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23Peces RPobes ARhabdomyolysis associated with concurrent use of simvastatin and diltiazemNephron 892001117-8.

In a clinical trial in which 12,064 patients . with a history of myocardial infarction were treated with simvastatinmean follow-up 6.7 yearsthe incidence of myopathydefined as unexplained muscle weakness or pain with a serum creatine kinaseCK10 times upper limit of normalULNin patients on 80 mg/day was approximately 0.9compared with 0.02for patients on 20 mg/dayThe incidence of rhabdomyolysisdefined as myopathy with a CK40 times ULNin patients on 80 mg/day was approximately 0.4compared with 0for patients on 20 mg/dayThe incidence of myopathyincluding rhabdomyolysiswas highest during the first year and then notably decreased during the subsequent years of treatmentIn this trialpatients were carefully monitored and some interacting medicinal products were excluded.

31Davidson MHMaccubbin DStepanavage MStrony JMusliner TStriated muscle safety , . of ezetimibesimvastatinvytorinAm J Cardiol 972006223-8.

Persistent elevations in liver function tests three times normal values are reported in up to 1.5of patients on simvastatin in clinical trialsIn one studythis led to the discontinuation of simvastatin in 0.6of patientsIn other patientselevations in liver function tests were transient and returned to normal with continued simvastatin therapyRef]

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