Ciclosporin can cause marked rises in the
plasma levels of atorvastatin,
fluvastatin,
lovastatin,
pravastatin and
simvastatin, and for some of the
statins this had led to the development of serious myopathy (rhabdomyolysis) accompanied by kidney failure. The
plasma levels of
ciclosporin appear not to be affected by
fluvastatin,
lovastatin or
pravastatin, but some moderate changes have been seen when atorvastatin or
simvastatin were used.
Concurrent use should be very well monitored, a precautionary recommendation being to start (or reduce) the statin at the lowest daily dose, appropriate to the patient's condition. It has been suggested by some manufacturers that the dose of
simvastatin should not exceed 10 mg daily, and the dose of
lovastatin should not exceed 20 mg daily, in patients taking
ciclosporin. Patients should be told to report any signs of myopathy and possible rhabdomyolysis (i.e. otherwise unexplained muscle pain, tenderness or weakness or dark coloured urine). If myopathy does occur, withdrawing the statin has been shown to resolve the
symptoms. Only
simvastatin and atorvastatin appear to affect
ciclosporin levels, and it may be prudent to monitor
ciclosporin levels more closely with these two drugs.