▶ St John’s Wort decreases the efficacy of ulipristal. For FSRH
Contraceptives, interactions p. 794.r
▶ St John’s Wort is predicted to decrease the exposure to
velpatasvir. Avoid.oTheoretical
▶ St John’s Wort is predicted to decrease the exposure to
▶ St John’s Wort is predicted to decrease the exposure to
vismodegib. Avoid.oTheoretical
▶ St John’s Wort is predicted to decrease the concentration of
voxilaprevir. Avoid.rTheoretical
Statins → see TABLE 1 p. 1375 (hepatotoxicity)
▶ Antacids moderately decrease the absorption of rosuvastatin.
Separate administration by 2 hours.oStudy
▶ Antiarrhythmics (amiodarone) are predicted to increase the risk
of rhabdomyolysis when given with atorvastatin. Monitor and
▶ Antiarrhythmics (amiodarone) are predicted to increase the
exposure to fluvastatin.rTheoretical
▶ Antiarrhythmics (amiodarone) increase the risk of
rhabdomyolysis when given with simvastatin. Adjust
simvastatin dose, p. 205.rStudy
BNF 78 St John’s Wort — Statins 1533
▶ Antiarrhythmics (dronedarone) are predicted to increase the
atorvastatin. Monitor and adjust dose.r
▶ Antiarrhythmics (dronedarone) slightly increase the exposure to
rosuvastatin. Adjust dose.rStudy
▶ Antiarrhythmics (dronedarone) are predicted to increase the
exposure to simvastatin. Use with caution and adjust
simvastatin dose, p. 205.rStudy
▶ Antiepileptics (carbamazepine) moderately decrease the
▶ Antiepileptics (carbamazepine, eslicarbazepine) are predicted to
decrease the exposure to atorvastatin. Monitor and adjust
dose.oTheoretical → Also see TABLE 1 p. 1375
▶ Antiepileptics (eslicarbazepine) moderately decrease the
are predicted to increase the exposure to atorvastatin.
Monitor and adjust dose.rStudy → Also see TABLE 1 p. 1375
▶ Antifungals, azoles (fluconazole, isavuconazole, posaconazole)
are predicted to increase the exposure to simvastatin. Use with
caution and adjust simvastatin dose, p. 205.rStudy → Also
▶ Antifungals, azoles (fluconazole, miconazole) are predicted to
increase the exposure to fluvastatin.rTheoretical → Also
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to atorvastatin. Avoid or
adjust dose and monitor rhabdomyolysis.rStudy → Also
▶ Antifungals, azoles (itraconazole, ketoconazole, voriconazole) are
predicted to increase the exposure to
Study → Also see TABLE 1 p. 1375
▶ Antifungals, azoles (miconazole) potentially increase the
exposure to atorvastatin.rAnecdotal
▶ Antifungals, azoles (miconazole) are predicted to increase the
exposure to simvastatin. Avoid.rTheoretical
▶ Antifungals, azoles (isavuconazole) are predicted to increase the
statins (fluvastatin, rosuvastatin).o ▶ Apalutamide slightly decreases the exposure to rosuvastatin.
▶ Apalutamide is predicted to decrease the exposure to
simvastatin. Avoid or monitor.oStudy
▶ Aprepitant is predicted to increase the exposure to
atorvastatin. Monitor and adjust dose.rStudy
▶ Aprepitant is predicted to increase the exposure to
simvastatin. Use with caution and adjust simvastatin dose,
▶ Bosentan slightly decreases the exposure to atorvastatin.n
moderately decreases the exposure to simvastatin.
▶ Calcium channel blockers (amlodipine) slightly increase the
exposure to simvastatin. Adjust simvastatin dose, p. 205.n
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to atorvastatin. Monitor and adjust
▶ Calcium channel blockers (diltiazem, verapamil) are predicted to
increase the exposure to simvastatin. Use with caution and
adjust simvastatin dose, p. 205.rStudy
▶ Cephalosporins (ceftobiprole) are predicted to increase the
concentration of statins.oTheoretical
▶ Ciclosporin very markedly increases the exposure to
. Avoid or adjust atorvastatin dose, p. 202.r
moderately increases the exposure to fluvastatin.
▶ Ciclosporin markedly to very markedly increases the exposure
to pravastatin. Adjust dose.rStudy
▶ Ciclosporin markedly increases the exposure to statins
(rosuvastatin, simvastatin). Avoid.rStudy
▶ Clopidogrel increases the exposure to rosuvastatin. Adjust
rosuvastatin dose, p. 204.oStudy
▶ Cobicistat is predicted to increase the exposure to atorvastatin.
Avoid or adjust dose and monitor rhabdomyolysis.
