Table 1:

The Clinical Pharmacogenetics Implementation Consortium (CPIC) Recommendations for Simvastatin Based on SLCO1B1 Phenotype in Adults (2022)

PhenotypeImplicationsDosing recommendationClassification of recommendationConsiderations
SLCO1B1 increased functionTypical myopathy risk and statin exposurePrescribe desired starting dose and adjust doses based on disease-specific guidelines.StrongThe potential for drug–drug interactions and dose limits based on renal and hepatic function and ancestry should be evaluated before initiating a statin.
SLCO1B1 normal functionTypical myopathy risk and statin exposurePrescribe desired starting dose and adjust doses based on disease-specific guidelines.StrongThe potential for drug–drug interactions and dose limits based on renal and hepatic function and ancestry should be evaluated before initiating a statin.
SLCO1B1 decreased (or possible decreased) functionIncreased simvastatin acid exposure as compared with normal function; increased risk of myopathyPrescribe an alternative statin depending on the desired potencya. If simvastatin therapy is warranted, limit dose to <20 mg/day.StrongThe potential for drug–drug interactions and dose limits based on renal and hepatic function should be evaluated before initiating a statin. The effects of drug–drug interactions may be more pronounced, resulting in a higher risk of myopathy.
SLCO1B1 poor functionIncreased simvastatin acid exposure as compared with normal function; highly increased myopathy riskPrescribe an alternative statin depending on the desired potencya.StrongThe potential for drug–drug
Interactions and dose limits based on renal and hepatic function should be evaluated before initiating a statin. The effects of drug–drug interactions may be more pronounced, resulting in a higher risk of myopathy.
a

Statin potency and genotype recommendations are summarized in Figure 1.

Table adapted from (2).

From: Simvastatin Therapy and SLCO1B1 Genotype

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