66 year old female was newly diagnosed with atrial fibrillation. Her other diagnoses included hypertension, diabetes, hyperlipidemia, and GERD.
Current medication list included:
- Aspirin 81 mg daily
- Simvastatin (Zocor) 40 mg at bedtime
- Tylenol as needed
- Protonix 40 mg daily
- Lisinopril 10 mg daily
- Metformin 500 mg twice daily
With the new diagnosis of atrial fibrillation, the primary provider started the patient on Diltiazem (Cardizem) CD 180 mg daily.
Within a few weeks, the patient began to feel worsening muscle pains and aching. She could not attribute it to physical activity or anything else going on in her life. She began taking the Tylenol as needed 2-3 times per day to try to help with the pain she was having.
Upon investigation of the medication regimen, it was discovered that the Diltiazem had been started a few weeks back. Diltiazem can increase the serum concentration of simvastatin which is likely what happened in this case leading to the muscle pain/soreness.
Per Lexicomp, simvastatin and diltiazem used together should be avoided if other alternatives exist. If use can’t be avoided, then a maximum recommended dose of Zocor at 10 mg daily should be considered. The Zocor and Diltiazem interaction is one you need to be aware of!
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