▶ Cobicistat is predicted to increase the exposure to simvastatin.
▶ Colchicine increases the risk of rhabdomyolysis when given
▶ Statins (fluvastatin, rosuvastatin) increase the anticoagulant
effect of coumarins. Monitor INR and adjust dose.rStudy
▶ Crizotinib is predicted to increase the exposure to atorvastatin.
Monitor and adjust dose.rStudy
▶ Crizotinib is predicted to increase the exposure to simvastatin.
▶ Danazol is predicted to increase the risk of rhabdomyolysis
when given with atorvastatin.rTheoretical
▶ Danazol increases the risk of rhabdomyolysis when given with
▶ Statins are predicted to increase the risk of rhabdomyolysis
when given with daptomycin.rTheoretical
▶ Dasabuvir increases the exposure to rosuvastatin. Adjust
rosuvastatin dose, p. 204.oStudy
is predicted to increase the exposure to simvastatin.
▶ Efavirenz slightly decreases the exposure to atorvastatin.n
moderately decreases the exposure to simvastatin.
▶ Elbasvir increases the exposure to atorvastatin. Adjust
atorvastatin dose, p. 202.oStudy
▶ Elbasvir is predicted to increase the exposure to fluvastatin.
Adjust fluvastatin dose, p. 203.qTheoretical
▶ Elbasvir increases the exposure to rosuvastatin. Adjust
rosuvastatin dose, p. 204.oStudy
▶ Elbasvir is predicted to increase the exposure to simvastatin.
Adjust simvastatin dose, p. 205.qTheoretical
▶ Eltrombopag is predicted to increase the exposure to statins.
Monitor and adjust dose.oStudy
▶ Enzalutamide is predicted to decrease the exposure to
▶ Ezetimibe potentially increases the risk of rhabdomyolysis
when given with statins.rAnecdotal
▶ Fibrates (bezafibrate, ciprofibrate) increase the risk of
rhabdomyolysis when given with
▶ Fibrates (bezafibrate, ciprofibrate) increase the risk of
rhabdomyolysis when given with rosuvastatin. Adjust
rosuvastatin dose, p. 204.rStudy
▶ Fibrates (bezafibrate, ciprofibrate) increase the risk of
rhabdomyolysis when given with simvastatin. Adjust
simvastatin dose, p. 205.rStudy
▶ Fibrates (ciprofibrate) increase the risk of rhabdomyolysis
atorvastatin. Avoid or adjust dose.r
▶ Fibrates (ciprofibrate) increase the risk of rhabdomyolysis
when given with fluvastatin.rStudy
▶ Fibrates (fenofibrate) are predicted to increase the risk of
rhabdomyolysis when given with fluvastatin. Adjust
fenofibrate dose, p. 199.rTheoretical
▶ Fibrates (fenofibrate) are predicted to increase the risk of
rhabdomyolysis when given with
▶ Fibrates (fenofibrate) increase the risk of rhabdomyolysis when
given with rosuvastatin. Adjust fenofibrate and rosuvastatin
doses, p. 199, p. 204.rAnecdotal
▶ Fibrates (gemfibrozil) increase the risk of rhabdomyolysis when
given with statins. Avoid.rAnecdotal
▶ Fibrates (bezafibrate) increase the risk of rhabdomyolysis when
given with statins (atorvastatin, fluvastatin).rStudy
▶ Fibrates (fenofibrate) increase the risk of rhabdomyolysis when
given with statins (atorvastatin, simvastatin). Adjust
fenofibrate dose, p. 199.rAnecdotal
▶ Fusidic acid increases the risk of rhabdomyolysis when given
with statins. Avoid.rAnecdotal
▶ Glecaprevir (with pibrentasvir) markedly increases the
exposure to atorvastatin. Avoid.rStudy
▶ Glecaprevir (with pibrentasvir) is predicted to increase the
exposure to fluvastatin.oTheoretical
▶ Glecaprevir (with pibrentasvir) increases the exposure to
pravastatin. Use with caution and adjust pravastatin dose,
▶ Glecaprevir (with pibrentasvir) increases the exposure to
rosuvastatin. Use with caution and adjust rosuvastatin dose,
▶ Glecaprevir (with pibrentasvir) increases the exposure to
▶ Grapefruit juice increases the exposure to atorvastatin.n
increases the exposure to simvastatin. Avoid.
