Statin Drugs- Interactions and Warnings

Statin Drugs
– Interactions and Warnings

Statins are associated with a very small risk for myopathy (which may progress to fatal or nonfatal rhabdomyolysis). Potential for interactions with other lipid-lowering agents such as fibrates and niacin (nicotinic acid), which may be used in patients with mixed lipidemia, and with immunosuppressive agents, such as cyclosporine, which are commonly used in patients after transplantation. Clinicians should be alert to the potential for drug-drug interactions to minimize the risk of myopathy during long-term statin therapy in patients at high risk for coronary heart disease.
– Arch Intern Med 2003 Mar 10;163(5):553-64 — Risk for myopathy with statin therapy in high-risk patients. — Ballantyne CM, Corsini A, Davidson MH, Holdaas H, Jacobson TA, Leitersdorf E, Marz W, Reckless JP, Stein EA.

Clopidogrel was less effective in inhibiting platelet aggregation with coadministration of atorvastatin.
– Circulation 2003 Jan 7;107(1):32-7 — Atorvastatin reduces the ability of clopidogrel to inhibit platelet aggregation: a new drug-drug interaction. — Lau WC, Waskell LA, Watkins PB, Neer CJ, Horowitz K, Hopp AS, Tait AR, Carville DG, Guyer KE, Bates ER.

Clarithromycin should be avoided in patients taking this and similarly metabolized HMG-CoA inhibitors.
– J Clin Pharmacol 2002 Apr;42(4):444-9 — A study of the interaction potential of azithromycin and clarithromycin with atorvastatin in healthy volunteers. — Amsden GW, Kuye O, Wei GC.

Impaired renal function can interfere with statin pharmacokinetics. Furthermore, other drugs administered to these patients may cause serious interactions with statins.
– Angiology 2002 Sep-Oct;53(5):493-502 — Statins and renal function. — Elisaf M, Mikhailidis DP.

Coenzyme Q10, or ubiquinone, is a nutrient that is produced in small amounts by the body and is also obtained from food. It plays a key role in helping the body convert food into energy. Co-enzyme Q10 is also an important antioxidant, the need for which appears to increase during HIV infection and in people who use certain lipid-lowering drugs called statins.
– Treatmentupdate 2001 Jun;13(2):4-7 — Extra co-enzyme Q10 for statin-users?

Grapefruit juice can greatly increase serum concentrations of lovastatin and its active metabolite, lovastatin acid. The concomitant use of grapefruit juice with lovastatin and simvastatin should be avoided.
– Clin Pharmacol Ther 1998 Apr;63(4):397-402 — Grapefruit juice greatly increases serum concentrations of lovastatin and lovastatin acid. — Kantola T, Kivisto KT, Neuvonen PJ.

A report of the first death associated with rhabdomyolysis in a patient treated with a statin and a protease inhibitor, which produced a significant drug-drug interaction.
– Clin Infect Dis 2002 Nov 15;35(10):e111-2 — Simvastatin-nelfinavir interaction implicated in rhabdomyolysis and death. — Hare CB, Vu MP, Grunfeld C, Lampiris HW.

Pharmacokinetic interactions such as increased bioavailability, myositis, and rhabdomyolysis have been reported following concurrent use of atorvastatin, cerivastatin, simvastatin or lovastatin and cyclosporine A, mibefradil or nefazodone. An increase in pravastatin bioavailability has been reported in the presence of cyclosporine A, possibly because of an interaction at the level of biliary excretion.
– Atheroscler Suppl 2002 May;3(1):35-40 — Pharmacological interactions of statins. — Paoletti R, Corsini A, Bellosta S.

Repeated St John’s Wort treatment tended to lower plasma simvastatin concentration and significantly lowered concentrations of simvastatin hydroxy acid, its active metabolite.
– Clin Pharmacol Ther 2001 Dec;70(6):518-24 — Different effects of St John’s wort on the pharmacokinetics of simvastatin and pravastatin. — Sugimoto K, Ohmori M, Tsuruoka S, Nishiki K, Kawaguchi A, Harada K, Arakawa M, Sakamoto K, Masada M, Miyamori I, Fujimura A.

Report of the combined toxicities of rhabdomyolysis and hepatitis being induced by the addition of diltiazem to simvastatin therapy.
– Tenn Med 2001 Sep;94(9):339-41 — Simvastatin-diltiazem drug interaction resulting in rhabdomyolysis and hepatitis. — Kanathur N, Mathai MG, Byrd RP Jr, Fields CL, Roy TM.

Coadministration of simvastatin with nelfinavir should be avoided.
– Antimicrob Agents Chemother 2001 Dec;45(12):3445-50 — Pharmacokinetic interactions between nelfinavir and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors atorvastatin and simvastatin. — Hsyu PH, Schultz-Smith MD, Lillibridge JH, Lewis RH, Kerr BM.

Coadministration of simvastatin with nelfinavir should be avoided, whereas atorvastatin should be used with nelfinavir with caution.
– Antimicrob Agents Chemother 2001 Dec;45(12):3445-50 — Pharmacokinetic interactions between nelfinavir and 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors atorvastatin and simvastatin. — Hsyu PH, Schultz-Smith MD, Lillibridge JH, Lewis RH, Kerr BM.

Simvastatin should be avoided and atorvastatin may be used with caution in persons taking ritonavir and saquinavir.
– AIDS 2002 Mar 8;16(4):569-77 — Pharmacokinetic interactions between protease inhibitors and statins in HIV seronegative volunteers: ACTG Study A5047. — Fichtenbaum CJ, Gerber JG, Rosenkranz SL, Segal Y, Aberg JA, Blaschke T, Alston B, Fang F, Kosel B, Aweeka F; NIAID AIDS Clinical Trials Group.

Itraconazole alters the pharmacokinetics of atorvastatin.
– Clin Pharmacol Ther 2000 Oct;68(4):391-400 — Itraconazole alters the pharmacokinetics of atorvastatin to a greater extent than either cerivastatin or pravastatin. — Mazzu AL, Lasseter KC, Shamblen EC, Agarwal V, Lettieri J, Sundaresen P.

Atorvastatin coadministration may increase digoxin concentrations.
– J Clin Pharmacol 2000 Jan;40(1):91-8 — Atorvastatin coadministration may increase digoxin concentrations by inhibition of intestinal P-glycoprotein-mediated secretion. — Boyd RA, Stern RH, Stewart BH, Wu X, Reyner EL, Zegarac EA, Randinitis EJ, Whitfield L.

The increase in LDL-cholesterol and triglycerides on atorvastatin and troglitazone combination therapy compared with atorvastatin mono-therapy is suggestive of a drug interaction. Further studies involving troglitazone and atorvastatin may be warranted to substantiate this interaction.
– J Clin Pharm Ther 2000 Aug;25(4):279-82 — Potential interaction between troglitazone and atorvastatin. — DiTusa L, Luzier AB.

Guggul can have an effect on cholesterol levels in the body.
– Satyavati GV, Dwarakanath C, Tripathi SN. — Experimental studies on the hypocholesterolemic effect of Commiphora mukul. Engl. (Guggul). — Indian J Med Res. 1969 Oct;57(10):1950-62.

Statin drugs may interact with other prescription medications. Consult with your physician regarding the use of other medications or herbs, supplements and vitamins.

Not recommended if you are pregnant, planning to be or breastfeeding.

last update: November 2008

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