Basic Information
ID DDInter1035 and DDInter133
Interaction The risk of rhabdomyolysis may be increased during coadministration of lenalidomide with HMG-CoA reductase inhibitors (statins). The mechanism is unknown but may involve additive pharmacodynamic effects.
Management European product labeling recommends caution and increased clinical and biological monitoring if lenalidomide is used in combination with statins, especially during the first several weeks of treatment. All patients treated with statins should be advised to promptly report any unexplained muscle pain, tenderness, or weakness, particularly if accompanied by malaise or fever.
References [1] EMEA. European Medicines Agency "EPARs. European Union Public Assessment Reports. Available from: URL: http://www.ema.europa.eu/ema/index.jsp?curl=pages/includes/medicines/medicines_landingpage.jsp&mid." [2] EMA. European Medicines Agency. Committee for Medicinal Products for Human Use (CHMP) "Revlimid. Available from: URL: http://www.ema.europa.eu/docs/en_GB/document_library/EPAR_-_Scientific_Conclusion/human/000717/WC500160159.pdf." ([2013 Sept 19]): [3] Cerner Multum, Inc. "UK Summary of Product Characteristics." O 0 [4] EMA. European Medicines Agency. PRAC. Pharmacovigilance Risk Assessment Committee "Pharmacovigilance Risk Assessment Committee (PRAC) Minutes of the meeting on 2-5 September 2013. Available from: URL: http://www.ema.europa.eu/docs/en_GB/document_library/Minutes/2013/10/WC500152672.pdf." ([2013 Oct 10]): [5] Richter WO, Jacob BG, Schwandt P "Interaction between fibre and lovastatin." Lancet 338 (1991): 706 [6] Neuvonen PJ, Backman JT, Niemi M "Pharmacokinetic comparison of the potential over-the-counter statins simvastatin, lovastatin, fluvastatin and pravastatin." Clin Pharmacokinet 47 (2008): 463-74 [7] Lilja JJ, Kivisto KT, Neuvonen PJ "Grapefruit juice-simvastatin interaction: Effect on serum concentrations of simvastatin, simvastatin acid, and HMG-CoA reductase inhibitors." Clin Pharmacol Ther 64 (1998): 477-83 [8] "Product Information. Mevacor (lovastatin)." Merck & Co, Inc, West Point, PA. [9] Thompson PD, Clarkson P, Karas RH "Statin-associated myopathy." JAMA 289 (2003): 1681-90 [10] "Product Information. Zocor (simvastatin)." Merck & Co, Inc, West Point, PA. [11] Kantola T, Kivisto KT, Neuvonen PJ "Grapefruit juice greatly increases serum concentrations of lovastatin and lovastatin acid." Clin Pharmacol Ther 63 (1998): 397-402 [12] Bailey DG, Malcolm J, Arnold O, Spence JD "Grapefruit juice-drug interactions." Br J Clin Pharmacol 46 (1998): 101-10
Alternative for Lenalidomide L04A
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Alternative for Atorvastatin C10B
Indapamide Bempedoic acid Perindopril

C10A
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Potential Metabolism Interactions
Substrate-Substrate Interaction：If more than one drug is metabolized by the same CYP, it is possible that its metabolism is inhibited because of the competition between the drugs. That means, it can be useful to lower the dosage of the drugs in the drug-cocktail because they remain longer in the organism than in monotherapy.
Inhibitor-Inhibitor Interaction：Combining two or more inhibitors of one CYP, should be compensated by lowering the dosage of these drugs because the metabolism is reduced and the drugs remain longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.
Inhibitor-Substrate Interaction：Combining drugs that have inhibitory effect and are substrates of one particular CYP, should be compensated by lowering the dosage. They rest longer in the organism than in monotherapy. Not adapting the dosage bears the risk of even more side effects.