▶ Grazoprevir increases the exposure to atorvastatin. Adjust
atorvastatin dose, p. 202.oStudy
▶ Grazoprevir is predicted to increase the exposure to
fluvastatin. Adjust fluvastatin dose, p. 203.qTheoretical
▶ Grazoprevir increases the exposure to rosuvastatin. Adjust
rosuvastatin dose, p. 204.oStudy
▶ Grazoprevir is predicted to increase the exposure to
simvastatin. Adjust simvastatin dose, p. 205.qTheoretical
▶ HIV-protease inhibitors are predicted to increase the exposure
to atorvastatin. Avoid or adjust dose and monitor
▶ HIV-protease inhibitors slightly to moderately increase the
exposure to rosuvastatin. Avoid or adjust dose.rStudy
▶ HIV-protease inhibitors are predicted to increase the exposure
▶ Idelalisib is predicted to increase the exposure to atorvastatin.
Avoid or adjust dose and monitor rhabdomyolysis.
▶ Idelalisib is predicted to increase the exposure to simvastatin.
▶ Imatinib is predicted to increase the exposure to atorvastatin.
Monitor and adjust dose.rStudy
▶ Imatinib is predicted to increase the exposure to simvastatin.
▶ Ledipasvir is predicted to increase the exposure to
rosuvastatin. Avoid.rTheoretical
▶ Ledipasvir is predicted to increase the exposure to statins
(atorvastatin, fluvastatin, pravastatin, simvastatin). Monitor
▶ Leflunomide is predicted to increase the exposure to
rosuvastatin. Adjust dose.oStudy → Also see TABLE 1
▶ Leflunomide is predicted to increase the exposure to statins
(atorvastatin, fluvastatin, pravastatin, simvastatin)
Study → Also see TABLE 1 p. 1375
.o ▶ Letermovir moderately increases the exposure to atorvastatin.
Avoid or adjust atorvastatin dose, p. 202.rStudy
▶ Letermovir is predicted to increase the exposure to fluvastatin.
Monitor and adjust dose.oTheoretical
▶ Letermovir is predicted to increase the exposure to
pravastatin. Avoid or adjust dose.oTheoretical
▶ Letermovir is predicted to increase the exposure to statins
(rosuvastatin, simvastatin). Avoid.rStudy
▶ Lomitapide increases the exposure to atorvastatin. Adjust
lomitapide dose or separate administration by 12 hours, p. 207.
nStudy → Also see TABLE 1 p. 1375
▶ Lomitapide increases the exposure to simvastatin. Monitor and
adjust simvastatin dose, p. 205.oStudy → Also see TABLE 1
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to atorvastatin. Avoid or adjust dose and monitor
▶ Macrolides (clarithromycin) moderately increase the exposure
▶ Macrolides (clarithromycin) are predicted to increase the
exposure to simvastatin. Avoid.rStudy
▶ Macrolides (erythromycin) are predicted to increase the
atorvastatin. Monitor and adjust dose.r
▶ Macrolides (erythromycin) are predicted to increase the
exposure to pravastatin.rStudy
▶ Macrolides (erythromycin) are predicted to increase the
exposure to simvastatin. Use with caution and adjust
simvastatin dose, p. 205.rStudy
is predicted to decrease the exposure to simvastatin.
▶ Monoclonal antibodies (sarilumab) are predicted to decrease the
exposure to statins (atorvastatin, simvastatin).oStudy
▶ Monoclonal antibodies (tocilizumab) are predicted to decrease
the exposure to statins (atorvastatin, simvastatin). Monitor and
▶ Netupitant is predicted to increase the exposure to
atorvastatin. Monitor and adjust dose.rStudy
▶ Netupitant is predicted to increase the exposure to
simvastatin. Use with caution and adjust simvastatin dose,
▶ Nevirapine slightly decreases the exposure to atorvastatin.
moderately decreases the exposure to simvastatin.
▶ Nicotinic acid is predicted to increase the risk of
rhabdomyolysis when given with statins.rTheoretical
▶ Nilotinib is predicted to increase the exposure to atorvastatin.
Monitor and adjust dose.rStudy
▶ Nilotinib is predicted to increase the exposure to simvastatin.
slightly increases the exposure to rosuvastatin.
▶ Paritaprevir (in fixed-dose combination) is predicted to
increase the risk of rhabdomyolysis when given with
atorvastatin. Avoid.rTheoretical
▶ Paritaprevir (with ritonavir and ombitasvir) is predicted to
fluvastatin. Avoid.o ▶ Paritaprevir (with ritonavir and ombitasvir) increases the
pravastatin. Adjust pravastatin dose, p. 203.
▶ Paritaprevir (with ritonavir and ombitasvir) slightly to
moderately increases the exposure to rosuvastatin. Adjust
rosuvastatin dose, p. 204.oStudy
▶ Paritaprevir (in fixed-dose combination) is predicted to
increase the risk of rhabdomyolysis when given with
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