Muscle Aches With Simvastatin
Serious muscle problems are more common when simvastatin is first started or when your dosage is increased, but they can happen at any time. There are also certain medicines that, when combined with simvastatin, can increase the risk of serious muscle problems. These medicines include:
- Cobicistat-containing products (such as Stribild®)
- Cyclosporine (Gengraf®, Neoral®, Sandimmune®)
- Danazol (Danocrine®)
- Diltiazem (Cardizem®, Cardizem CD®, Cardizem LA®, Cartia XT®, Dilacor XR®, Dilt-CD®, Diltia XT®, Dilt-XR®, Taztia XT®, Tiazac®)
- Fibrates, such as:
- Niacin (nicotinic acid, Niacor®, Nicolar®)
- Clarithromycin (Biaxin®)
- Telithromycin (Ketek®)
- Protease inhibitors, such as:
- Nefazodone (Serzone®)
- Amiodarone (Cordarone®, Pacerone®)
- Amlodipine (Norvasc®)
- Ranolazine (Ranexa®)
- Verapamil (Calan®, Calan® SR, Verelan®, Verelan PM®, Isoptin®, Covera-HS®)
- Antifungals, such as ketoconazole (Nizoral®), posaconazole (Noxafil®), and itraconazole (Sporanox®).
Grapefruit juice and grapefruit products (including grapefruit supplements) should also be avoided (see Simvastatin and Grapefruit).
Some of these medications should not be combined with simvastatin at all, while others can be taken as long as the dosing with simvastatin is reduced (see Drug Interactions With Simvastatin for more information).
Keep in mind that the risks increase with higher simvastatin dosages and appear to be highest in the first year of use. The highest simvastatin dosage (80 mg a day) should be reserved only for people who have already been on that dosage for a year or more without any muscle problems. For everyone else, the maximum dosage is 40 mg a day (or even less, in some situations).