Preventing rhabdomyolysis in patients taking amiodarone and simvastatin

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Given concerns about rhabdomyolysis in patients treated concurrently with amiodarone and simvastatin, what is the best way to reduce adverse events while maintaining the lipid-lowering effects of statins as well as the antiarrhythmic effects of amiodarone?—WALTER BUSSEY, PA-C, MPAS, Council Bluffs, Iowa

What are the indications for lipid-lowering in this patient? If it is primary prevention, you may be forced to choose dietary and lifestyle changes over drug therapy; if not, another class of lipid-lowering drug (though not a fibrate or ezetimibe, since these can also cause muscle damage) should be considered. Such medications include the bile acid sequestrants and nicotinic acid.—Reuben W. Zimmerman, PA-C (142-3)

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