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Amlodipine is most commonly used antihypertensive agent in renal transplantation. Compared to diltiazem and verapamil, amlodipine is considered a weak inhibitor of the CYP3A4 isoenzyme. Though the potential of an interaction with simvastatin exists (32), most literature has not shown a significant correlation of amlodipine with statin-induced myotoxicity by itself (33). Nonetheless, the FDA decision to recommend avoiding doses higher than 20 mg of simvastatin in patients receiving amlodipine is reasonable since it conveys the general message of potential toxicities with higher doses of simvastatin. Rosuvastatin has recently been associated with increased proteinuria and renal failure at higher doses in a post-marketing report from the FDA (34). This would be of special concern in RTR. The findings from the Prospective Evaluation of Proteinuria and Renal Function in Diabetic http://www.selleckchem.com/products/epacadostat-incb024360.html and Non-Diabetic Patients with Progressive Renal Disease trials, http://www.selleckchem.com/products/MG132.html which have compared atorvastatin 80 mg/day with rosuvastatin 10 or 40 mg/day in dyslipidemic patients with moderate proteinuria, should help provide further insight into this potentially serious adverse event. Until these results are published, it is reasonable to limit rosuvastatin to the lowest recommended doses. The following recommendations have been adapted from 2004 K/DOQI guidelines, which were incorporated in the 2009 KDIGO clinical practice guidelines for the management of RTR. Taking into account the most recent literature on the matter and the FDA-issued warning on simvastatin, we detail some suggestions for managing dyslipidemia in RTRs (Table 1). LDL levels have a direct correlation with cardiovascular events; therefore, aggressive management of the high-risk population, including organ transplant recipients, should be a major focus of posttransplant care. Mild elevations of LDL (100�C129 mg/dL) should be initially managed with therapeutic lifestyle changes (TLC), including diet, exercise and weight reduction (16). An emphasis on dietary incorporation of plant sterols, soy protein, viscous fibers and nuts has been recently shown to decrease LDL by more than 12% (35). There have been no randomized trials in the transplant population testing the efficacy of TLC and conclusions have been extrapolated from the general population. Nonetheless, increased physical activity has been linked to decreased overall and cardiovascular-related http://www.selleck.cn/products/pfi-2.html mortality in transplant recipients and should be strongly encouraged (36). In patients with LDL above 100 mg/dL after TLC, a low-dose statin should be initiated (Table 1). The dose should be titrated to achieve LDL goal (