Fluvastatininteractions

Gemfibrozil: Avoid use with fluvastatin.

Cyclosporine and Fluconazole: Avoid use with fluvastatin. Fibrates, Lipid-modifying doses (≥ 1 g/day) of Niacin, and Colchicine: Consider if the benefit of concomitant use with fluvastatin outweighs the increased risk of myopathy and rhabdomyolysis. If concomitant use is decided, monitor patients for signs and symptoms of myopathy, particularly during initiation of therapy and during upward dose titration.

Warfarin: Obtain an International Normalized Ratio (INR) before starting and frequently enough after initiation or discontinuation to ensure that no significant alteration in INR occurs. Once the INR is stable, monitor INR at regular intervals.

Glyburide: Monitor blood glucose levels when fluvastatin is initiated.

Phenytoin: Monitor plasma phenytoin levels when fluvastatin treatment is initiated.

7.1 Drug Interactions

That Increase the Risk of Myopathy and Rhabdomyolysis with Fluvastatin Table 3 includes a list of drugs that increase the risk of myopathy and rhabdomyolysis when used concomitantly with fluvastatin and instructions for preventing or managing them. Table 3. Drug Interactions That Increase the Risk of Myopathy and Rhabdomyolysis with Fluvastatin Gemfibrozil Clinical impact There is an increased risk of myopathy/rhabdomyolysis when fluvastatin is administered with gemfibrozil Intervention Avoid concomitant use of gemfibrozil with fluvastatin. Cyclosporine Clinical impact Cyclosporine coadministration increases fluvastatin exposure. The risk of myopathy and rhabdomyolysis may be increased with concomitant use of cyclosporine with fluvastatin. Intervention Avoid concomitant use of cyclosporine with fluvastatin. Fluconazole Clinical impact Fluconazole coadministration increases fluvastatin exposure. The risk of myopathy and rhabdomyolysis may be increased with concomitant use of fluconazole with fluvastatin. Intervention Avoid concomitant use of fluconazole with fluvastatin Niacin Clinical impact Risk of myopathy and rhabdomyolysis may be enhanced with concomitant use with lipid-modifying doses (≥ 1 g/day) of niacin with fluvastatin. Intervention Consider if the benefit of using lipid-modifying doses (≥ 1 g/day) of niacin concomitantly with fluvastatin outweighs the increased risk of myopathy and rhabdomyolysis. If concomitant use is decided, monitor patients for signs and symptoms of myopathy, particularly during initiation of therapy and during upward dose titration. Fibrates Clinical impact Fibrates may cause myopathy when given alone. The risk of myopathy and rhabdomyolysis may be increased with concomitant use of fibrates with fluvastatin. Intervention Consider if the benefit of using fibrates concomitantly with fluvastatin outweighs the increased risk of myopathy and rhabdomyolysis. If concomitant use is decided, monitor patients for signs and symptoms of myopathy, particularly during initiation of therapy and during upward dose titration. Colchicine Clinical impact Cases of myopathy and rhabdomyolysis have been reported with concomitant use of colchicine with fluvastatin. Intervention Consider if the benefit of using colchicine concomitantly with fluvastatin outweighs the increased risk of myopathy and rhabdomyolysis. If concomitant use is decided, monitor patients for signs and symptoms of myopathy, particularly during initiation of therapy and during upward dose titration.

7.2 Fluvastatin

Effects on Other Drugs Table 4 presents fluvastatins effect on other drugs and instructions for preventing or managing them. Table 4. Fluvastatin Effects on Other Drugs Warfarin Clinical impact There are postmarketing reports of clinically evident bleeding and/or increased INR in patients taking concomitant statins and warfarin. Intervention In patients taking warfarin, obtain an INR before starting fluvastatin and frequently enough after initiation or discontinuation to ensure that no significant alteration in INR occurs. Once the INR is stable, monitor INR at regularly recommended intervals. Glyburide Clinical impact Concomitant administration of fluvastatin and glyburide increased glyburide exposures. Intervention Monitor blood glucose levels when fluvastatin is initiated. Phenytoin Clinical impact Concomitant administration of fluvastatin and phenytoin increased phenytoin exposures. Intervention Monitor plasma phenytoin levels when fluvastatin is initiated.