Risky to take itraconazole while on simvastatin?

[allencraig]

Wondering if anyone has deeper knowledge on this beyond the general warning provided on the package insert.

 

I've been taking 40mg of Bestatin (simvastatin) daily and would like to begin a 12-week cycle of itraconazole, an oral anti-fungal, for a persistent, chronic toenail fungal problem (onychomycosis). It had been diagnosed as such by a doctor in NY years ago but his one-month oral treatment didn't do the trick.

 

Warning states "Itraconazole is also contraindicated for concomitant use with 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors, such as atorvastatin (Lipitor), because of the increased risk of rhabdomyolysis."

 

I'm 54, thin, healthy, exercise regularly and have no liver issues as far as I know other than my general hypochondriasm. Should I avoid taking Itraconazole alltogether, or move ahead but with caution?

 

Thanks for any input.

[Sheryl]

There is indeed an increased risk of rhabdo if you take an anti-fungal of this type with a statin of the group that is "CYP3A4-metabolized" which includes aotrvastatin and simvastatin.

 

The best solution if topical antifungals don't suffice would be to first switch to a statin not in that group, for example rosuvastain which is available here under brand names:

 

• Alvostat
• Cholestor 10
• K-zuva
• Otagil
• Rostatin
• Rosucor
• Rosuvastatin Sandoz
• Rovastor
• Surotin

 

Of these brands,  Alvostat, Rosucor and Rosuvastion Sandoz and expensive imports. The other brands are locally made and will cost much less though probably still a bit more than Simvastatin.

Note that doses are not equivalent rather 1:4 i.e. if you are on 20 mg Simva the rosuvastin dose would be 5mg; if youy are on 40 then 10 etc.

https://pubmed.ncbi.nlm.nih.gov/12709722/

 

[allencraig]

On 10/6/2020 at 6:52 PM, Sheryl said:

The best solution if topical antifungals don't suffice would be to first switch to a statin not in that group

Ahhh... that's a good idea. I'd researched a bit before settling on simvastatin, but if I'm committed to taking the oral antifungals I could (carefully) switch my statin and even if I wanted to, I could (carefully) switch back after i complete the antigungal cycle. Thanks!