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Table 27. Clinical Recommendations on Management of DDI
With Statins and Cardiovascular Medications
Interacting Drug Statin Clinical Recommendation for Management
Gemfibrozil Atorvastatin Avoid combination
Lovastatin Avoid combination
Pitavastatin Avoid combination
Pravastatin Avoid combination
Rosuvastatin Avoid combination
Simvastatin Avoid combination
Lomitapide Lovastatin Reduce dose of lovastatin by 50%
Simvastatin Reduce dose of simvastatin by 50% and limit dose
to 20 mg daily
Ranolazine Lovastatin Combination is acceptable to use if clinically
indicated and an alternative non-CYP3A4 statin
cannot be used. However, doses of lovastatin or
simvastatin should not exceed 20 mg daily.
Simvastatin
Ticagrelor Atorvastatin Combination is acceptable without dose limitations
Lovastatin Limit dose of lovastatin to 40 mg daily
Simvastatin Limit dose of simvastatin to 40 mg daily
Verapamil Lovastatin Limit dose of lovastatin to 20 mg daily
Simvastatin Limit dose of simvastatin to 10 mg daily
DDI indicates drug-drug interaction.
Modified with permission from Kellick et al. Copyright © 2014 Elsevier. Modified with
permission from Wiggins et al. Copyright © 2016 American Heart Association, Inc. See additional
references for prescribing information for each statin.
(cont'd)
