Simvastatin is now contraindicated with ciclosporin, danazol and gemfibrozil, and should not be used at doses higher than 20mg a day in patients taking diltiazem or amlodipine, the MHRA has said.

Simvastatin is now contraindicated with ciclosporin, danazol and gemfibrozil	More on statins Dishing out statins A statin for everyone Update: Cholesterol
	The changes follow new evidence of the possibility of raised simvastatin plasma concentrations when taken concomitantly, thus increasing the risk of myopathy or rhabdomyolysis (the breakdown of muscle fibres).

The MHRA has previously warned simvastatin 80mg is associated with an increased risk of myopathy and should only be used in patients with severe hypercholesterolaemia or at high risk of cardiovascular complications, if lower doses do not prove effective.

Simvastatin is also contraindicated in patients taking erythromycin, clarithromycin, ketoconazole and itraconazole, and patients should be advised to avoid drinking grapefruit juice. Simvastatin doses should not exceed 20mg a day in patients also taking amiodarone and verapamil.