Use of statins with ciclosporin

doi:10.1136/bmj.a2788

Published 2 December 2008, doi:10.1136/bmj.a2788
Cite this as: BMJ 2008;337:a2788

Letters

Statin induced myopathy

Use of statins with ciclosporin

The first 100% of the full text of this article appears below.

Sathasivam and Lecky say that lipophilic statins (simvastatin,atorvastatin, lovastatin) are more likely to produce musculareffects than are relatively hydrophilic agents (pravastatin,rosuvastatin, fluvastatin).¹

However, simvastatin, atorvastatin, and lovastatin are metabolisedby the hepatic cytochrome P450 3A4 (CYP3A4) enzyme system whereaspravastatin, fluvastatin, and rosuvastatin do not rely on CYP3A4.This is especially important in patients with a renal transplant(and other transplants and other conditions) who are receivingimmunosuppressive drugs and also require a statin. CYP3A4 metabolisesciclosporin, tacrolimus, and sirolimus. As highlighted in box1,¹ increased statin concentrations occur with ciclosporin treatment,increasing the risk of myopathy.

The maximum dose of statin with ciclosporin according to productinformation is simvastatin 10 mg, atorvastatin 10 mg, pravastatin20 mg increasing to 40 mg; caution is advised wih fluvastatin,and rosuvastatin is contraindicated.

Cite this as: BMJ 2008;337:a2788

Brian Camilleri, consultant nephrologist¹

¹ Ipswich Hospital NHS Trust, Ipswich IP4 5PD

brian.camilleri@ipswichhospital.nhs.uk

Competing interests: None declared.