CYP3A4 Interactions: Name the classic strong CYP3A4 Inhibitors and the fatal interaction when combined with Simvastatin or Lovastatin.
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Strong CYP3A4 Inhibitors:
- Mnemonic: G·P·A·C·M·A·N
- Grapefruit juice
- Protease inhibitors (Ritonavir)
- Azole antifungals (Ketoconazole, Itraconazole)
- Cyclosporine / Cimetidine
- Macrolides (Clarithromycin, Erythromycin — NOT Azithromycin)
- Amiodarone
- Non-DHP CCBs (Diltiazem, Verapamil)
Fatal Interaction:
- Simvastatin/Lovastatin are extensive CYP3A4 substrates. Co-administration causes dramatic blood level spikes $\rightarrow$ severe Rhabdomyolysis, myoglobinuria, and acute renal failure.
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