QuestionSBA
QuestionChoice
Aspirin is not known to interact with simvastatin to cause myalgia
34274
e
Aspirin 75 mg PO OD
QuestionChoice
Co-amoxiclav is not known to interact with simvastatin to cause myalgia
34272
c
Co-amoxiclav 1.2 g IV TDS
QuestionChoice
Metformin is not known to interact with simvastatin to cause myalgia
34271
b
Metformin hydrochloride 500 mg PO TDS
QuestionChoice
Clarithromycin is a potent CYP3A4 inhibitor, which prevents the metabolism of simvastatin. This increases simvastatin plasma levels, significantly raising the risk of muscle pain, myopathy, and potentially life-threatening rhabdomyolysis. Patients on simvastatin should avoid clarithromycin or temporarily discontinue simvastatin when macrolides are prescribed.
34270
a
Clarithromycin 500 mg PO BD
QuestionChoice
Lisinopril is not known to interact with simvastatin to cause myalgia
34273
d
Lisinopril 20 mg PO OD
QuestionComment
@serotonin stasis, suck ya mutha, whats that got to do with the price of fish?
42461
User
subscriber
ButtMuncher
Concept
Chapter
#### Monitoring

The BNF advises to monitor lung function (in patients with a history of obstructive airway disease).

#### Overdoses

Overdosages with beta-blockers may cause cardiac effects such as bradycardia, hypotension, syncope, conduction abnormalities, and heart failure. Bradycardia is the most common arrhythmia, but some beta-blockers may induce ventricular tachyarrhythmias secondary to prolongation of QT interval (e.g. sotalol) or QRS duration (e.g. propranolol).
Non-cardiovascular effects include central nervous system effects (including drowsiness, confusion, convulsions, hallucinations, and in severe cases coma), respiratory depression, and bronchospasm.

Management
 - Airway protection 
 - Activated charcoal within 1 hour
 - IV Fluids
 
IV glucagon is the first-line management.
 
For symptomatic bradycardia, IV atropine may be used.

2618
2797
Statin side effects
Topic
9
Internal Medicine
6865
Case presentation: A 70-year-old woman is admitted to hospital for community-acquired pneumonia. During the ward round, she reports that she has been having muscle pain in both her arms and legs.  

PMH: Diabetes Mellitus, Hypertension, Myocardial infarction, Reflux oesophagitis
DH: Her current regular prescriptions, in addition to Simvastatin 80 mg PO nightly, are listed below
Observations: Temperature 37.5, Respiratory rate 32, Blood pressure 88/64, Heart rate 76

Question: Select the prescription that is most likely to have interacted with simvastatin to cause the muscle pain
a