Abstract
Answer E. Switch simvastatin to pravastatin
The maximum recommended dose for simvastatin in conjunction with amlodipine or diltiazem is 20 mg/day. If a patient is on simvastatin 40 mg in conjunction with amlodipine, the options in order of preference are:
Change to an alternative formulary statin (Pravastatin does not interact with amlodipine) Reduce simvastatin dose 20 mg/day Maintain simvastatin on ‘off label’ dose of 40 mg/day after discussion of risks and benefits with patients
Change to an alternative formulary calcium channel blocker (diltiazem and verapamil are not options as the maximum dose of simvastatin is also 20 mg/day)
Wales NHS: Medicines and Healthcare products regulatory agency recommendations on simvastatin interactions-implications for patients taking amlodipine and simvastatin 40 mg/day http://www.wales.nhs.uk/sites3/docopen.cfm?orgid=814&id=198057