Identification of the effect of multiple polymorphisms on the pharmacokinetics of simvastatin and simvastatin acid using a population-modeling approach

Clin Pharmacol Ther. 2014 Jul;96(1):90-100. doi: 10.1038/clpt.2014.55. Epub 2014 Mar 5.


The aim of this work was to develop a joint population pharmacokinetic model for simvastatin (SV) and its active metabolite, simvastatin acid (SVA), that incorporates the effects of multiple genetic polymorphisms and clinical/demographic characteristics. SV/SVA plasma concentrations, demographic/clinical data, and genotypes for 18 genetic variants were collected from 74 individuals (three clinical trials) and analyzed using a nonlinear mixed-effects modeling approach. The structural model that best described the data included a two- and a one-compartment disposition model for SV and SVA, respectively. Age, weight, Japanese ethnicity, and seven genetic polymorphisms-rs4149056 (SLCO1B1), rs776746 (CYP3A5), rs12422149 (SLCO2B1), rs2231142 (ABCG2), rs4148162 (ABCG2), rs4253728 (PPARA), and rs35599367 (CYP3A4)-were identified as significantly affecting model parameters. The developed model was used to assess combinations of these covariates, highlighting specific risk factors associated with altered SV/SVA pharmacokinetics, and consequently myopathy cases that cannot be solely attributed to the rs4149056 CC genotype.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Asian People
  • Genotype
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / pharmacokinetics*
  • Models, Biological*
  • Polymorphism, Genetic*
  • Risk Factors
  • Simvastatin / analogs & derivatives*
  • Simvastatin / pharmacokinetics
  • White People


  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • simvastatin acid
  • Simvastatin