American Board of Internal Medicine (ABIM) Certification Practice Exam

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In patients taking amiodarone with simvastatin, what is the maximum recommended dose of simvastatin?

40 mg/d
20 mg/d
10 mg/d
15 mg/d

The correct answer is: 20 mg/d

In patients taking amiodarone alongside simvastatin, the maximum recommended dose of simvastatin is 20 mg per day. This is due to the increased risk of statin-related adverse effects, particularly myopathy and rhabdomyolysis, when simvastatin is co-administered with amiodarone. Both drugs can potentially affect the metabolism of each other. Specifically, amiodarone inhibits certain cytochrome P450 enzymes that are responsible for metabolizing simvastatin, leading to increased levels of simvastatin in the bloodstream. This heightened exposure can significantly elevate the risk of muscle-related side effects. Therefore, to mitigate these risks while still allowing for effective management of conditions such as hyperlipidemia and arrhythmias, the recommendation is to limit the simvastatin dosage to 20 mg daily when used concurrently with amiodarone. Maintaining this dosage helps ensure patient safety while achieving the desired therapeutic outcomes.