Use of statins with ciclosporin

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

However, simvastatin, atorvastatin, and lovastatin are metabolised by the hepatic cytochrome P450 3A4 (CYP3A4) enzyme system whereas pravastatin, 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 receiving immunosuppressive drugs and also require a statin. CYP3A4 metabolises ciclosporin, tacrolimus, and sirolimus. As highlighted in box 1,1 increased statin concentrations occur with ciclosporin treatment, increasing the risk of myopathy.

The maximum dose of statin with ciclosporin according to product information is simvastatin 10 mg, atorvastatin 10 mg, pravastatin 20 mg increasing to 40 mg; caution is advised wih fluvastatin, and rosuvastatin is contraindicated.