Marked rises in statin plasma levels have been seen when lovastatin was given with diltiazem, and when simvastatin was given with diltiazem or verapamil. Isolated cases of rhabdomyolysis have been seen when atorvastatin or simvastatin were given with diltiazem or verapamil. However, it seems that problems with combinations of statins and calcium-channel blockers are rare.
It has been suggested that treatment with a statin in those taking diltiazem (and probably verapamil) should be started with the lowest possible dose and titrated upwards, or considerably reduced if either of these calcium-channel blockers is started. The manufacturers recommend a maximum simvastatin dose of 20 mg in patients taking verapamil and 40 mg in patients taking diltiazem. Patients should be told to be alert for any signs of possible rhabdomyolysis (i.e. otherwise unexplained muscle tenderness, pain or weakness or dark coloured urine).
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