A 62-year-old woman on amlodipine also takes simvastatin, bendroflumethiazide and paracetamol. She reports a side effect. Which is most likely?

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Multiple Choice

A 62-year-old woman on amlodipine also takes simvastatin, bendroflumethiazide and paracetamol. She reports a side effect. Which is most likely?

Explanation:
The key idea is a drug interaction that raises the risk of muscle injury from a statin. Simvastatin is metabolized mainly by the liver enzyme CYP3A4. Amlodipine can mildly inhibit CYP3A4, so when taken together, simvastatin levels rise in the blood. Higher statin exposure increases the chances of statin-induced muscle toxicity, and in some cases this can progress to rhabdomyolysis, a serious breakdown of muscle tissue. In a patient like this, rhabdomyolysis is the most plausible side effect to report because it is a known, dose- and interaction-related risk with combining a statin (simvastatin) and a CYP3A4-metabolized drug (amlodipine). Headache or nausea are common and nonspecific, while hyperkalemia is more typical of drugs such as ACE inhibitors or potassium-sparing diuretics, not this combination.

The key idea is a drug interaction that raises the risk of muscle injury from a statin. Simvastatin is metabolized mainly by the liver enzyme CYP3A4. Amlodipine can mildly inhibit CYP3A4, so when taken together, simvastatin levels rise in the blood. Higher statin exposure increases the chances of statin-induced muscle toxicity, and in some cases this can progress to rhabdomyolysis, a serious breakdown of muscle tissue. In a patient like this, rhabdomyolysis is the most plausible side effect to report because it is a known, dose- and interaction-related risk with combining a statin (simvastatin) and a CYP3A4-metabolized drug (amlodipine). Headache or nausea are common and nonspecific, while hyperkalemia is more typical of drugs such as ACE inhibitors or potassium-sparing diuretics, not this combination.

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