Drug Interaction between Azithromycin and Simvastatin

Azithromycin is a macrolide antibiotics used to treat or prevent various types of bacterial infections.
Simvastatin is an HMG CoA reductase inhibitor and a member of the statins drug class used to manage high cholesterol and to lower the risk of stroke, heart attack and other heart complications.

The concomitant use of both Azithromycin and Simvastatin can lead to a major drug interaction. This is because macrolide antibiotics inhibit CYP450 3A4 which can increase the plasma concentrations of HMG-CoA reductase inhibitors. There have been reports of up to severalfold increase in plasma levels of HMG-CoA reductase inhibitors used with macrolides. Patients have also been reported to come down with severe myopathy or rhabdomyolysis.

This is considered a very serious drug interaction in which close monitoring or an alternative is strongly recommended. A reduced dose of Simvastatin (or the HMG CoA reductase inhibitor involved) is also recommended.

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