January 22, 1997

Myositis and Rhabdomyolysis Associated With Concurrent Use of Simvastatin and Nefazodone-Reply

Author Affiliations

Bristol-Myers Squibb Co Princeton, NJ

JAMA. 1997;277(4):296-297. doi:10.1001/jama.1997.03540280034022

In Reply.  —To our knowledge, this is the first report of these adverse events associated with concomitant use of simvastatin and nefazodone. Since simvastatin is thought to be metabolized by cytochrome P-450 3A4 (CYP3A4),1 an increased likelihood of these adverse events might be expected if simvastatin is coadministered with any agent that inhibits the activity of the CYP3A4 isoenzyme (eg, nefazodone, fluvoxamine, fluoxetine, sertraline, grapefruit juice, erythromycin, ketoconazole, or itraconazole).2 In addition, myositis and rhabdomyolysis are adverse events associated with simvastatin monotherapy.